There is not a universally recognized ribbon or a highly publicized awareness campaign, yet lung cancer is responsible for more deaths every year than the three most common cancers – breast, prostate, and colon cancer – combined.
With that in mind, UTMB’s team of pulmonary specialists are committed to helping reduce the number of lung cancer deaths. November is National Lung Cancer Screening Awareness Month, bringing attention to the recently updated lung cancer screening guidelines aimed at diagnosing more cases earlier, resulting in more lives saved.
“You see the pink ribbons for breast cancer, and so many people know about colon cancer now, but lung cancer does not get a lot of press,” says Shawn Nishi, MD, Interventional Pulmonologist in the Division of Pulmonary Critical Care and Sleep Medicine.
Per the new screening guidelines, those who should be screened are 50 to 80 years old, with a history of smoking a pack a day for 20 years or two packs a day for 10 years, who are current smokers or who have quit within the past 15 years.
Screening entails a low-dose CT scan, a brief and painless procedure that should be performed once a year, to detect pulmonary nodules or other abnormalities that may be indicators of cancer.
In addition to patients who have low-dose CT scans to screen for lung cancer, UTMB has a lung nodule program in which individuals who have a lung nodule detected via an incidental scan may also be referred to Pulmonary for follow-up.
“We are finding early-stage lung cancers these days and the conundrum is, when they're early, they're a lot harder to diagnose because they're small nodules. They require a lot of specialty training or procedures to get to them,” Dr. Nishi says. “The lung is a hard organ to biopsy because it moves with every breath.”
Fortunately, UTMB has recently acquired a new, highly advanced robotic tool with the potential to provide earlier and more accurate diagnoses, and lead to better patient outcomes.
The Ion Robotic Bronchoscopy system provides diagnostic capabilities far beyond what other diagnostic approaches have offered. With a long, extendable catheter and easy navigational functions, the system offers considerably more flexibility and precision, as well as enhanced safety. Patients are under general anesthesia for the procedure.
“In the past, we would try to do bronchoscopic guidance, but we are very limited because of the type of scope that we have in the size that it has,” Dr. Nishi says.
Alternatively, Interventional Radiology may perform a percutaneous biopsy, in which the skin is numbed so that a needle can be inserted through the chest wall and the lung to biopsy the lesions. However, the pneumothorax rate is anywhere from 15 to 30 percent, and there is a small risk of bleeding from the procedure.
“Now we can reach pretty much any lesion in the lung with much less potential risk that is associated with interventional pulmonary procedures,” she says.
The difference in prognosis depending on the stage at diagnosis can be significant. For those diagnosed at an advanced stage, the five-year survival rate is about 20 percent; for those diagnosed early, it can be upwards of 85 to 90 percent.
Early diagnosis ensures the best opportunity for patients to overcome the disease, as surgery may be a highly effective option for those whose cancer is localized and has not spread.
“We have been working with Surgery to help diagnose and refer patients to ultimately lung resection, which is curative for early-stage lung cancers. This is the goal for all of our patients,” she says.
Roman Petrov, MD, PhD, MBA, FACS, is a member of the Cardiothoracic Surgery team at UTMB who specializes in thoracic oncology. As a surgeon who treats patients with lung cancer, he is appreciative of the Pulmonary division's efforts to adopt new technology that helps to diagnose more patients early.
"Diagnosis of lung cancer at the early stages has enabled us, in combination with robotic surgical operations to achieve the best rates of cure by intervening early in a minimally invasive fashion and ultimately to save lives. By pushing the boundaries of what is achievable in pulmonary diagnostics, Dr. Nishi’s team is playing a crucial role in the broader effort to reduce the mortality associated with lung cancer and shaping the future of thoracic medicine," Dr. Petrov says.
Dr. Nishi said the division originally set a goal to perform 100 Ion procedures in the first year – a goal she believes is very reasonable considering the volume they have seen so far, as well as the success other institutions have had with this system.
The Ion Robotic Bronchoscopy system is currently available for patients at the Galveston campus. Patients who are candidates for the procedure should be referred for a Pulmonary consult, so they may be scheduled into Dr. Nishi’s clinic.
-web.jpg?sfvrsn=aa416556_3/) | Shawn Nishi, MD, sees patients at the UTMB Health Pulmonary and Sleep Medicine, UHC Galveston. Learn more about Interventional Pulmonary at UTMB. |