NHRMC patients benefiting from newest technique for staging lung cancer

July 02, 2007
Lung cancer is the leading cause of death from cancer among both men and women in the United States. About 160,000 new cases are diagnosed each year and the death rate has remained the same for the past 20 years. Experts say diagnosing lung cancer in its early stages is difficult because it usually doesn’t have any symptoms. New Hanover Regional Medical is one of only two hospitals in North Carolina, and 30 across the country, offering Endobronchial Ultrasound, a technique that allows doctors to diagnose and stage lung cancer more accurately. Endobronchial ultrasound (EBUS) is the newest technique available to help stage lung cancers, primarily non-small-cell lung cancer, which accounts for about 80 percent of all cases. According to Wilmington Pathologist Dr. Christian Lloyd, it appears to be extremely accurate. While its primary benefit is staging lung cancer, it can also diagnose at the same time. It is also less invasive and less costly to the patient than other surgical procedures used to stage lung cancer. Identifying cancer in the chest lymph nodes is critical as these are usually the first place to which lung cancer spreads. In EBUS, an ultrasound probe on the end of a bronchoscope (a tube inserted through the nose and into the bronchi of the lungs) allows doctors to look through the walls of the bronchi to see the exact location of the lymph nodes in the chest. A needle is then inserted through the bronchoscope and, while being viewed through the ultrasound, guided into the lymph nodes to remove cells. Those cells are then tested to determine if they are cancerous. The procedure requires light sedation and takes about an hour. Patients go home a couple of hours later. “A mild sore throat afterward is usually the only result of the procedure,” Dr. Lloyd said. “Many patients don’t even remember the experience.” Determining the stage of lung cancer is the most important thing next to diagnosis, Dr. Lloyd said. The stages of cancer range from I to IV, with Stage I being small, only in one spot in the lung and the most curable, and Stage IV having spread outside of the lung and incurable. Treatment options, which are determined by the diagnosis and stage, are more limited and cure rates drop when cancers are found in later stages. Prior to EBUS, a surgery called mediastinoscopy was the most accurate method for staging lung cancer. That often requires a stay in the hospital and an operation to look at and test the lymph nodes in the chest. Mediastinoscopy can’t reach all of the lymph nodes. The advantages of EBUS are many. Compared to mediastinoscopy, it is less invasive for the patient, and can be used to biopsy lymph nodes that are inaccessible or difficult to access by mediastinoscopy. Its advantages over blind transbronchial needle biopsy include the ability to visualize and biopsy small nodes with seemingly good accuracy. It also allows diagnosis and staging to occur at the same time. Being able to diagnose and stage lung cancer accurately is extremely important, said Dr. Lloyd. Surgery is the preferred treatment for non-small-cell lung cancer in its earlier stages, and finding out that a cancer has spread to the lymph nodes allows a patient to avoid surgery. “The goal of preoperative staging of non-small-cell lung cancer is to identify patients who will benefit from surgery,” said Dr. Lloyd. “Endobronchial ultrasound gives us a new tool to accurately stage cancer patients relatively noninvasively.”Talk to your doctor about whether EBUS is right for you. Call VitaLine, 815.5188, to find a pulmonologist that performs the procedure.