99% of all neoplasms occurring in the lung are cancer. Benign tumors do occur. However, of the cancers that occur in the lung and those considered primary to the lung, there are two broad categories, small cell and non-small cell carcinoma.
It is important to establish a diagnosis when a suspected cancer is identified in the lung because the treatment may vary widely.
Small cell carcinomas are treated primarily with chemotherapy. Once we at Pulmonary Specialists have identified this as the primary diagnosis, the usual response is for medical oncology referral for further evaluation and treatment.
Non-small cell carcinoma encompasses cell types such as squamous cell carcinoma, adenocarcinoma and large cell carcinoma. These tumors are treated preferentially with surgery. If a patient is not considered a surgical candidate then other modalities are commonly used such as chemotherapy and radiation therapy. Additional therapies that are offered may include laser therapy, photodynamic therapy, or endobronchial brachytherapy. These latter three therapies are primarily considered palliative. However, the use of these therapies may substantially improve a patients well being, particularly in the face of obstructing tumors. Laser therapy is utilized for obstructing bronchial carcinoma and is administered through either rigid or fiberoptic bronchoscope for control of endobronchial tumor. Similarly, photodynamic therapy is endobronchial application of laser for stimulation of light activated pharmaceutical agent. Endobronchial brachytherapy is direct application of radiation within the bronchus that helps control tumor locally.
We consider our job not only to establish a diagnosis and to determine cell type, but also to determine the patient’s suitability for surgical therapy. This is done through pulmonary function testing and occasionally other exams.
Although lung cancer is a horrible diagnosis with often poor outcomes particularly when discovered in late disease stages, there have been significant advances in treatment as well as palliative modalities to aide in the care of the lung cancer patient.