Minimally Invasive Approaches to Lung Cancer Diagnosis and Treatment
Reginald Abraham, MD, FACS addresses who would benefit from a lung treatment and diagnostic screening and the minimally invasive procedures used to diagnose and treat lung cancer.
Dr. Reginald Abraham, MD
Dr. Abraham is certified by the American Board of Thoracic Surgery and General Surgery and is a Fellow of the American College of Surgeons, American College of Cardiology and American College of Chest Physicians. He has been practicing cardiac and thoracic surgery for close to 15 years. He completed his residencies at Yale Medical School and New York Medical College and has a special interest in minimally invasive thoracic procedures.
Deborah Howell (Host): Hello, and welcome to the show. You’re listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I’m Deborah Howell, and today’s guest is Dr. Reginald Abraham. Dr. Abraham is certified by the American Board of Thoracic Surgery and General Surgery and is a Fellow of the American College of Surgeons, American College of Cardiology, and American College of Chest Physicians. He has been practicing cardiac and thoracic surgery for close to 15 years now. He completed his residencies at Yale Medical School and New York Medical College and has a special interest in minimally invasive thoracic procedures and is currently deeply involved in his work at Orange Coast Memorial and Long Beach Memorial Medical Centers. Welcome to the program, Dr. Abraham. Dr. Reginald Abraham (Guest): A very good morning to you. Deborah: We are calling today’s show Minimally Invasive Approaches to Lung Cancer Diagnosis and Treatment. It’s a long, long title and a big topic, so let’s dive right in. First of all, who needs lung treatment? Dr. Abraham: Well, just about everyone needs lung treatment. It’s a matter of how we define what treatment is. And certainly, people who have suffered from long-standing lung illnesses, be it asthma, COPD, or emphysema, from long-standing smoking or even just from allergens, all benefit from some degree of treatment. We go further on down the line whereby people need some diagnostic aids—in other words, some sort of imaging or something to be done about a spot seen in the lung—then that treatment can further along all the way to the play where we need to take a biopsy and/or remove that spot. Deborah: Okay. So, that’s pretty much everybody in that category that we at least need to be looked at along the way of life. And who’s going to be benefiting the most from a diagnostic screening? Dr. Abraham: So we think about who is at risk, much like heart disease. Who is at risk? People with high cholesterol, people with family history, et cetera, et cetera. A similar sort of paradigm applies to people with lung spots or people who have higher risk. And who are these people? People certainly who have been smokers for the better part of their life. What does that mean? Anywhere from 5 to 10 to even 20 years of smoking history, people over the age of 50, if you have a family history of lung cancers or any kind of lung illnesses. These are people who would benefit from a screening early detection and thereby hopefully catching a disease in its early stage where we can impact a cancer, if this is the cancer that we’re talking about, at a much earlier stage, and perhaps even offer a cure. Deborah: People are very, very aware of the radiation it takes. Now, can you rest our minds at ease a little bit about the amount of radiation? Dr. Abraham: The amount of radiation at a lung cancer screening CAT scan is minimal. It’s a fraction of the amount of radiation from a regular CAT scan, so they shouldn’t be concerned at all. It’s probably less than a month’s or few months’ worth of radiation from several CAT scans put together, and the benefit that you get out of it far outweighs any infinitesimal risk of increased radiation exposure. When I tell people and my patients that you get radiation exposure when you fly in an aircraft that’s higher than normal, then they sort of open their eyes and realize that there is something to this. Deborah: Good. I wanted them to hear that from your mouth. So what is the percentage of survival for someone if lung cancer is detected earlier rather than later with CT lung screenings? Dr. Abraham: If we are able to pick up lung cancers—and lung cancers are staged based on several criteria, and perhaps we’ll get in to that a little later—but if you get a lung cancer in an earlier stage, like stage 1a or 1b or 2a or 2b, the survival is upwards of 50 to 60 percent, which in lung cancers are tough to get because most of the lung cancers we end up seeing are 2b, 3a, 3b, or higher, in which case our survival rates drop off precipitously a lot. So the earlier we can catch the lung cancers in stage 1a, 1b, or 2a, the much better we can perform. Deborah: We will get into the stages if we have time. But right now, there’s E-B-U-S. Can we talk about that a little bit, what it is? Dr. Abraham: EBUS stands for endobronchial ultrasound. And what this is, is basically a fancy bronchoscope. A bronchoscope is a device much like a colonoscope. Most people are familiar with what colonoscopies are. Bronchoscopy is where we look down the windpipe. You’re sedated or asleep, we look down the windpipe, and we look at your trachea, which is the main windpipe going down in your neck, and