With Lung Cancer, Sometimes the Only Way to Know Is With a Scan

In its early stages, lung cancer often doesn’t have symptoms. That’s why getting a lung cancer screening is so important for those at risk. Once symptoms are felt, such as a persistent cough or shortness of breath, the cancer has most likely grown and spread. At Lehigh Valley Health Network (LVHN), we have taken steps to be able to diagnose lung cancer early and quickly and provide the follow-up care that can mean a longer life for patients.

The U.S. Preventive Services Task Force recommends a yearly low-dose CT scan for people who:

• Have a 20 pack-year or more smoking history (20 pack-year means one pack a day for 20 years, two packs a day for 10 years, one-and-a-half packs a day for a little longer than 13 years or three packs a day for a little longer than six-and-a-half years)
• Smoke now or have quit within the past 15 years
• Are between 50 and 80 years old (up to age 80 with most private insurances and up to age 77 with Medicare and Medicaid)
• Have other risk factors such as: exposure to radon or occupational hazards such as asbestos, family history of lung cancer or personal history of pulmonary fibrosis or chronic obstructive lung disease

Pulmonologist Christopher Lenivy, DO, with LVPG Pulmonary and Critical Care Medicine, points out that low-dose CT scans use a very small amount of radiation. They serve as the annual base from which to determine next steps.

“People who are not at risk don’t need a lung cancer screening,” says Dr. Lenivy, who was instrumental in creating the Lung Nodule Clinic at LVHN. “While everyone who meets the characteristics above should get scanned, nonsmokers are not necessarily immune from lung cancer.”

Dr. Lenivy notes that the team finds lung nodules in a significant number of people over 50. However, most are noncancerous, perhaps from mucus, scarring from old infections or from dust. “Our job is to consider size, shape and behavior. If it’s something suspicious, we will want to get a sample through a biopsy,” he says.

LVHN has added the Ion Robotic Bronchoscopy platform for minimally invasive peripheral lung biopsies. It’s based on the concept that time from lung nodule detection on a CT scan to biopsy could be shorter, making diagnosis quicker. Ion’s ultrathin, ultra maneuverable catheter allows clinicians to reach small lesions in the peripheral lung, where more than 70 percent of cancerous lung nodules are located.

“The majority of nodules are now reachable by robotic bronchoscopy,” Dr. Lenivy says. “With this technology, clinicians can examine even the hardest-to-reach areas of the lungs and give patients the all-clear or start treatment months earlier.”

He explains that patients many times also require sampling of lymph nodes in the chest to determine if lung cancer is present, since treatment options and prognosis vary depending on the stage. “We can sample the lymph nodes and get the stage during the same procedure, which speeds up diagnosis and treatment,” Dr. Lenivy says.

The numbers remain steady on lung cancer, making it the leading cause of cancer death for both men and women. While standard treatment for lung cancer staged between 1 and 4 is either surgery, radiation and/or chemotherapy, cancer at stage 3 or 4 is often not curable. The goal of the Lung Nodule Clinic is to diagnose patients with lung cancer earlier leading to earlier stage cancer at the time of diagnosis and a higher chance of cure. At the same time, it’s to diagnose and stage lung cancer in the least invasive, most effective way – with an emphasis on “Don’t wait.”

The clinic has been focusing on getting patients in within 10 to 14 days from the time of referral and setting them up for biopsy right away. The staff rearranges the workings of the office and puts in extra hours to achieve the efficiency that gets patients seen sooner.

“This efficiency combined with Ion technology allows clinicians to detect abnormalities they wouldn’t have been able to sample before and is an incredible boost to diagnosing cancer earlier,” Dr. Lenivy says. “The result, born out by data, is we’re curing patients at a higher rate.”