MEDICAL BREAKTHROUGHS RESEARCH SUMMARY

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1 TOPIC: Using Video to Kill Lung Cancer REPORT: MB #4111 MEDICAL BREAKTHROUGHS RESEARCH SUMMARY BACKGROUND: Lung cancer is the second most common cancer in both men and women, excluding skin cancer. About 14 percent of all new cancers cases are lung cancers and according to the American Cancer Society, there will be an estimated 224,390 new cases of lung cancer in 2016 and about 150,000 deaths from lung cancer. It is by far the leading cause of cancer death among both men and women with about 1 out of 4 cancer deaths from lung cancer. More people die of lung cancer each year than of colon, breast, and prostate cancers combined. Lung cancer mainly occurs in older people, with about 2 out of 3 people diagnosed with lung cancer being 65 or older. The chance that a man will develop lung cancer in his lifetime is about 1 in 14, while for a woman, the risk is about 1 in 17. These numbers include both smokers and non-smokers, but for smokers the risk is much higher. (Source: TREATMENT: There are three main types of lung cancer: non-small cell lung cancer, small lung cancer and lung carcinoid tumor. The type of lung cancer is important because it affects a patient s treatment options and prognosis. The type of surgery to treat lung cancer can include the following: Pneumonectomy: This surgery removes an entire lung. This might be needed if the tumor is close to the center of the chest. Lobectomy: The lungs are made up of 5 lobes (3 on the right and 2 on the left). In this surgery, the entire lobe containing the tumor is removed. Segmentectomy or wedge resection: In these surgeries, only part of a lobe is removed. This approach might be used if a person doesn t have enough lung function to withstand removing the whole lobe. Sleeve resection: This operation may be used to treat some cancers in large airways in the lungs. A surgeon may be able to do this operation instead of a pneumonectomy to preserve more lung function. Nearby lymph nodes are also removed with any of these operations to look for possible spread of the cancer. These operations are usually done through a surgical incision between the ribs in the side of the chest. (Source: NEW TECHNOLOGY: Doctors are now treating early-stage lung cancers in the outer parts of the lung with a procedure called video-assisted thoracic surgery (VATS). This requires smaller incisions than traditional surgery. During the operation, a thin tube with a tiny video camera is placed through a small cut in the side of the chest to help the surgeon see inside the chest. Since only small incisions are needed, there is usually less pain after the surgery and a shorter hospital stay than traditional surgery. (Source:

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3 Raja Flores, M.D., a professor and chairman of the Department of Thoracic Surgery at Icahn School of Medicine at Mount Sinai in New York City talks about how videoassisted surgery is saving lives. Interview conducted by Ivanhoe Broadcast News in April I wanted to start by asking you a little bit about, about VATS. If you could tell me what it stands for and essentially what it is. Dr. Flores: VATS is video assisted thoracic surgery. It s a minimally invasive procedure that removes lung cancer. VATS has been around for about 20 years. The thing that is different now is screening for lung cancer. In the old days, the recommendation was not to screen. Now, with these new CAT scanners, screening has become the standard of care for patients who are at high risk. Essentially what you have are cancers being found at a very, very early stage where they re curable and where they re very small. Now, VATS has a wider role because of instead of making a big incision in the chest for a cancer that has grown this size, you re finding cancers with lung cancer screening this small, and you re making three small holes in the chest and taking them out with smaller pieces. It s not necessarily that the technology is new, VATS, which we ve been doing for years, which I have been doing for years, but it is the screening that is the thing that is new for lung cancer. For that reason, because prior to these, these CAT scans, there was not a really good way to screen for lung cancer 5, 10 years ago, is that the case? Dr. Flores: Lung cancer screening is really a very controversial topic. There are many different viewpoints when it comes to lung cancer. Before CAT scan, people used to get chest x-rays. Chest x- rays will miss the most majority of cancers. That s why you need to get a CAT scan. A CAT scan will find it at a very early stage. One that is more amenable to VATS; one when you, where you can spare more lung tissue, as opposed to the older days when you found it later, big incision like this, take out a lobe which is about half of a lung or an entire lung, a pneumonectomy, now you re finding it much earlier and you re doing lesser invasive procedures and taking out less lung. Amy had mentioned, wedge. Could you describe how much that is and how that s different? Dr. Flores: She had a very slow growing cancer, but still a cancer nevertheless. When you have something that s slow growing, you don t want to do a very big operation on it. You want to get a clean margin, and you want to save as much lung as possible. We did a VATS wedge resection on her, where you make three little small holes and you take out what essentially is a pizza pie shaped portion of the lung with the tumor right in the middle. Once you take that out with the three small holes, you send it to the pathologist; they cut the edges off and they look at it under the microscope to make sure there is no tumor left behind. Once that s clean, you look at the lymph nodes in that area. Some patients have a lot of

