Detect, Treat Lung Cancers

March 31, 2010
By Dr. Henry Louie

Dr. Henry Louie
Thoracic and cardiac surgeon, Hawaii Medical Center Thoracic Cancer Center

How long have you been practicing? About 15 years.

What is your area of specialty? I do mostly cardiac and also thoracic surgery. Cardiac surgery is bypass surgery and valve surgery. Thoracic surgery is surgery of the chest, the lungs, chest wall and esophagus. Almost all of the chest surgery is related to cancer.

Can you talk about the various surgical procedures you do? For the thoracic surgery, the vast majority of what I do is lung surgery - lung cancers and lung infections. Most of the time we are doing lung surgery to diagnose lung cancers. Unfortunately, most of the lung cancers out there right now are in the advanced stage when they are discovered. So most of our surgeries are for diagnosis, but about15 percent of the cancer patients we do see are candidates for curative lung surgery. In those situations, we remove the portion of the lung that contains the cancer. So, basically, there is a left and right lung - the right side has three segments and the left side two segments. Depending on where the cancer is, we remove the segment that contains the cancer. We want to make sure we get all the lymph nodes, blood vessels, nerves and airways where the cancer can travel. This is so the cancer doesn’t have the chance to spread. So we can remove a single segment or lobe, or sometimes we remove the entire lung.

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How much of the lung can be removed for a person to survive? It depends on the lung function. This is why before we do any lung surgery we always have to get a breathing test. This tells us how much lung tissue we can anticipate to remove so that the patient can survive. A normal, healthy person can live on just one lung or even a part of one lung, that’s how much lung reserve there is. They won’t be able to do any major physical activity. Usually, depending on the lung function, we can remove a whole lung if we have to.

So when would someone qualify for a lung transplant? Most cancers of the lung can’t be treated with a lung transplant because for lung transplants you need to be on immuno-suppressants so that the patient doesn’t reject the lung. But immuno-suppressants encourage cancer formations, so usually you can’t do that.

What are typical lung cancer symptoms? Unfortunately, the symptoms are a late sign because symptoms mean that the cancer is starting to do something to the body, such as blocking an airway so they cough a lot, or the cancer will erode into the blood vessel and there’s bleeding, so people will cough up blood. Unfortunately, that’s a very late sign and the cancer has already started to grow. It’s been thought that, when the cancer is big enough to cause physical manifestations, it’s probably been there for five to 10 years already. But certainly anytime people are coughing up blood or have a persistent cough or pneumonia, these are people who should be getting chest X-rays and seeing their physicians. But more importantly, people who smoke or have been exposed to secondhand smoke or are exposed to other cancer-causing agents such as asbestos are in a higher risk category, and those are people who should get checked regularly.

Are there any types of cigarettes that are “safer” than others? It’s the burning of the tobacco that causes a lot of carcinogens.

So whether you have a filter or no filter, menthol or non-menthol, it doesn’t do anything to prevent you from inhaling the carcinogens, and that’s the problem. Also, having less tar doesn’t make it a safer cigarette. There is no safe cigarette.

What’s the best way to detect lung cancer early?

People in high-risk groups - smokers, those exposed to secondhand smoke, those with a family history of lung cancer and those with an exposure to carcinogens in the workplace, such as asbestos at a shipyard, may want to be tested. There are two basic screening tools. A chest X-ray can detect a lesion that is 1 centimeter in size - not that big, but it’s been there for a while already. The other, a CT scan, is really not cost-effective for the general population, but it can detect a lesion much earlier and as small as 2 millimeters.

Can you discuss treatments available for patients?

Treatments are getting better as we are progressing. The best treatment is surgery, but surgery is not a magic bullet. It’s just that the lung cancer was found at an early enough time that surgery got it out before it was able to spread. That’s what the benefit of surgery is. Once the lung cancer has spread, you are really limited to radiation therapy, chemotherapy or both.

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Can you explain the work done at Hawaii Medical Center Thoracic Cancer Center?

Generally, the time from finding a lung mass to the time a cancer is found to the time a treatment plan has been devised, the average time is three to four months. Physicians at this clinic have always felt that this was way too long. Instead, we offer a patient who is found with a lung mass a place where they can have all the diagnostics done and can be seen in a multidisciplinary way with a thoracic surgeon, medical oncologist and radiation oncologist sitting together to come up with a plan. We’ve shortened that time frame down to about a week. So it’s a huge savings in efficiency. But, for me, the most important thing is the patients aren’t at home not really knowing what’s going on for three to four months - and that’s the average, so there are certainly people who are waiting much longer. That has been the most impressive thing about the clinic.