Recent Advances in the Management of Lung Cancer
By Divyakant B. Gandhi, MD
Published in the Lansing State Journal, April 29, 1996
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Lung cancer is the leading cause of cancer death in the U.S.
Death rates from lung cancer in females has quadrupled the last 50 years and almost 7 times more in males over the same period.
The American Cancer Society has estimated that almost 180,000 new cases of lung cancer will develop in 1996 and almost 160,000
patients will die from lung cancer in the U.S. in 1996.
These statistics are ironic given the fact that lung cancer is probably the most important, potentially preventable, cancer in the world.
With the decline in rates of smoking, this goal may be reached in the next century.
Meanwhile new cases of lung cancer continue to be diagnosed.
One of the problems with lung cancer has been that by the time diagnosis has been made,
the cancer has usually spread to the lymph nodes in the chest and neck and other organs.
It has been estimated that only 15% of lung cancer is localized to the lung at the time of diagnosis,
for these patients, and depending upon the type of cancer, surgery and removal of the portion of the lung along with regional
lymph nodes is the treatment of choice and results in excellent cure rates of 70-80%.
For those patients who present with distant spread of lung cancer, estimated to be 45-50% of patients, chemotherapy with or without radiation
seems to be the only hope of curtailing the disease.
For the rest, 25-30% of patients who have locally advanced or regional disease with tumor spread only into the lymph nodes of the chest
or tumor involving the chest wall or major structures like the trachea (windpipe) or aorta or the spine,
there is renewed hope of survival because of a number of recent advances.
- Newer classification systems allowing more patients to be treated by surgery.
- Innovations in surgical techniques allowing more extensive and aggressive removal of tumors along w/chest wall or windpipe or aorta
w/simultaneous reconstruction of the same.
- Understanding by those caring for lung cancer patients that for best long term results a multi-modality approach,
that is, combination of chemotherapy, radiation and surgery in a specific sequence is essential.
The multi-modality approach allows some large extensive bulky tumors to be shrunk in size,
either with chemotherapy and/or radiation. When they have reduced to manageable proportions surgery allows total
extirpation of any residual tumor.
To fully accrue benefit from these recent advances it is essential to establish a multi-disciplinary clinic where radiation therapists,
oncologists, pulmonologists and thoracic surgeons would see patients together and formulate a plan of treatment for each patient.
There is significant interest in the medical community for such an enterprise in the Lansing area and hopefully this will come to
fruition in the coming year.
Dr. Gandhi specializes in General and Thoracic Surgery.
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