4 lymph nodes; some patients really don t have any lymph nodes. You take out whatever is there and you examine those; make sure there is no cancer in those areas as well. The type of cancer she had is very slow growing, very indolent, so with this type of procedure, she is likely cured. She had mentioned she didn t need chemo. Dr. Flores: No chemo. No radiation. Is that typical when you re sure that you have everything out? Dr. Flores: Now, sometimes, the CAT scan will underestimate the amount of disease that s there. It s up to the surgeon when the surgeon operates on the patient to be sure that they check everything. That they check to make sure the resection is complete, that they check and see are there any involved lymph nodes, and to look at the rest of the chest, make sure there is no spots or any other nodules in any other parts of lung. Before we take these patients to the operating room, we usually get something called a PET scan on them. A PET scan looks at the whole body from top to bottom to see if there are any cancer cells present. How does it tell? Every cell in the body takes up sugar, glucose. Every cell needs sugar, so what they do is they take a sugar and they put a radioactive label onto that sugar. Now, that s being absorbed by all the cells. Cancer cells divide quicker than normal cells. They take up more sugar than normal cells, so they will take up more of the radioactive material as well, so when you get a scan and if it does show a cancer in a certain location, it lights up, so you can see areas that you normally would not be able to detect with CAT scan by getting a PET scan. Amy had mentioned that hers was caught almost by accident. She was seeking treatment for food poisoning. She was not one of these patients that would have been high risk that would have had a CAT scan. Can you speak to that a little bit? Was this, as she called it serendipity, was she lucky that she got food poisoning? Dr. Flores: That s and important point. Many of the patients who will have tumors in their lung will not have risk factors. Everyone automatically assumes smoking, lung cancer, but no, there s a good number that can have cancers that have never smoked. Maybe if they have a family history; maybe they were exposed to second hand smoke; if they re exposed to radon in their basement; if they had asbestos exposure from their occupation; if they down for example, maybe 9/11 where you had some other things that you could inhale. Now, you could have no risk factors whatsoever, and still develop it. What we are trying to figure out, which patients who are nonsmokers are the best to screen and that s a difficult question. We have research studies on going here at Mount Sinai, trying to figure that out. Right now, for her case, it was serendipity that it was found. But, in essence, every case that I see as a surgeon, most of them are curable, they were found by serendipity. We need to come up with a consistent method of identifying patients who should be screened. Now the biggest thing that people worry about when you screen is that you re subjecting the patient to unnecessary harm, meaning you see something, it may not be a cancer, but they end up going to surgery to get that out. Now, we did a big study here at Sinai looking at that and we found that you can keep that unnecessary surgery rate down to the 1 to 2% if you follow a specific guideline that have been developed, that has been developed here by one of the pioneers, Dr. Claudia Henschke, who has done all the research in this area. Doctor, what are the implications of having the CAT scan and having the VATS option? I mean, does this mean, lung cancer is no longer the death sentence that it was a decade ago, generation ago? Dr. Flores: Lung cancer is the number one cancer killer of men and women. Kills more women than breast, ovarian, uterine, all the woman s cancers combined. Lung cancer still kills more women than

5 anything else. Lung cancer kills more men. You combine it with prostate, colon, etc. Lung cancer still kills more men. The problem with lung cancer is not that we don t have a cure for it. We have a cure, it is called surgery. The problem is that you don t find it early enough. If you find it early, 80% of lung cancers can be cured. Stage 1 lung cancer if it s caught by CAT scan and you do surgery in a timely fashion, 80% of those patients will be cured. Was Amy s considered stage 1? Dr. Flores: Early, stage 1. What is her prognosis? Dr. Flores: Excellent. She s cured. Does she have any restrictions from cancer? Dr. Flores: Nothing. Business as usual. Dr. Flores: Nope, she could have been playing tennis 2 weeks later. That was my next question. With the VATS procedure, is it easier on patients? Talk to me about recovery. Dr. Flores: The VATS procedure usually will lead to a quicker recovery in patients. There are many patients after the VATS procedure that can go home the next day. Some patients are in the hospital 2 days. Of course, you have outliers in everything. Some can go home the same day and some will stay in the hospital 5 or 6 days. There are outliers in each direction, but the majority usually are in the hospital 1 to 2 days. END OF INTERVIEW This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters. If you would like more information, please contact: Lucia Lee Media Relations Lucia.lee@mountsinai.org Sign up for a free weekly on Medical Breakthroughs called First to Know by clicking here.