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Wake Forest Baptist Approach Thoracic Oncology Program View Lung Cancer Video The Thoracic Oncology Program, the region’s only multidisciplinary thoracic oncology clinic, consolidates the services of a team of physicians and other health care professionals involved in care of patients with malignancies of the chest, including lung cancer, mesothelioma, carcinoid tumor and thymoma.  The Program’s primary goal is to facilitate communication between physicians to provide the highest level of care for patients with these common and uncommon chest malignancies.  Evaluating treatment options and determining a course of action as quickly as possible is of great importance.  In most cases, patients need to come to the clinic only once to see appropriate specialists and receive a treatment plan for their care. The team includes cancer specialists in pulmonary medicine, medical oncology, cardiothoracic surgery, radiation oncology, radiology and pathology.  The members of the team meet weekly to discuss new cases and develop the most effective treatment plan for each patient.  The patient sees the specialists in the morning, his/her case is discussed at a noon conference, and in the afternoon the patient leaves with an initial treatment plan in place. As a comprehensive cancer center, we offer our patients access to the best diagnostic tools and the latest advances in treatment, including interventional pulmonary procedures, surgical techniques, radiation techniques and chemotherapy. The team is involved in clinical trials testing novel therapies including combinations of surgery, radiation and chemotherapy.  Research protocols are available to study new approaches in each of these areas.  Wake Forest Baptist is the lead site for a clinical trial evaluating the use of dose-dense chemotherapy as front-line treatment for patients with advanced non-small cell lung cancer. This clinical trial involves intensive chemotherapy with the support of growth factors to stimulate the production of red blood cells and white blood cells which should minimize symptoms such as fatigue, weakness, fever, and infections. Half of the patients will also be assigned to receive an investigational medicine that may reduce side-effects on the peripheral nervous system such as numbness and tingling in the hands and feet.  This research study is sponsored by the Cancer and Leukemia Group B (CALGB), a national cooperative cancer research group. Making cutting-edge research and treatments available to lung cancer patients is the only way real progress will be made in improving both quantity and quality of life. 3D Conformal and Intensity Modulated Radiation Therapy Among the newer treatment options for cancer of the prostate, brain, lung, and head and neck are two methods of focusing radiation on the tumor and surrounding at-risk tissues while optimally sparing nearby normal tissues, 3-dimensional (3D) conformal radiation therapy, and intensity modulated radiation therapy (IMRT).  This approach uses anatomic computed tomogrphic and/or magnetic resonance images of the patient, computer-generated radiation dose calculations, and a computer-controlled linear accelerator to conform or “paint” the radiation dose very precisely to match the shape of the tumor to be treated, avoiding critical structures that may be only millimeters away. The linear accelerator radiation beam intensity is varied, or modulated, over space and time during the patient’s treatment, hence the term “Intensity Modulated” radiation therapy. In combination with advanced imaging techniques like magnetic resonance spectroscopy and positron emission tomography that image both tumor anatomy and biology, IMRT holds great promise for improving local tumor control and survival, even in the most resistant and aggressive human cancers.   Lung cancer - small cell Lungs Lung cancer, lateral chest X-ray Lung cancer - chemotherapy treatment Small cell carcinoma   Secondhand Smoke and Lung Cancer Normal lungs and alveoli Smoking hazards Bronchoscope   Definition: Small cell lung cancer (SCLC) is a fast-growing type of lung cancer. It tends to spread much more quickly than non-small cell lung cancer. There are three different types of small cell lung cancer: Small cell carcinoma (oat cell cancer) Mixed small cell/large cell carcinoma Combined small cell carcinoma Most small cell lung cancers are the oat cell type. Alternative Names: Cancer - lung - small cell; Small cell lung cancer; SCLC Causes, incidence, and risk factors: About 15% of all lung cancer cases are small cell lung cancer, according to the American Cancer Society. Small cell lung cancer is a bit more common in men than women. Smoking almost always causes small cell lung cancer. This type of lung cancer is rare in those who have never smoked. Small cell lung cancer usually starts in the air tubes (bronchi) in the center of the chest. Although the cancer cells are small, they grow quickly and create large masses (tumors) that can rapidly spread to other parts of the body, including the brain, liver, and bone. Symptoms: Cough Bloody sputum Shortness of breath Wheezing Chest pain Loss of appetite Weight loss Additional symptoms that may be associated with this disease: Weakness Swallowing difficulty Nail abnormalities Hoarseness or changing voice Fever Facial swelling Signs and tests: The health care provider will perform a physical exam and ask questions about your medical history. You will be asked if you smoke, and if so, how long you have smoked. When listening to the chest with a stethoscope, the health care provider can sometimes hear fluid around the lungs, which could (but doesn't always) suggest cancer. Small cell lung cancer has usually spread by the time it is diagnosed. Tests that may be performed include: Chest x-ray CBC Sputum test Bone scan CT scan MRI Positron emission tomography (PET) scan Thoracentesis In some cases, the health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this: Bronchoscopy combined with biopsy Pleural biopsy CT scan directed needle biopsy Mediastinoscopy with biopsy Open lung biopsy Endoscopic esophageal ultrasound (EUS) with biopsy Usually, if a biopsy reveals cancer, more imaging tests are done to find out the stage of the cancer. (Stage means how big the tumor is and how far it's spread.) However, the traditional staging system, which uses numbers to tell how bad the cancer is, is usually not used for patients with SCLC. Instead, SCLC is grouped as either: Limited (cancer is only in the chest) Extensive (cancer has spread outside the chest) Most cases are extensive. Treatment: Because small cell lung cancer spreads quickly throughout the body, treatment must include cancer-killing drugs (chemotherapy) taken by mouth or injected into the body. Chemotherapy may be combined with high-powered x-rays (radiation therapy). Surgery is rarely used to treat small cell lung cancer. It is only considered if it is limited small cell lung cancer with only one tumor that hasn't spread. Chemotherapy or radiation will be needed after surgery. However, because the disease has usually spread by the time it is diagnosed, very few patients with small cell lung cancer are candidates for surgery. Combination chemotherapy and radiation treatment is given to persons with extensive small cell lung cancer. However, the treatment only helps relieve symptoms; it does not cure the disease. Some patients with limited small cell lung cancer may receive radiation therapy to the head after they have completed treatment for the lung area. This method, called prophylactic cranial irradiation (PCI), helps prevent any lung cancer from spreading to the brain. Support Groups: For additional information and resources, see cancer support group. Expectations (prognosis): How well a patient does depends on how much the lung cancer has spread. This type of cancer is very deadly. Only about 6% of people with this type of cancer are still alive after 5 years. Complications: Cancer spreads to other parts of the body Side effects of surgery, chemotherapy, or radiation therapy Calling your health care provider: Call your health care provider if you have symptoms of lung cancer (particularly if you smoke). Prevention: If you smoke, stop smoking. It's never too early to quit. Try to avoid secondhand smoke. Routine screening for lung cancer is not recommended. Many studies have been done to look at the idea, but scientists have concluded that, at this time, screening would not help improve a person’s chance for a cure. References: American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society; 2006. U.S. Preventive Services Task Force. Lung cancer screening. Ann Int Med. 2004;140:738-739. Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:1708-1722. Jackman DM, Johnson BE. Small-cell lung cancer. Lancet. 2005;366:1385-1396.

Review Date:7/31/2006 Reviewed By:Rita Nanda, M.D., Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL. Review provided by VeriMed Healthcare Network.