then as it divides into the left and right lungs, we are able to look at different structures and make sure that there is that anything we can diagnose or treat or pick up or biopsy. Now, the EBUS, which is the endobronchial ultrasound, has a fancy little ultrasound probe at the end of the bronchoscope, so much so that I can see within and through the tracheobronchial tree, in other words, the windpipe itself, and look at lymph nodes that may be living just outside the trachea. Now, I can extend the needle out and biopsy those lymph nodes. So it’s a lesser invasive way of staging someone or seeing if in fact there is disease in some of those lymph nodes. Deborah: Well, that is a fabulous development. I had not heard about that. That’s wonderful. I’m sure it has caught a lot of things that you would have missed otherwise. Dr. Abraham: Absolutely. And Orange Coast and MemorialCare have been leaders in this field obtaining the equipment and technology and making it available to the practitioners and thereby our community. Deborah: We have another -- as long as we are talking about acronyms, we have EBUS, we just discussed. Now, we have VATS. Maybe you can enlighten us about what that is. Dr. Abraham: We do love our acronyms, don’t we? Deborah: Yes, we do. Dr. Abraham: So that stands for video-assisted thoracoscopic surgery. And the best way to explain it is much like the way we take gall bladders out these days. We don’t do big incisions underneath the right chest anymore and in to the upper abdomen. We make small incisions and put camera ports in and look at TV monitors and do all our surgeries that way. We do the similar thing in the chest. And when that surgery is done in the chest to either biopsy lymph nodes, take a piece of lung or even do lobectomies, when we have to remove a cancer, that’s video-assisted thoracoscopic surgery. Deborah: Interesting. I had a lobectomy. I wish I had VATS back then. Okay. Now we can get into the stages, because we actually have VATS using its capabilities to stage and treat lung cancer. Dr. Abraham: Absolutely. So when we look at lung cancers, we always try to make sure that we get an accurate as possible staging of what this patient may present with. Presumably, this patient may have already had a biopsy of a mass. There may be some question of lymph nodes. What constitutes whether you’re stage 1, 2, 3, or higher would be the TNM criteria. T stands for tumor, the size of the tumor, where it’s located, what else is involved; N stands for lymph nodes, where these lymph nodes are, are they on one side, both sides. Where they are, the location, really affects your staging quite a bit, so biopsy and getting minimally invasive approach to those lymph nodes is extremely important. That’s where EBUS and VATS come in. And M, metastasis, has this tumor gone anywhere else? Deborah: Right. I’m thinking, lung cancer, you better be very scared, because you’re coming after them from all areas. Dr. Abraham: That’s a great way to put it. I tell my patients that once they have the diagnosis, get all your crying, get all your anxiety out of the way. I mean, it’s important to get a good support system. I’m part of that support system, but now it’s time to put your head down and fight like hell. Deborah: That’s right. Dr. Abraham: And that means using all modalities that we have, and we have much more available to us today both diagnostically and therapeutically, both in the operating room and out of the operating room, to affect cancers, lung cancer, in a way that we never have before even a short 10 years ago. Deborah: You just can’t lie down and say, “Oh no.” You just have to say, “Okay. This is the task at hand, and we’re going to go conquer it.” Dr. Abraham: It’s true. Deborah: If you don’t have that mentality, is there a difference in outcomes? Dr. Abraham: Absolutely. So, several centers have shown that your attitude affects your immune system. In fact, the good Dr. Mehmet Oz, who is someone I know, showed this many years ago, 10 or 15 years ago when he was at Columbia Presbyterian, that in fact your immune response is keyed up and turned up, if you will, the better and more optimistic your outlook is. So it’s not just something we tell people to make them feel better. It has a physiologic difference. Deborah: And this is not only just for the patients. It’s for everyone surrounding the patient. Dr. Abraham: Absolutely. So, we are all human beings and we’re emotional people, so we definitely feed off what emotion is in and around of the room. And if someone is in fact very positive about it, you inspire others to be around you, and that helps you with your support system. Deborah: And it’s really not just pie-eyed Pollyannaism. It’s really going to affect your outcome. Deborah: Thank you so, so much, Dr. Abraham. Get out there and keep fighting for everybody. We really appreciate the work that you do. Dr. Abraham: It’s my privilege. Thank you so much. Deborah: And for finding the time to talk to us in your incredibly busy day, we really appreciate your talking to us about lung cancer diagnosis and treatment. Get your numbers, get out there, see your doctors, get your screenings, and don’t be afraid of the radiation. Dr. Abraham: Absolutely. Deborah: Okay. I’m Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Get out there, have yourself a great day, and love the ones you love.