What Are Thoracic/ Head and Neck Cancers?
Thoracic cancers are malignancies of the lung, esophagus, trachea, chest wall, pericardium, and pulmonary system. Lung and esophageal cancer are the most common thoracic cancers. Head and neck cancers include cancers of the larynx, trachea, oral cavity, tongue, pharynx (throat), nasopharynx, salivary glands and thyroid.
Lung Cancer
Lung cancer occurs when cells in the lungs change and grow in an uncontrolled manner, forming tumors. If left untreated, these cells metastasize or spread outside the lungs. Smoking accounts for the majority of lung cancers. Cancers that begin in the lungs are divided into two major types - small cell lung cancer and non-small lung cancer - depending on how the cells look under a microscope. Each type of lung cancer grows and spreads in different ways and is treated differently.
Small Cell Lung Cancer
Sometimes called oat cell cancer, small cell lung cancer (SCLC) is less common than non-small cell lung cancer. Typically, this type of cancer responds well to chemotherapy and radiation therapy. SCLC tends to grow rapidly and requires aggressive treatment.
The three stages of SCLC are:
- Limited - confined to one lung and neighboring lymph nodes
- Extensive - spread outside the lungs
- Recurrent - the patient has had SCLC before
Non-Small Cell Lung Cancer (NSCLC)
Non-small cell lung cancer is more common than small cell lung cancer. There are three main types of non-small cell lung cancer. They are named for the type of cells in which the cancer develops squamous cell carcinoma (also called epidermoid carcinoma), adenocarcinoma, and large cell carcinoma.
In the early stages of NSCLC, surgery typically is used to remove the cancerous part of the lung. Some lymph nodes near the lung are taken to determine if the cancer has spread to the lymphatic system. In some cases, the patient may require a pneumonectomy, a complete removal of the lung. In addition to surgery, the patient may require radiation therapy, which may impair lung capacity.
In more advanced NSCLC cases, combinations of chemotherapy and radiation are used that may cure the cancer or relieve symptoms by shrinking tumors.
Mesothelioma
Also affecting the chest cavity is a rare cancer called mesothelioma, which occurs in the pleura (the membranes surrounding the lungs). Exposure to asbestos is the main risk factor for mesothelioma. Changes in the pleura occur when people breathe in asbestos fibers that penetrate the lining of the lung.
Esophageal Cancer
Esophageal cancer is a disease in which cancer cells form in the tissues of the esophagus through several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows. The two most common forms of esophageal cancer are named for the type of cells that become malignant.
Squamous cell carcinoma is cancer that forms in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus.
Adenocarcinoma is cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.
Key Technologies and Treatments
Cancers of the lung, as well as cancers of the head and neck, are approached in a multidisciplinary manner at M. D. Anderson - Orlando. The options for treatment often include surgery, radiation, and chemotherapy. In the thoracic/head and neck specialty, the treatment is individualized according to the stage and type of the tumor.
M. D. Anderson - Orlando doctors also are actively investigating new types of treatment to improve upon current options. This includes experimental chemotherapy, experimental biologic agents and new types of radiation therapies. We work closely with surgical oncologists to help formulate the best treatment plans.
Novalis® Shaped Beam SurgeryTM
M. D. Anderson - Orlando offers Novalis Shaped Beam Surgery as a treatment option for cancers of the head, neck, and lungs. Novalis is the non-invasive delivery of a precise dose of high-energy radiation to shrink or control the growth of a tumor by killing tumor cells or interfering with their ability to grow. Using detailed computer generated images as well as a highly accurate patient positioning system; the Novalis treatment exactly mirrors the shape and size of a patient's tumor. Each beam of radiation conforms to the tumor's exact dimensions, specifically targeting and, unlike conventional beam radiation, treating diseased tissue while leaving surrounding healthy tissue unharmed.
