Interventional Pulmonology

Interventional pulmonology uses non-surgical, minimally invasive procedures for the diagnosis and treatment of lung cancer, thoracic cancer, tracheal cancer and other diseases of the respiratory system. It relies on endoscopic techniques, which involve inserting an instrument into the body to view internal organs and tissues and to conduct additional procedures. Interventional pulmonary medicine is also used to treat related symptoms that may cause discomfort, such as shortness of breath, coughing and chest pain.

The Interventional Pulmonology Program at City of Hope provides advanced treatments for:

• Primary lung cancer
• Cancers that metastasize to the lung
• Airway obstruction (due to an abnormal growth)
• Mediastinal and hilar adenopathy
• Undiagnosed lung nodules and masses
• Pleural diseases (including effusions or undiagnosed disease)
• Bronchopleural fistulas
• Pneumothoraces

City of Hope pulmonologists may also treat pneumonia, emphysema, chronic obstructive pulmonary disease (COPD), tuberculosis, asthma and pulmonary hypertension.

Cancer Treatment Centers of America^® (CTCA) is now City of Hope^®, joining forces to expand patient access to personalized, comprehensive cancer care.

What are the benefits of interventional pulmonology?

Interventional pulmonology addresses a simple but critical patient need: the ability to breathe. As it turns out, about 30 percent of lung cancers may cause an obstruction in the airway.

City of Hope interventional pulmonologists use imaging technology to determine what may be causing underlying symptoms. Interventional pulmonology focuses on minimally invasive pulmonology techniques and procedures to remove obstructions in the airway and to treat respiratory cancers.

The interventional procedures used may be used to help open the airway immediately, without having to wait for chemotherapy or radiation therapy to shrink tumors. The procedures may also remove excess fluid from around the lungs, a condition called pleural effusion, and reduce symptoms that cause discomfort, to help patients breathe more comfortably.

With interventional pulmonologists using less invasive techniques, patients may experience less trauma, fewer complications and quicker recovery times.

What are interventional pulmonology procedures?

City of Hope uses state-of-the-art diagnostic tools and procedures to locate, diagnose and treat lung cancer and other respiratory system diseases, without performing surgery. Our interventional pulmonologists are experienced in performing advanced, minimally invasive interventional procedures on the airways and chest cavity, including advanced bronchoscopic and pleuroscopic techniques.

A bronchoscope is a thin, tube-like instrument with a light and a lens used for viewing. It may also have a tool designed to remove tissue that can later be examined for signs of disease. The bronchoscope is inserted through the nose or mouth and used to examine the inside of the trachea, bronchi and lungs.

A pleuroscope is inserted into the chest cavity through a small incision in the chest wall, then directed around the chest wall and pleura on one side of the body.

Interventional pulmonology procedures and techniques may include:

• Endobronchial ultrasound (EBUS): In this procedure, a flexible bronchoscope is inserted with the guidance of an ultrasound probe to identify lymph nodes and masses outside of the airways. This scope allows for biopsies of the nodes or masses.
• Navigational bronchoscopy: This procedure involves the insertion of a steerable catheter through a bronchoscope that is directed to masses that cannot be seen in the airway.
• Medical pleuroscopy: In this procedure, a rigid or flexible tube is inserted into a patient’s chest, typically to take biopsies of the lining of the chest wall or lung, masses of the pleura itself, or to address pleural effusions.
• Removing endoscopic bronchial tumors: This procedure involves the insertion of a bronchoscope to deliver laser and other cancer-killing technologies to tumors buried deep inside the lungs.
• Placing fiducial markers: This procedure places markers in or close to a tumor to create a point of reference during highly precise, stereotactic radiation therapy.
• Airway stent placement: This procedure inserts a stent into an airway to open it up and help patients breathe better.
• Argon plasma coagulation(APC): This procedure cauterizes blood vessels to stop bleeding for patients who are coughing up blood.
• Pleurodesis and thoracentesis: These procedures are designed to drain excess fluid from around the lungs, including by using a pleural catheter.
• Photodynamic therapy (PDT): This procedure uses light-sensitive medicine in conjunction with a light source to destroy cancer cells.
• Hypoxia altitude simulation test (HAST): This test is used to determine whether a patient with breathing problems needs supplemental oxygen for air travel.

Interventional pulmonologists are not surgeons, but some of their procedures may seem surgical to patients because the procedures may be performed in an operating room and they may have complications similar to those for some surgeries. While it may be appropriate for these procedures to be performed under moderate sedation or local anesthesia, City of Hope doctors typically provide patients with general anesthesia to facilitate a more comfortable experience.

Some interventional pulmonology procedures have surgical counterparts. Video-assisted thoracic surgery (VATS), for example, is a surgical version of medical pleuroscopy and is performed by a thoracic surgeon.

What is interventional pulmonology’s role in cancer care?

Interventional pulmonologists work closely with City of Hope oncologists, critical care physicians and other cancer experts to tailor treatments to each patient’s specific needs, helping to preserve lung function and reduce side effects. Throughout your treatment, your interventional pulmonologist will monitor your progress and modify your treatment plan accordingly.

Interventional pulmonologists treat symptoms of lung disease that may not only impact your quality of life, but they may also delay or interrupt your cancer treatments. Some of these procedures are performed on an outpatient basis.

Throughout your treatment, we’ll also provide supportive care services, such as nutritional support, pain management, psychotherapeutic counseling and physical therapy, to help you maintain your quality of life.