DONATETHORACIC 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 Cancer
![Mediastinum-[-thymus,-germ-cell-tumor,-Neuroendocrine-tumor]](https://www.rgcirc.org/wp-content/uploads/elementor/thumbs/Mediastinum-thymus-germ-cell-tumor-Neuroendocrine-tumor-qgp9o3ulgvb35tx4rjgcx767k5d6xg3z7cfxu4an98.png "Mediastinum-[-thymus,-germ-cell-tumor,-Neuroendocrine-tumor]")
Mediastinum [ thymus, germ cell tumor, Neuroendocrine tumor]
![Esophagus-[food-pipe]](https://www.rgcirc.org/wp-content/uploads/elementor/thumbs/Esophagus-food-pipe-qgp9o2wra19su7yhx11qcpeqyrhtpr08v7sgcuc1fg.png "Esophagus-[food-pipe]")
Esophagus [food pipe]
Trachea( wind pipe)
Ribs and chest wall.
![Sternum-[breast-bone]](https://www.rgcirc.org/wp-content/uploads/elementor/thumbs/Sternum-breast-bone-qgp9o7ly87g8g9ro5l2v7681xouns8iwjv1vr852kc.png "Sternum-[breast-bone]")
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 RGCIRC 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)
Thoracic Cancer : Risk Factors
Smoking
Exposure to radiation & radioactive materials
Workplace exposure-Asbestos
Exposure to other carcinogens-Arsenic,Cadmium,coal, silica,diesel fumes, air pollution
Family history of cancer
Alcohol consumption.
Carbonated soft drinks
Low intake of fresh fruits and vegetables.
HPV
Gastro esophageal reflux disease
Thoracic Cancer : Prevention
Unavoidable risk factors
Family history
Ground radiation
Air pollution
Unavoidable risk factors
Not smoking, no alcohol
Using proper protective equipments
Reduce your exposure to carcinogens
Maintain overall good health
Body weight, watch your diet
Get yourself treated for reflux oesophagitis
Regular screening
DO’s after Surgery
- Eat food you find appealing
- Walk as much as you can
- Rest when you feel tired
- Shower as needed.
- Use your incentive spirometer atleast 5 times a day
- Take care of your drains and dressing.
- Report to emergency if you get blood streaked sputum,persistent cough,fever
DON'Ts after Surgery
- Don’t do strenuous work, or lift heavy weight
- Don’t drive till you are painfree
- Don’t empty your drains without clamping connecting tube
Patient may ask to doctor
- What type of cancer do I have? What is its stage?
- What are the treatment options?
- Can surgery be avoided altogather?
- What are the complications of this surgery?
- How will it be performed? Open or by Robot?
- What precautions should I take after discharge from hospital?
- What is the possible prognosis in my case?
- Can I continue to smoke and take alcohol?
- When can I go back to my routine activities?
- What follow up is required and how frequently?
- Will I need Radiation ,chemotherapy or immunotherapy before or after surgery?