Helical Tomotherapy
Helical Tomotherapy - the future of image-guided Intensity Modulated Radiation Therapy (IMRT) - is the only radiation therapy device that combines a computed tomography (CT) scanner (for 3-D precision planning) with the ability to change the size, shape, location, and amount of radiation delivered in a single unit.
The radiation beam is shaped to a patient's specific needs as a tumor changes shape. That means the tumor receives a higher dose of radiation, while sparing or minimizing radiation to surrounding healthy tissue. In addition, if you have large or unevenly shaped tumors or many tumors, this system can treat them all at once.
SuperDimension Bronchus SystemTM
The SuperDimension Bronchus system uses electromagnetic and wireless tracking of a flexible catheter probe as it moves, coupled with virtual three-dimensional images, for the pulmonologist to view as the probe descends deep within the lungs and toward the targeted spot.
Based on electromagnetic technology, wireless tracking of a flexible catheter and virtual three-dimensional images, SuperDimension allows doctors to access areas deep within the lungs that were once considered out of reach of a pulmonologist's probe. This access allows doctors to precisely diagnose even the smallest abnormalities, and in turn, possibly identify lung cancer sooner in patients.
Adaptive Respiratory Gated Breathing
Patients suffering from tumors obstructed by respiratory movement can benefit from more precise IMRT treatment with BrainLAB's Adaptive Respiratory Gating system. M. D. Anderson - Orlando was one of the first sites in the United States to treat lung tumor patients using the technology, which enables physicians to target tumors by adjusting to the patient's breathing patterns within a millimeter of accuracy.
The technology overcomes treatment limitations caused by breathing-induced tumor motion in three steps. First, the gating system synchronizes tumor motion with a patient's breathing pattern by taking multiple pictures of the tumor inside the lung. From the images, the three-dimensional movement of the tumor is captured and its exact location for treatment delivery is calculated. Finally, the technology delivers radiation only when the tumor is exactly in the path of the treatment beam. If the tumor moves out of the treatment beam, radiation is automatically interrupted to protect a patient's healthy tissue.
For patients with lung and liver tumors, this means treatments that are more effective and fewer complications from side effects like fatigue and shortness of breath.
Experimental Therapeutics
At M. D. Anderson- Orlando, specialized medical oncologists offer the latest treatment options for cancer treatment. With expertise in thoracic cancers, medical oncologists formulated a treatment plan in collaboration with other cancer experts. Clinical trails are often available for selected patients, with the newest chemotherapy options.
Minimally Invasive Surgery
The thoracic surgery service provides state of the art surgical treatment for patients with operable chest malignancies. Also known as VATS (video assisted thoracic surgery), selected patients can undergo less invasive operations by using smaller incisions and videocameras to perform surgery, resulting in less pain and a faster recovery to normal activities.
Robotic surgery (da Vinci® Surgical System)
Surgeons can now perform surgery in the chest using the da Vinci® surgical system. This surgical tool allows the surgeon to have a 3-D view of the surgical field and control the robotic arms that mimic the surgeon’s hand movements. This permits performing complex surgeries with small incisions and high precision. The superior visualization and instrument control can offer an advantage over other video-assisted approaches (VATS). Patients with selected diseases may benefit from this approach for surgery.
Endobronchial Ultrasound (EBUS)
Using a special videotelescope or bronchoscope equipped with an ultrasound device, surgeons can image lymph nodes and tumors in the center of the chest. As an outpatient procedure, needle biopsies of lymph nodes can be obtained through the airway, avoiding the need for more invasive surgery. This allows more accurate diagnosis and tumor staging for cancers of the chest.
Esophageal and airway stents
Stents are plastic or metal devices or stretching and opening narrowing or blockages in the esophagus or the airway. When feasible, symptoms can improve with these endoscopic treatments without the need for surgery.
Our Team of Experts
* Indicates team leader
(T) Thoracic Cancers
(H/N) Head and Neck Cancers
For more information, schedule an appointment or for a second opinion please call 321.843.1460.