Each year, 200,000 Americans are told they have lung cancer and 160,000 die. The disease is often deadly because patients are diagnosed in the late stages when the cancer has spread. Now, there’s a new way to spot tumors earlier that is like a GPS system for the lungs.
Arranging a homemade bouquet is one way Natalie Barnhill celebrates today’s special milestone.
“It was my last chemo!” Natalie told Ivanhoe.
Natalie was diagnosed with lung cancer. When doctors spotted the growth on a scan, they told her about a new biopsy method.
“It’s basically like a GPS system,” Samir Makani, MD, FCCP, Director, Interventional Pulmonology and Bronchoscopy, Associate Clinical Professor of Medicine, University of California, San Diego and San Diego VA Healthcare System, told Ivanhoe.
Dr. Makani performs electromagnetic navigation bronchoscopy. First, he maps the target using special software. Then, he places a bronchoscope down the patient’s windpipe. A catheter navigates to the tumor in real-time.
“It just takes me to where the lesion is,” Dr. Makani explained.
A traditional biopsy may require a needle through the chest and into the lung and could cause bleeding, or a collapsed lung. Electromagnetic navigation nearly eliminates the risks.
“It’s really allowed us to biopsy areas that we weren’t able to biopsy before, prove that there is lung cancer there, and then provide them with early definitive therapy,” Dr. Makani said.
Because of this technology, Natalie was diagnosed in the early stages. She’s determined to beat the same cancer that killed her mother and her aunt. She’s now cancer free and enjoying all the beauty around her.
BACKGROUND: Lung cancer is the growth of abnormal cells that grow uncontrollably in one or both lungs. These abnormal formations may cause tumors that may prevent oxygen being transported to the body. There are two forms of lung cancer: primary and secondary. Primary lung cancer originates in the lungs and may travel to another part of the body. Secondary lung cancer occurs when cancer forms in another part of the body, then spreads to the lungs. (Source: http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/265-what_is_lung_cancer)
SYMPTOMS: At times, symptoms for lung cancer may take years to develop. They may not even be noticed until the disease has progressed. Common symptoms include:
• Chest pain
• Shortness of breath
• Changes in voice
• Coughing up blood
• Intense coughing
• Coughing up mucus or phlegm (Source: http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/266-symptoms)
NEW TECHNOLOGY: Rather than performing traditional needle biopsies, doctors are now turning to a new procedure. It is being described as a GPS system: electromagnetic navigation bronchoscopy (ENB). It extends the reach of the bronchoscope to regions deep within the lung enabling doctors to locate small lung lesions for diagnostic testing and potential treatment. The system uses natural airway access, and implements proprietary software and electromagnetic technology. ENB is a less invasive procedure. It also provides the ability to detect lung disease and lung cancer earlier, even before symptoms are evident, enhancing treatment options for patients. (Source: http://www.superdimension.com/index.cfm/go/Patients.iLogic)
FOR MORE INFORMATION, PLEASE CONTACT:
Samir Makani, MD, FCCP
Director, Interventional Pulmonology and Bronchoscopy
Associate Clinical Professor of Medicine
University of California, San Diego and San Diego VA Healthcare System
Samir Makani, MD, Associate Clinical Professor of Medicine at the University of California, San Diego and the Director of Interventional Pulmonology, talks about a new way to detect lung cancer.
How many people do you treat with lung cancer a day?
Dr. Makani: That is my primary practice. I generally see between 5 and 7 patients on a daily basis for evaluation of different cancer related issues; whether it be lung cancer or cancer that has spread to the lungs from other parts of the body.
How do you normally detect it?
Dr. Makani: Well, there are multiple ways. The initial evaluation usually happens with some type of radiologic study; either with a chest x-ray or with a CAT scan. These are usually found through an incidental finding where the patient goes in for an evaluation for knee surgery or something like that and part of that procedure involves a screening chest x-ray where we pick up these spots and then they come see me in the clinic.
Then what happens?
Dr. Makani: Based on the lesion, patient’s history, and risk factors we determine whether there needs to be a biopsy or not. Sometimes we watch these lesions over time. Most of the time based on the history, we do proceed with some type of biopsy of these lesions.
What does the biopsy involve?
Dr. Makani: There are various types of biopsies. They involve minimally invasive techniques, which I perform, to more invasive techniques such as an open lung biopsy, which is performed by a thoracic surgeon. They can entail little needles, which I would do, or large pieces of tissue that we remove via open procedures with thoracic surgeons.
Even though the needle is minimally invasive, it does seem invasive; you are sticking it through the side, correct?
Dr. Makani: Right. There is a procedure called transthoracic needle aspiration, which is done by interventional radiologists, who are my colleagues. They generally put the patient in a CAT scanner and visualize the spot. Then, while they have you in the CAT scanner, after giving you local numbing medication, they put a needle from the outside of your body through the soft tissues and then directly into the lung and the spot itself. It is generally a safe procedure, but one of the major complications, depending on the depth of the lesion within the lung, it can cause the lung to collapse partially. The other major problem that can occur is bleeding.
