Our Services
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The Thoracic Oncology Program provides the following services for
patients with thoracic cancer:
Chemotherapy, either alone or in combination with surgery and/or
radiation oncology, is offered as an outpatient service at the
Dana-Farber Cancer Institute. The outpatient infusion units are
staffed by highly specialized oncology nurses, nutritionists, and
social workers. All levels of complex care are offered to patients
with thoracic malignancies, including new and experimental treatments
for patients with lung cancer, mediastinal
cancers, and cancer metastasized (or spread) from other areas of the
body.
Medical oncologists, located at the Dana-Farber Cancer Institute,
participate in a number of national groups that include the Cancer and
Leukemia Group B (CALGB), the Radiation Therapy Oncology Group (RTOG),
and the Harvard Collaborative Oncology Group (H-COG) as well as others
to develop new research protocols. The physicians also develop their
own institutional research protocols. Standard or conventional
treatments are offered to patients who do not wish to participate in a
clinical research trial.
The goal of chemotherapy may be to cure a specific cancer, to
control the tumor growth when a cure is not possible, to relieve
symptoms such as pain, to shrink tumors before surgery or
radiotherapy, and to enhance the radiotherapy or to destroy
microscopic metastasis after a tumor has been surgically removed.
Newer drug developments are being targeted at the prevention of
tumor evolution in the cell stage. Surgery and radiotherapy treat
localized tumors. Chemotherapy treats the body system as a whole,
aiming at tumor cells that have broken off from the main tumor
spreading through the blood or lymph systems to penetrate other parts
of the body. Chemotherapy is given either before surgery or
radiotherapy (referred to as neo-adjuvant treatments), instead of
surgery or radiotherapy (referred to as primary treatments),
concurrently with radiotherapy or after surgery or radiotherapy
(referred to as adjuvant treatments).
Surgery is performed to diagnose, biopsy, stage, or treat a benign
or cancerous process located in the chest. Surgery may be curative or
done to minimize symptoms of advanced disease or distress. It may be
reconstructive or rehabilitative to repair an anatomic defect such as
a fistula (i.e. an abnormal passage between the lung and esophagus) or
to improve function.
The thoracic surgeons, located at Brigham and Women's Hospital,
are highly skilled and very experienced in the diagnosis and treatment
of the various malignancies that can grow in the chest. They
understand the local patterns of growth, the metastatic potential of a
tumor and the appropriate use of new multimodality or combination
treatments for patients with thoracic malignancies. Multi-combination
treatments for patients with cancers originating in the chest have
improved cure and control rates, and surgery plays an integral
part. Physicians, nurses, physical therapists, nutritionists and
social workers work as a team. The team places a specific emphasis on
pain control, pulmonary rehabilitation, wound-care, nutrition, as well
as emotional and educational needs. The following are some of the
surgical services available to a patient with a cancer in the
chest.
- Bronchoscopy: (look into lungs with a lighted instrument) This
is done to visualize lungs and take biopsies of abnormal
tissue.
- Esophagoscopy: (look into esophagus) This is done to visualize
the lining of the esophagus and stomach and to take biopsies of
abnormal tissue.
- Mediastinoscopy: (look into the middle of the chest) This is
done to examine and biopsy the lymph nodes in the middle of the
chest. This helps stage lung cancers and sometimes cancers in the
esophagus.
- Esophageal Dilatation: Done in combination with esophagoscopy to
widen the diameter of esophagus to allow for better
swallowing. Sometimes a stent or hollow tube may be placed to keep
esophagus open and allow food to pass through to the stomach.
- Bronchial Dilatation: Done in combination with Bronchoscopy to
widen the diameter of the bronchus (tube that leads into
lung). Sometimes a stent is also placed in order to aid the patient
to breath better.
- Laser Surgery: Will occasionally be done to relieve a blockage
in a bronchial tube in the lung or in the esophagus if thought to be
appropriate.
- Brachytherapy: Collaboration of surgeon and radiation oncologist
to place sealed radioactive catheters next to a tumor using a
bronchoscope or an esophagoscope.
- Surgical Resection of tumors: Removal of tumors located in the
chest through a surgical incision in the front, side, or back of the
chest. Common incisions: Thoracotomy (usually side of chest) and
Median Sternotomy (incision through the breastbone).
- Lobectomy: Removal of a lobe of lung (these are portions of the
lung marked off by natural dividers known as fissures). The right
lung has three and the left lung has two.
- Wedge Resection: Removal of small piece of lung that may be done
for biopsy or resection of a cancer spread from another part of the
body.
- Pneumonectomy: Removal of whole lung on one side of chest.
- Thymectomy: Removal of thymus, usually because of tumor
(Thymoma) or Myasthenia Gravis.
- Thoracoscopic Surgery: A surgical procedure using a video camera
that is often used for biopsy, and/or for resection of small
portions of lung tissue. It is sometimes referred to as VATS. It
may also be done for patients who have unstable medical conditions
and may be at high risk for a bigger surgery.
