Lung cancer is an abnormal cancerous growth originating in the lung tissue. It is the most common cause of cancer death in Ireland and, in 2011, became the leading cause of cancer death in Irish women, overtaking breast cancer. The number of cases of lung cancer diagnosed in Ireland every year continues to rise, reflecting a large annual increase in the number of cases diagnosed in Irish women. This trend is expected to continue rising for the next decade.
Lung cancer is divided into two main types of cancer: small cell cancer and non-small cell cancer, which is more common. These are identified based on the appearance of the cells on a microscopic level.
Smoking is the most common risk factor for the development of lung cancer; other factors include radon, secondhand smoking, occupational exposure and genetic predisposition. There has been a significant increase in the number of lung cancers diagnosed in patients who have never smoked. These cancers tend to occur in older women and have unique characteristics.
The National Cancer Control Programme has reorganised the care of lung cancer patients in Ireland in recent years in order to facilitate the early and rapid diagnosis of patients with worrying symptoms. This allows patients who are early in the disease process to be referred for curative treatments such as surgery.
St James’s Hospital has a long history in the treatment of lung cancer. It is the largest comprehensive centre for the diagnosis and treatment of the disease in Ireland, both in terms of the number of patients and the complexity of disease treated. St James’s is one of eight National Rapid Access Centres for patients with symptoms of lung cancer, and it is one of four designated surgical centres for the treatment of lung cancer. Its surgeons perform just under half of all lung cancer operations in Ireland each year.
St James’s Hospital has a long-established and dedicated multidisciplinary team for the treatment of lung cancer patients. The team’s weekly meeting is attended by various specialists involved in the diagnosis and treatment of lung cancer, who assess the needs of patients diagnosed in St James’s and elsewhere, with live video links to Mullingar, Tullamore, Letterkenny, Limerick and Waterford. The cardiothoracic surgeons in St James’s also attend multidisciplinary team meetings in Beaumont and Tallaght Hospitals, bringing patients from those hospitals to St James’s for surgical treatment if appropriate.
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 multidisciplinary team 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.
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 the hospital.
At the multidisciplinary team 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.
Medical oncology involves using chemotherapy (drugs) to treat cancer. We have 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 multidisciplinary team 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.
Radio-Frequency & Microwave Ablation Treatment
The Radiology Department 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.
All of the specialists involved in lung cancer care in St James’s Hospital aim to provide a high-quality and efficient service. Consequently, the team is fully involved with the National Cancer Control Programme and regularly submits data on key performance indicators.
Lung Cancer Care Team
Lung Cancer Coordinator Nurses