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Applied for: Thoracic Cancer Services

Thoracic Cancer

Overview

Welcome to the specialty of Thoracic Surgery also called Chest Surgery. We focus on organs of the chest / lung, including the mediastinum, esophagus (tube between mouth and stomach), the trachea (airway) and the chest wall (rib cage and breastbone).

The department works in close coordination with Medical and Radiation oncologists to provide personalized care of thoracic diseases.

The department continuously thrives to provide safe and patient friendly surgery by adopting Minimally invasive surgery using VATS/Thoracoscopy and Robotic surgery.

The Thoracic tumor board meeting helps us provide multidisciplinary approach to thoracic cancer patients and improve their outcomes for survival.

What is Thoracic Cancer ?

Cancers occurring in chest cavity including lung, thymic, oesophageal and tracheal cancers. Tumors affecting chest wall and diaphragm are also included in thoracic tumors.

Thoracic Cancer Includes:

Lung
Mediastinum [ thymus, germ cell tumor, Neuroendocrine tumor]
Esophagus [food pipe]
Trachea( wind pipe)
Ribs and chest wall.
Sternum [breast bone]
Diaphragm

Signs and Symptoms of Thoracic Cancer

Symptoms depend on the site and organ of origin. In early stages most cancers are asymptomatic. Symptoms could be

Chest pain which may worsen with coughing, deep breathing, laughing.
Coughing with bloody sputum or rusty sputum.
Fatigue
Heartburn,indigestion, vomiting, dysphagia
Hoarseness of voice

Shortness of breath or wheezing
Weakness
Loss of weight ,loss of appetite
Neck nodes, armpit nodes
Chest wall swelling

These symptoms are common in other benign conditions also. Such symptoms does not always mean cancer.

Screening and Diagnosis of Thoracic Cancer

Most of the chest disease are detected during imaging (CXR, CT scan) for chest symptoms or incidentally during routine checkup.

The confirmation of cancer and staging of cancer is critical to starting treatment. Following diagnostic procedure are available under one roof:(Xray chest is basic investigation)

CT scan Chest/ MRI scan
Ultrasound guided biopsy / CT guided biopsy / PET guided biopsy
Fiberoptic Bronchoscopy biopsy
Endo-Bronchial Ultra Sound [EBUS] guided biopsy / Radial Probe guided EBUS biopsy [RP-EBUS]
Upper GI endoscopy and Endoscopic Ultra Sound [EUS] for esophageal / food pipe cancer
Whole body PET scan
DOTANOC scans for Carcinoid tumor
Video-Mediastinoscopy / Thoracoscopy lung biopsy
Molecular testing for tumors

Lung Cancer Screening Program

Early detection of lung cancer using LDCT [Low dose CT chest] has shown to save lives in up to 20 to 26% of screened population.

Eligibility for LDCT Chest screening at RGCIRC

Age 45 – 64 years with 20 pack years and smoking cessation < 15 years
Age 45-64 years with 15 pack years and additional risk factor
Long-term lung cancer survivors who have completed 4 years of surveillance without recurrence, and who are in good performance status with a life expectancy of 10 years in order to detect second primary lung cancer until the age of 70.
Willing to undergo counseling for cessation of smoking
[PACK YEAR –It is calculated by multiplying the no’s of packs of cigarettes smoked per day by the no’s of Years the person has smoked. Example, 1 pack year is equal to smoking 20 cigarettes [1 pack] per day for 1 year.

Treatment of Thoracic Cancer

Treatment depends on origin of cancer, biopsy report and stage of disease. Now a days lung cancer is being treated with targeted therapy and immunotherapy. Oesophagus cancers are treated with chemoradiation followed by surgery.
Lung Cancer can be treated in different ways based on the his histological and molecular types. Unfortunately 90% of lung cancer are detected in advanced stages.

Surgery

It is the operation where the surgeon will take out the cancer tissues and remove it. It gives best results in early stage NSCLC.

Chemotherapy:

Chemotherapy is the mainstay of treatment in small cell lung cancer and advanced non small cell lung cancer.

Targeted therapy:

The drugs are generally in the form of pills. Targeted Therapy will depend on molecular studies/NGS etc. Now a days lung cancer treatment is personalized and lung cancer is becoming a Chronic disease.

Radiation therapy:

Radiotherapy is useful in early lung cancer patient who is medically unfit. It may be used also for bony metastasis ,Brain metastasis.
Here, Doctors from different specializations work together to treat lung cancer. One who is expert in treating lung cancer is called pulmonologists, and another specialist like a thoracic surgeon with the specialization for chest surgery also analyzes the patients for the right treatment. RGCIRC has team of medical thoracic oncologists, thoracic surgeons, thoracic radiation oncologists and pulmonologists. We have thoracic tumor boards on every Thursday.

So choose the right doctor, right institution where all facilities exist under one roof.

Optimal approach using minimally invasive technique.

Robotic surgery using Da vinci system
Age 45-64 years with 15 pack years and additional risk factor

Commonly Performed Procedures

Thoracotomy / Thoracoscopy for lung / Robotic lung cancer surgery
Lobectomy / Bilobectomy / Pneumonectomy with Radical mediastinal nodal dissection
Sleeve resection of lung – Emphasis on lung preservation
Thoracoscopic pulmonary Metastatectomy
VATS / Robotic for mediastinal tumor
Sternotomy for Mediastinal disease / Germ cell tumor/ thymoma / neurogenic tumor
Chest wall tumor removal and reconstruction
Mesothelioma surgery
Thoracoscopic Decortication / Pleurodesis
Robotic lobectomy-lung surgery / Robotic Thymoma /
Robotic esophagus surgery
Tracheal tumor / Tracheal stenting

How is RGCI Different

Thoracic Multispecialty Tumor Board

Thoracic cancer patients are evaluated by a specialist team of Thoracic surgeon, Medical Oncologists, Radiation Oncologists, pathologists and Imaging Specialists. Depending on the general condition of the patient and the staging and pathology of cancer a treatment plan is worked out as per accepted International Treatment Guidelines. (NCCN – National Comprehensive Cancer Network)