With lung cancer, sometimes the only way to know is with a scan
In its early stages, lung cancer often doesn’t have symptoms. That’s why getting a lung cancer screening is so important for those at risk. Once symptoms are felt, such as a persistent cough or shortness of breath, the cancer has most likely grown and spread. At Lehigh Valley Health Network (LVHN), part of Jefferson Health, we have taken steps to be able to diagnose lung cancer early and quickly, and provide the follow-up care that can mean a longer life for patients.
U.S. Preventive Services Task Force recommends a yearly low-dose CT scan for people who meet all the following criteria:
“Everyone who meets the high-risk characteristics above should get scanned,” says pulmonologist Christopher Lenivy, DO, who was instrumental in creating the Lung Nodule Clinic at LVHN. “Although nonsmokers are not necessarily immune from lung cancer, secondhand smoke and certain occupational exposures and inflammatory conditions can be associated with a higher risk for lung cancer.”
The team finds lung nodules in a significant number of people over 50. However, most are noncancerous, perhaps from mucus, scars from old infections, or from dust. “Our job is to consider size, shape, and behavior,” Dr. Lenivy says. “If it’s something suspicious, we will want to either get a sample through a biopsy or remove it upfront.”
If the nodule is found to be cancerous, recommended treatments for lung cancer vary based on stage, and can involve surgery, radiation, chemotherapy, or immunotherapy. Stage 1 lung cancers can be cured with just surgery or radiation.
“Over the last few years, at LVHN, we have been finding more stage 1 lung cancers than stage 4,” he says. “We expect this number to continue to climb. This goes to show how valuable an efficient lung nodule program can change the lives of those in our community.”
LVHN has added a robotic bronchoscopy platform for minimally invasive peripheral lung biopsies. It’s based on the concept that time from lung nodule detection on a CT scan to biopsy could be shorter, making diagnosis quicker. The system’s ultrathin, ultra maneuverable catheter allows clinicians to get to small lesions in the peripheral lung, where more than 70% of cancerous lung nodules are located.
“The majority of nodules are now reachable,” Dr. Lenivy says, noting that LVHN’s robotic bronchoscopy team has improved volumes to reach No. 1 in Pennsylvania, with a total approaching 1,500 robotic bronchoscopies in the first three years of its program.
Treatment options and prognosis vary depending on the stage, so the team can sample the lymph nodes and get the stage at the same time. “In addition,” he says, “with this technology, clinicians can sample not just all areas of the lung, but multiple locations in one procedure. This allows timely explanation of what the nodule is, and what the next steps are for the patient.”
The numbers remain steady on lung cancer, making it the leading cause of cancer death for both men and women. While standard treatment for lung cancer staged between 1 and 4 is either surgery, radiation, and/or chemotherapy, cancer at stage 3 or 4 is often not curable.
The Lung Nodule Clinic is making great progress at diagnosing patients with lung cancer earlier leading to earlier stage cancer at the time of diagnosis and a higher chance of cure. This is consistent with the team’s goal of diagnosing and staging lung cancer in the least invasive, most effective way – with an emphasis on “Don’t wait.”
The clinic has been focusing on getting patients in within 10 to 14 days from the time of referral and setting them up for biopsy right away. The staff rearranges office workflow and puts in extra hours to achieve the efficiency that gets patients seen sooner.
“This efficiency combined with robotic technology allows clinicians to detect abnormalities they wouldn’t have been able to sample before and is an incredible boost to diagnosing cancer earlier,” Dr. Lenivy says. “The result, born out by data, is we’re curing patients at a higher rate.”
