Q and A: Advances in lung cancer diagnosis and treatment

Neeraj R. Desai, M.D., M.B.A., FACP, FCCP, interventional pulmonologist

How is lung cancer detected?

Several diagnostic tools are used to detect lung cancer, beginning with a computed tomography (CT) scan or chest X-ray. If abnormal findings are discovered (like a suspected tumor) by either test, a patient may undergo an interventional pulmonology procedure, such as electromagnetic navigational bronchoscopy or an endobronchial ultrasound, to biopsy (sample) lymph nodes or masses. The biopsy allows doctors to properly diagnose and stage lung cancer, helping ensure patients get the most appropriate treatment.

What is electromagnetic navigational bronchoscopy?

Electromagnetic navigational bronchoscopy, or, simply, navigational bronchoscopy, is a minimally invasive procedure used to reach and biopsy lung nodules in difficult-to-access areas of the lungs. Routine bronchoscopy oftentimes cannot reach deeply into smaller airways (i.e., bronchi) or airways blocked by a tumor. Navigational bronchoscopy is like GPS for the lungs. Using sophisticated computer imaging, doctors guide the tool’s flexible tube (a bronchoscope), which has a camera at its tip, to look inside the lungs and airways. Once the navigational bronchoscope reaches a lung nodule or tumor, tiny tools are passed through the bronchoscope and are used to biopsy the nodule or mass.

In some cases, doctors use navigational bronchoscopy to place fiducial (also called reference) markers in the lungs. The fiducial markers resemble grain-sized, metallic gold seeds and correspond with radiation therapy delivery systems. For example, Northwest Community Healthcare (NCH) offers CyberKnife^®, which uses a computer to track the fiducial markers as a patient receives radiation treatment. The patient breathes normally and the system follows the movement of the markers, adjusting so that the radiation is delivered precisely to the targeted area. This technology helps prevent surrounding healthy lung tissue from receiving the radiation.

Navigational bronchoscopy may be an option for patients who need:

• Diagnosis of their lung nodule(s)
• Fiducial marker placement to help direct radiation therapy
• Marking prior to surgical removal of a lung nodule

What if a patient has a suspicious lung nodule or mass?

Typically, patients diagnosed with a lung nodule or mass immediately start thinking the worst scenario—lung cancer. My job as a physician and interventional pulmonologist is to determine as quickly as possible whether the suspicious area is cancer, and to do so using the least invasive procedure(s). At NCH, a pathologist is in the procedure room when navigational bronchoscopy is performed. The pathologist analyzes the nodule or tissue sample immediately, providing preliminary confirmation that it is cancerous or noncancerous. If we do discover the patient has cancer, we quickly map out the next steps and work with the patient to choose the most appropriate treatment plan. The sooner patients are able to start treatment—whether it involves surgery, radiation therapy, chemotherapy or a combination of those treatments—the better.

To schedule a consultation with Dr. Desai, call 847-818-1184. To learn more about lung cancer screening, diagnosis and treatment at NCH, call 847-618-6572.