Because they have disease within the chest, patients with lung cancer may develop symptoms such as shortness of breath, cough, chest pain or coughing up blood. They may also develop symptoms in other parts of the body.
When patients exhibit suspicious symptoms, they are referred to the Rapid Access Lung Clinic. The aim of this clinic is to quickly establish whether lung cancer is present, to determine the extent of the disease and to bring the patient’s case for discussion to the Multi-Disciplinary Meeting. When appropriate, patients at this stage will have a chest X-ray, bronchoscopy (a procedure used to look inside the lungs’ airways) and CT scans. Commonly, a biopsy, or small piece of the lung cancer, will be obtained to confirm the diagnosis. Most often, this is obtained by a bronchoscopy or by a CT-guided biopsy.
Rapid Access Lung Clinic Information Booklet
Once a diagnosis of lung cancer is made, the next step is to determine the extent of the disease, a process known as ‘staging’. Various tests are used to determine the size of the cancer within the chest and to establish whether it has spread to other parts of the body. The information gathered determines whether the cancer is called stage I, II, III or IV. Depending on the stage, the appropriate treatment is decided. Cancers in stage I or II are called early stage cancers.
There are a number of special staging investigations. The respiratory consultants in St. James’s Hospital provide specialist bronchoscopy procedures to help with staging. One of these is an endobronchial ultrasound (EBUS), which involves an examination through the windpipe as a day case under sedation. This allows the respiratory doctor to examine the windpipe and, if necessary, the lymph nodes (glands) around it. St. James’s Hospital was the first centre in Ireland to offer an EBUS service to patients.
A special form of staging X-ray is a PET scan. This gives a view of the whole body (excluding the brain). St. James’s Hospital was the first public hospital in Ireland to offer on-site PET scanning.
Other tests and examinations for diagnosis and staging may be required such as an MRI scan or a mediastinoscopy, a form of surgery that allows doctors to look at and biopsy lymph glands inside the chest. All of these tests are available in St. James’s Hospital.
At the Multi-Disciplinary Meeting, all of the information obtained during diagnosis and the staging tests is discussed. The patient is then offered an appointment to discuss the most appropriate treatment. Depending on the stage or extent of the cancer and the patient’s health, there are a number of treatment options. Some patients may have a single treatment; others may receive a combination of treatments such as surgery, followed by add-on (adjuvant) chemotherapy, if appropriate, when they have recovered from surgery.
Surgery remains the best chance of cure for patients with lung cancer. Patients who have early stage disease and are fit may be suitable for surgical treatment. They will normally undergo breathing tests before being offered an appointment with a cardiothoracic surgeon to discuss the surgery and determine their fitness for surgery. Surgery involves removing the part of the lung containing the cancer. These operations are carried out through a thoracotomy (an incision made in the side of the chest) or by video-assisted thoracoscopic surgery (VATS) in a minimally invasive way. The surgeons in St. James’s Hospital have a special interest and experience in extended resections. These are major complex operations which are suitable for a small number of patients. In these cases the cancer involves the lung and an adjacent area of the body (for example the ribcage) but can still be removed by an operation with reconstruction.
The cardiothoracic anaesthetists and advanced nurse practitioners run a preadmission clinic for those about to have surgery. Here, patients are assessed and outstanding tests are carried out. Patients are also given information on what to expect when having surgery and during the recovery time. Additionally, they have an opportunity to meet and be assessed by the physiotherapists and others involved in their care during their recovery from surgery.
Information booklets on biopsy procedures, surgery and discharge process.
Medical oncology involves using chemotherapy (drugs) to treat cancer. St. James’s Hospital has a dedicated medical oncologist for the treatment of cancers of the chest. Dr. Cuffe provides inpatient and outpatient chemotherapy, nonsurgical treatment of cancer and supportive and palliative care.
There are several different types and combinations of chemotherapy available, depending on the type of lung cancer and the fitness of the patient. Along with the traditional types of chemotherapy, new, targeted drugs are available, when appropriate.
Radiation oncology involves the use of high-energy X-rays to kill cancerous cells.
There is an on-site Radiation Oncology Service in St. James’s Hospital, as part of the St. Luke’s Network, and two radiation oncologists attend the Multi-Disciplinary Meeting. A full range of radiation oncology services is available to suitable lung cancer patients.
Stereotactic radiation is a recent development in the treatment of lung cancer. It involves aiming a highly focused beam of radiation at the lung cancer. This treatment is available to patients with early stage disease who are not fit to undergo surgery. This specialist service is available on-site in St. James’s Hospital.
Radio-Frequency & Microwave Ablation Treatment
The Radiology Department in St. James’s Hospital is the only site in Ireland offering radio-frequency or microwave ablation treatment for lung cancer. This is a relatively new technology and is suitable for patients with early stage disease, who are medically unfit for surgery.