Interventional Pulmonology: Treatment Options
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Your pulmonary treatment plan
To fight lung cancer and metastasis to the lung, CTCA must continually research and employ the latest treatments and technologies. Despite improved diagnostic techniques, lung cancer is sometimes inoperable. Our clinicians have to think outside of the box. “We help patients who have been given up on elsewhere,” says Morrow.
The Advanced Center for Lung and Thoracic Oncology uses advanced technologies and innovative techniques to provide you with powerful and thorough treatment options. Interventional pulmonology techniques can be used alone or in combination with other cancer treatments to treat the disease and/or improve your quality of life.
For example, many patients with lung cancer and lung metastasis experience difficulty breathing. Not only does central airway obstruction impact your quality of life, it can also interfere with your treatment regime. If you can’t breathe properly, you won’t be able to receive certain treatments, such as high-dose chemotherapy. The pulmonology team will help relieve your symptoms so you can maximize your breathing function and receive more aggressive treatment.
The following are some specific interventional pulmonology procedures and techniques the pulmonology team provides:
- Bronchoscopies: Endoscopy procedures in which a thin, lighted tube connected to a camera (a bronchoscope) is inserted through the mouth or nose to examine the bronchial path, including the trachea (windpipe), bronchi (tubes inside the lungs), and lungs. The pulmonology team uses top-of-the-line diagnostic bronchoscopy equipment, including advanced therapeutic bronchoscopes.
Some specific procedures our clinicians perform include rigid and flexible bronchoscopies, as well as laser (e.g., regular laser, argon plasma coagulation, electric cautery) bronchoscopies. A rigid ventilating bronchoscopy requires an experienced pulmonologist. Because it is rigid, your pulmonologist can use the bronchoscope to actually cut out the tumor and pull it out of the airway.
- Airway stenting: A procedure which involves inserting stents (tiny tubes) with a rigid or flexible bronchoscope to help with airway obstruction before or after other therapeutic approaches. The use of stents (e.g., silicone, self-expanding metallic) can help maintain an open airway to help you breath better.
- Balloon bronchoplasty: A procedure which involves opening the airway by dilating it with a balloon. This is useful for treating an airway that has become narrowed due to scarring or tumors.
- Photodynamic Therapy (PDT): An innovative cancer treatment that uses light-activated drugs and a light source to kill cancer cells. PDT is a two-part process. First, the patient receives an injection with a photosensitizing agent to make cells more sensitive to light. After the drug is absorbed by the cancer cells (about two days later), a bronchoscope is used to apply a spectrum of light. This activates the photosensitive drug to destroy cancer cells.
PDT is noted for its potential to destroy cancerous cells while sparing nearby healthy tissue. It can be used to help treat or relieve the symptoms of lung cancer. PDT is usually an outpatient procedure and takes only about five to eight minutes to complete. It is typically less risky than surgical procedures and is relatively pain free with minimal side effects.
- High-Dose Rate (HDR) Brachytherapy : An aggressive form of internal radiotherapy in which radioactive material is placed directly into or near a tumor. By delivering a powerful, precisely-focused dose of radiation directly to a tumor, HDR brachytherapy may reduce damage to nearby healthy tissue, and possibly decrease side effects associated with other forms of radiation therapy. In addition, HDR brachytherapy offers a treatment time of days, rather than weeks in standard radiation. Our pulmonologists will work with your radiation oncologist to perform HDR brachytherapy procedures.
- Interventional angiography: A procedure in which a thin tube (catheter) is inserted into a blood vessel and a substance (contrast agent) is injected to make the blood vessels show up on an X-ray. This procedure helps to treat a blocked blood vessel and improve blood flow throughout the body.
Argon plasma coagulation (APC): A rare procedure used to destroy tumors in the airways. APC involves the use of argon gas that behaves like a liquid. It is directed through a probe passed through an endoscope. By adding a high-frequency electrical current, the gas actually directs itself to the tumor, even bending around corners. When it reaches the tumor, the electricity destroys it.
Holmium and Nd: yttrium-aluminum-garnet laser: CTCA at Eastern Regional Medical Center recently purchased this technology, commonly referred to as a YAG laser. The pulmonology team uses the YAG laser to “vaporize” tumors. The vapor is then suctioned out of the lung, removing the tumor in the airway.
- Cyrogenics: A procedure which involves using extremely low temperatures to freeze and destroy cancer cells. The Philadelphia hospital is prepared to perform this procedure as soon as a patient needs it.
Treatments for pleural effusion
Pleural effusion, or abnormal fluid build-up around the lungs, can cause shortness of breath. For patients with this condition, the pulmonology team provides several procedures, including the following:
- Thoracentesis: A procedure which involves removing excess fluid from the pleural cavity (the body cavity containing the lungs) through a needle inserted into the pleural space. By analyzing pleural fluid under a microscope, thoracentesis can help diagnose and stage cancer. In addition, by draining fluid that surrounds the lungs, thoracentesis can help you breath better.
- Chest Tube: A procedure which involves the surgical placement of a hollow, flexible tube through the side of the chest into the pleural space (between the inner and outer lining of the lung). Chest tubes can help drain fluid, blood, or air to allow the lungs to fully expand. When the chest tube is no longer needed, it can be easily removed. A pleural catheter is a chest tube used to remove pleural fluid in the chest cavity to help improve breathing and overall quality of life.
- Pleurodesis: A procedure in which a chest tube is placed, fluid is removed, and a drug (e.g., chemotherapy), antibiotic, or power/talc is instilled into the chest cavity. This causes the linings of the lung and chest wall to stick together. By sealing the space, this procedure can help prevent further fluid buildup.