Lung cancer is the leading cause of cancer death in the United States. Most lung cancer is caused by smoking, but some other exposures, such as radon, can cause lung cancer. And some people may develop it without any known risk factors. Lung cancer often develops with no symptoms or with symptoms such as weight loss that do not clearly point to the lung as a cause.
Are you worried you may have lung cancer?
There is a lung cancer team at UAMS that helps to figure out what you have and how to approach it. We offer a full range of specialty services in the areas of diagnosis, treatment, and support.
The concern usually starts with an abnormality found on an x-ray. This could have been done because you had symptoms, or maybe an abnormality was discovered while your doctors were looking for something else. If an abnormality was found, you need to see a diagnostic Pulmonologist. Dr. Bartter heads this team. A member of the diagnostic team will examine you, study your films, and help decide whether you need a biopsy. If you do, the best available approach will be offered. There are several options:
- Bronchoscopy – a scope is used to look into the airways for abnormalities. Sometimes X-ray is used during the procedure.
- Endobronchial or esophageal ultrasound – UAMS is one of only 2 sites in the state which offer this special technique. A special scope with an ultrasound at its tip is used to look through the walls of the airway or esophagus and guide a biopsy.
- CT-guided biopsy – Some lesions are better approached through the chest wall with CT guidance. When this is the case, a specialist in Interventional Radiology will help with your diagnosis.
- PET scanning – A PET scan does NOT tell you whether or not you have cancer, but it can help us to understand different types of abnormality and where they are in the body. Sometimes a PET helps guide us to the best area to biopsy.
- Other options are available when called for.
Have you been diagnosed with lung cancer? If so, what are your options?
Before we can discuss your treatment options, we have to know the stage of your cancer. This may involve further studies, such as the diagnostic studies listed above. Once we know the stage, there are several possibilities for treatment.
Should I have surgery? Can I have surgery?
This question is important and sometimes can be complicated. The discussions about you and what should be done are an important part of the work of the lung cancer team. If you have a cancer which can be safely completely removed, surgery should be considered. Dr. Matthew Steliga is a thoracic surgeon with special training and expertise in lung cancer surgery. But in order to decide whether surgery is an option for you, several questions need to be answered:
- The first question we ask is, “What type of cancer do you have?” Did the cancer originate in the lung, or did it start somewhere else and spread to the lung? If it started somewhere else, then it is not a lung cancer and treatment would be different. If it is a lung cancer, there are 3 major types – adenocarcinoma, squamous cell carcinoma, and small cell lung cancer. Each of these has different treatment pathways. For example, if you have small cell cancer, surgery almost never helps and is very unlikely to be recommended.
- The second question we ask is, “What is the stage of your cancer?” Stage involves how big the cancer is, exactly where it is located, and the extent to which it has spread. Staging affects treatment options. For example, a stage 1 squamous cell cancer can usually be treated surgically, whereas chemotherapy and radiation combined might be the best choice for a stage 4 adenocarcinoma.If you would benefit from surgery, you may be a candidate for “VATS,” or video-assisted thoracoscopic surgery. This is a minimally invasive approach to the chest for which Dr. Steliga has special training. It is not available in most of Arkansas.
- The third question is about your overall health and lung function. This also affects your treatment choices. For example if you have a stage 1 cancer but your lung function is very poor then we may offer you a different specialized treatment option, ablation, in which the cells in the area of the cancer are frozen or heated in order to kill them.
What about chemotherapy and radiation therapy?
These two treatments are listed together because they are often used together to get the best possible outcome. When an operation is not what is best for you (or sometimes even when it is), a team of dedicated experts will discuss the possibility of treatment with chemotherapy and/or radiation. All of our team members use state-of-the-art approaches to lung cancer.
I need something not mentioned here. What should I do?
You should ask. There are other possible treatments available at UAMS.
What about clinical trials?
At UAMS, clinical research is just another way we are working toward improving the health of patients throughout Arkansas and the world. Our lung cancer team has access to more clinical trials than any other clinic in the state.
For both patients and doctors, trials offer a chance to gain access to new experimental drugs or procedures and devices before they are commonly available. If you are eligible for a clinical trial, your team will discuss options with you as part of your personalized treatment plan.
What about second opinions?
Our multidisciplinary team of experts welcomes patients with lung cancer who may be seeking a second opinion. This is an important role of an academic lung cancer center. Our team includes pulmonary, surgery, oncology, pathology, radiology, radiation therapy and palliative care physicians.
Cancer therapy is not working for my family member. Can you help?
Yes we can help. In two ways. First, we can offer a second opinion, as mentioned above. If there is more that we can do, we can offer that. Second, if our team agrees aggressive treatment options are no longer effective, we can ask our Palliative Care team to talk with your family member. Palliative care doctors relieve pain, improve function, and improve the quality of life for patients regardless of diagnosis and stage.
In conclusion, if you think you might have lung cancer or know that you do, the UAMS lung cancer team can work with you to form a personalized diagnostic or treatment plan. Because we are the only cancer center and academic hospital in the state of Arkansas, we have advanced therapies not available elsewhere in the state. A member of our lung cancer team can be reached through the number listed above. If you wish to e-mail the lung cancer coordinator, Teka Bartter, APN can be reached at BartterTekaM@uams.edu.