Indiana University Melvin and Bren Simon Cancer Center

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Thoracic Oncology Program Our Services

Individualized, comprehensive treatment plans are developed for each patient, guided by the exchange of knowledge at weekly Thoracic Oncology Program meetings. Our thoracic oncology team specializes in the treatment of cancers of the chest, including lung, esophagus, pleura, chest wall, and mediastinum.

Once cancer has been diagnosed, your doctor will want to determine the stage or extent of the disease. This involves finding out how large the tumor is and whether the cancer has spread or metastasized to other parts of the body. Your treatment options depend on knowing the stage of your disease. We use the TNM staging system. T stands for tumor and is used to describe the size and location of the primary (main) tumor. N is for lymph nodes that have cancer in them. M is for metastases, which describes the presence of cancer in other parts of your body (bone, brain, liver).

Patients have access to the most advanced diagnostic, treatment, and palliative care options available. Supportive care is also available through the CompleteLife Program whose staff compassionately support and educate our patients by tending to the emotional, mental, social, and spiritual needs of our patients.

Diagnostic Tools

Thoracic cancer diagnosis may be aided by one or more of the following tools:

fine needle biopsy to remove a lump, suspicious tissue or fluid using a small needle for examination under a microscope

transbronchial biopsy and transesophageal biopsy, which may be guided by an ultra-sound, to remove tissue through the wall of the bronchus or esophagus, respectively, for examination under a microscope

mediastinoscopy to surgically remove tissue and lymph node samples from between the lungs to look for abnormalities

video-assisted thoracoscopy to examine the inside of the chest using a thin, lighted tube

bronchoscopy to look inside the trachea and large airways in the lung for abnormal areas and to remove tissues for examination under a microscope

exploratory thoracotomy to open the chest in an operation and look for abnormalities

Any one of the available comprehensive imaging services may also aid diagnosis:

spiral CT scan uses a computer linked to an X-ray machine to scan the body in a spiral path to create detailed pictures of inside the body

nuclear medicine uses a liquid containing a small amount of radioactive material which is injected into the patient and collects in the part of the body to be imaged; sophisticated instruments then detect the radioactive substance in the body and process that information into an image

endoscopic ultrasound and total body PET scanning takes pictures of the chest or other locations in the body to find cancer cells

Treatment Options

Patients have access to all standard treatment therapies and, for those who qualify, clinical trials for care options not yet available elsewhere. Individualized treatment plans may include some combination of chemotherapy, surgery, and radiation therapy. When appropriate, lung and esophageal cancer patients are treated using minimally invasive techniques.

Treatment of thoracic cancer may include chemotherapy to kill cancer cells with drugs. Two drugs, Gemcitabine and Pemetrexed, have been approved for treatment of lung cancers as a direct result of the research of our medical oncologists, Dr. Lawrence Einhorn, Dr. Nasser Hanna, and Dr. Patrick Loehrer. Dr. Loehrer has become the leading expert in the care and research of thymoma. The Thoracic Oncology Program at the IU Simon Cancer Center has also previously studied the role of certain therapies that produce promising anti-cancer activity by targeting key mechanisms involved in cancer cell growth, including:

epidermal growth factor inhibitors, a substance which interferes with the epidermal growth factor that causes the quick division of cancer cells

Raf kinase inhibitors, a substance that prevents Raf kinase from triggering cancer cell growth

anti-angiogenic drugs to prevent the growth of new blood vessels that feed cancerous tumors

molecular targeted therapies to kill cancer cells by targeting key molecules involved in cancer cell growth

and photo dynamic therapy (PDT) to kill early esophageal cancer cells and or severe abnormal esophageal tissue (high-grade dysplasia) with drugs activated by light.

Please see listing of open or currently enrolling clinical trials for current therapies under investigation.

Surgery is frequently the primary treatment for non-small cell lung cancers to remove the cancer and sometimes some portion of the lung. The IU Simon Cancer Center offers expertise in complicated thoracic surgeries: pneumonectomies (removal of the entire lung) and esophagectomies (removal of the esophagus). Our gastroenterologists are experts in endoscopic muosal resection (EMR), a minimally invasive treatment to remove precancer (high-grade dysplasia) or early cancer from the lining of the esophagus using an endoscope.

Radiation therapy, or radiotherapy, kills cancer cells and shrink tumors with rays that may come from a machine outside the body or from material placed in the body (brachytherapy). The Thoracic Oncology Program offers the newest technologies of radiation treatment and offers clinical trials to qualified patients. Radiation treatment includes:

three-dimensional conformal radiotherapy guided by a computer-generated three-dimensional picture of the tumor, allowing the highest possible dose of radiation while sparing the normal tissue as much as possible

Gamma Knife radiosurgery aimed at a tumor from many angles in a single treatment session

stereotactic body radiation using special equipment to precisely deliver a large radiation dose to a tumor and not to normal tissue

Dr. Achilles Fakiris is the primary radiation oncologist for thoracic malignancies. His work in stereotactic body frame radiation puts him at the leading edge of this technology.

Palliative Care

Bronchoscopies, in addition to its diagnostic purposes, may also be used for palliative care to improve the comfort level of patients. For example, this thin, lighted tube may be used for stent placement to provide support and keep an opening in the airways or esophagus, and performing pleurodesis, to administer drugs to counteract the build-up of fluid in the lungs. Our pulmonologists and gastroenterologists bring prestige to our program with their in-depth knowledge and area of expertise.

Other non-invasive palliative therapies for obstructing lung and esophageal cancers include photo dynamic therapy (PDT) that activates drugs to kill cancer cells when exposed to light and cryotherapy that uses cold temperature for treatment.