When a patient undergoes imaging after an accident, the last result they might expect is something that leads to a cancer diagnosis.
But thoracic surgeon Roman Petrov, MD, PhD, MBA, FACS, says it happens more frequently than one might expect. “The majority of lung cancers present as incidental pulmonary nodules when imaging is done for other causes.”
Thoracic oncology surgery is one of Dr. Petrov’s areas of expertise. He names lung cancer, esophageal cancer, chest wall sarcomas, mediastinal tumors, schwannomas, and thymomas among the conditions he treats, along with benign thoracic conditions.
He recently joined UTMB’s Department of Surgery, Division of Cardiovascular and Thoracic Surgery, from Temple University and Fox Chase Cancer Center in Philadelphia, where he practiced since 2017. He is fellowship-trained in minimally invasive thoracic and esophageal surgery.
While there are screenings available for lung cancer, individuals with risk factors do not always seek out screening, hence so many diagnoses stemming from other imaging. Screening is recommended for current or former smokers ages 50 to 80 who have at least a 20-pack per year history and who currently smoke or have quit within the past 15 years.
When a patient is diagnosed with lung cancer, Dr. Petrov says, a multidisciplinary team approach is necessary to determine the best path forward – whether the patient needs radiation, chemotherapy, surgery, or a combination of these treatments.
For surgical cases, the approach is typically minimally invasive surgery and robotic surgery is rapidly gaining vast acceptance. Several types of lung resection may be performed, based on the tumor location, size, and type, and the patient’s overall health and lung function prior to diagnosis. Preference is chosen in favor of least possible surgery, that meets criteria of the oncologic radicality.
In treating esophageal cancer, timely diagnosis is essential in order for surgical intervention to be possible. Most often the patient experiences symptoms that lead them to seek care – but by the time symptoms are present or significant enough that the patient seeks care, the cancer is very advanced.
The most common symptom of esophageal cancer is dysphagia, which is difficulty swallowing, or the sticking of food in the chest. Esophageal cancer can also lead to weight loss, pain when swallowing, regurgitation of undigested food, and bleeding.
He says the majority of patients diagnosed with esophageal cancer are men in their late 50s or 60s, with higher rates among white men and those who are obese.
“Usually, these patients have a long-standing history of reflux, and frequently they self-medicate and develop new symptoms like dysphagia or weight loss,” he says. “Unfortunately, when someone presents with dysphagia, only about one-third are surgical candidates because many present with locally and systemically metastatic disease or locally advanced disease.”
Treatment of the esophageal cancer is complex and involves combination of radiation and chemotherapy, followed by surgery. For cases diagnosed early enough for surgery, Dr. Petrov performs a minimally invasive or robotic esophagectomy. He describes it as a complex surgery; however, patient outcomes and recovery have significantly improved recently with the application of minimally invasive technologies.
While there is a relatively small patient pool, he hopes that his experience with the procedure will help UTMB build a strong reputation for caring for these patients.
Dr. Petrov is also versed in treating a wide range of benign thoracic conditions – including thoracic outlet syndrome, one of his primary interests; Tracheobronchomalacia; hyperhidrosis; pectus deformities; as well as benign foregut diseases, GERD, paraesophageal hernias, achalasia, gastroparesis, trauma, and infections.