- Chest Wall Resection and Reconstruction: Removal of a portion of
the ribs or sternum (breastbone) and reconstruction of the chest
wall deficit with a special graft. Usually done for tumors on ribs
or sternum.
(Fluid built up between the linings of the lung and chest wall
inside the chest cavity) Chest tube insertion into chest. Insertion of
talc or antibiotic into the chest cavity to help prevent
reacculmulation of this fluid. Pleural effusion can also be treated
with a thoracoscopic procedure.
Radiation therapy is one of the major treatments used in thoracic
cancers. It can be used alone or in combination with the other two
major treatments, chemotherapy and surgery. The goal of radiation
therapy is to eradicate or shrink the tumor cells without damaging the
surrounding tissue. It may be used to cure a cancer, to help keep it
from spreading, or to help improve quality of life by relieving pain
or other symptoms.
Radiation therapy uses photons, electrons, and protons. Higher
energy x-ray beams set at a specific distance from the body are used
to destroy malignant tissues by causing a break down in the genetic
structure or DNA of the cells. These cells are permanently damaged and
cannot repair themselves.
External radiation therapy delivers radiation from outside the body
and internal radiation delivers radiation from inside the
body. Methods of delivering radiotherapy from outside the body include
standard radiotherapy, intra-operative radiotherapy, stereotactic
radiotherapy, and 3-D conformal radiotherapy.
Some internal methods of delivering radiotherapy available at the
Cancer Center for thoracic cancers include brachytherapy at tumor bed
and intraluminal radiation. Brachytherapy is the placement of the
radiation source directly into the tumor. This is sometimes used when
a tumor is growing into the lumen or opening of the lung or esophagus
to help shrink it. It is often used with the aid of a bronchoscopy or
esophagoscopy. This can be done alone or in combination with external
radiation therapy. Intra-operative radiation therapy is the actual
radiation of an area exposed during a surgical procedure. Stereotactic
is a treatment technique that allows the radiation oncologist to
deliver small-volume precision treatments, usually to brain
lesions. 3-D conformal radiotherapy allows the visualization of the
tumor in three dimensions utilizing a CT scanner or MRI in order to
deliver precise and accurate radiotherapy.
The radiation oncologist works with a team that includes radiation
therapists, dosimetrists, radiation physicists, computer scientists,
radiobiologists, and nurses to set up a treatment plan for each
patient.
The Department of Radiology offers a broad range of diagnostic
imaging services 24 hours a day throughout their specialty
divisions. Routine radiological examinations include chest
radiography, CT scans, routine musculoskeletal films, mammography,
MRI, nuclear medicine scans, ultrasounds, PET scans and more.
A wide variety of radiological examinations are available to assist
the clinicians in diagnosing and staging the patient with a
malignancy. There are radiologists that specialize in thoracic
radiology who participate in the multidisciplinary clinics offering
consultation and expert second opinions on films that are brought from
outside facilities by patients. This enables clinicians to provide a
more comprehensive and accurate diagnosis.
Thoracic radiologists do needle biopsies of lesions found in the
chest or upper abdomen to aid in the diagnosis and staging of
malignancies. Thoracic radiologists also attend case review
conferences to aid in radiological interpretations for patient care
planning.
A full range of pathological services are available through the
Cancer Center. Some of the services offered include Cytogenetics,
Cytology, Diagnostic Molecular Biology-Molecular Oncology,
Neuropathology, Surgical Pathology, and other specialties. Frozen
section diagnoses and other intra-operative consultations are
available to the surgeons to aid in diagnosing and staging a
malignancy. Special studies including histologic stains, electron
microscopy, and immunohistochemical and molecular studies are
done. Outside consultations and second opinions for specimens prepared
in outside facilities are offered to assist in diagnosing or
confirming diagnoses.
During thoracic clinic hours, the Cytology department is usually
on-call to come to the thoracic clinic and perform fine needle
aspirations for patients with palpable masses. With the results, the
cytologist can usually offer a preliminary diagnosis in a short period
of time. They also can give a preliminary interpretation of specimens
obtained in radiology from deep body sites.
The Pulmonary Department treats patients with all diseases related
to the lungs and lung function on both an inpatient and an outpatient
basis. These problems may include cancer, respiratory control, cystic
fibrosis, interstitial lung disease, occupational and environmental
lung disease, pulmonary vascular disease, pulmonary hypertension,
adult respiratory distress syndrome, asthma, sleep apnea, sarcoidosis,
chronic obstructive lung disease (COPD), acute lung injury, pulmonary
embolism, and pulmonary rehabilitation. There is a 24-hour inpatient
consultation service available at Dana-Farber Cancer Institute.
A full range of special tests and procedures are available through
the pulmonary department to aid in the diagnosis and comprehensive
care of patients with potential or ongoing respiratory problems. Some
of these include pulmonary function testing (PFTs), exercise tolerance
testing, bronchoscopy, sputum induction, methacholine challenge, and
gene therapy in cystic fibrosis. Pulmonary physicians work closely
with the thoracic surgeons, medical oncologist, and radiation
oncologists in assessing and preparing patients for surgical or
radiation treatment.