What happens when that occurs? What kind of danger is the patient in?
Dr. Makani: Most of the time the lung collapse is somewhat insignificant or incidental. They can see the collapse and put a little tube in there and suck out the air from the space and expand the lung like a balloon. Sometimes the situation could be more dire, where the patient becomes acutely short of breath and may require more advanced therapies besides a tube.
So, now there is a new way to get the same, or even a better biopsy, right?
Dr. Makani: Yes. The procedure that I perform is called bronchoscopy and this has been around since the late 60s. If you imagine what our air passages look like, most people think that there is just a solid cylindrical tube that branches off for the right lung and the left lung, but actually it’s like a tree in the winter time with several branches branching out in various different locations and the farther you go out the more branches there are. That is what the bronchial “tree” looks like. It’s really complicated to get an accurate biopsy. We used to go in blindly with real time x-ray and pass equipment out that we weren’t able to navigate to the exact location. We had difficulty reaching areas. Now, we are able to do more directed and accurate biopsies with a system called navigational bronchoscopy or electromagnetic navigation-guided bronchoscopy.
What exactly is that?
Dr. Makani: The best way to describe it is basically like a GPS system for your car. If you were to imagine yourself wanting to drive from here to wherever, you would put that in your phone and your phone would send signals to satellites that orbit the earth and then that information would get passed back to your cell phone. Your position would get triangulated and that information would get you to where you needed to go in real time as you are continuously moving. Similarly, when we go down the airway with the bronchoscope, I have a little catheter that sits at the end of the scope and that sends signals to “satellites” that we place on the top of your chest. This happens at 166 times per second. So, it is real time, really fast, and it tracks your position instantaneously and watches where I guide. I have planned out your “map” prior to your procedure on a computer system. We use that map to generate exactly where we want to go. Then, during the procedure, it guides me to where the lesion is. It’s like driving a car to your destination on the “bronchial highway”.
Is there a risk of collapsing a lung?
Dr. Makani: The risk of lung collapse is still there because we are taking bites of the lung tissue, but it’s less than two percent based on reported literature.
Compared to what before?
Dr. Makani: Depending on where it is in the tissues, it can be anywhere from five to 100 % if you are trying to put the needle from the outside.
Was it harder to get with the needle in some places of the lung? Does this make it easier?
Dr. Makani: Absolutely. A lot of the decision making occurs based on the depth of the lesion. When the spots are really close to the outside of the lung, it’s easy to go from the outside because they can see it and then put the needle into it with less risk. If the spot is deeper in the lung tissue it is advantageous to approach it via bronchoscopy.
Would it have been hard to get the same biopsy with Natalie because hers was in the lower lung?
Dr. Makani: There are two interesting situations with Natalie; one was her lesion was not as close to the wall as you would like to approach it from the outside. So, the chance of pneumothorax was there and she had also smoked in the past. Smokers have a higher propensity to develop these little air sacs that are destroyed, which can allow for a higher propensity for the chance of pneumothorax. The second thing is that her lesion was what we call more diffuse, or “ground glass” appearing, where it was not a solid object and for that reason it wasn’t as thick as one would like on a CAT scan if you were doing the needle from the outside. So, it was more of a vague spot that was more easily accessible via bronchoscopy.
With that biopsy that you took from Natalie, can you tell us what you found and what you were able to do?
Dr. Makani: There is a type of lung cancer called adenocarcinoma. From her biopsy we saw what is called adenocarcinoma in situ, which is one of the first stages of lung cancer. From the spot that we saw, most people probably would have watched it over time because it wasn’t changing on CT scans, but because we were able to diagnose it earlier, she was able to go on and have surgical resection and complete removal of her cancer.
Do you feel she’s clear?
Dr. Makani: At this point, yes.
What would her timeframe be if it had spread throughout her body?
Dr. Makani: It’s hard to say exactly, but I would have given her somewhere between months to years before we would have seen it metastasize or spread elsewhere.
By then, it’s in stage III, stage IV?
Dr. Makani: Correct, and your treatment modalities vary at that point. Also, your chance of 100% cure and long term survival diminishes greatly.
How important is it just to have this?
Dr. Makani: For us, this technology has been a major advancement in our field mainly because we are now able to access areas that we weren’t able to access before. We would either watch or have to do more invasive biopsies for patients. Lung cancer diagnostics and therapy has advanced quite rapidly in terms of screening tests too; there is now a screening test with CAT scans that has just come online. Also, because we are going to see a lot more of these spots, with this technology, we are actually going to be able to access these that need to be biopsied based on a patients risk profile.
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