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New Strides Gained in Diagnosis and Treatment of Lung Cancer

RUDY P. LACKNER, MD
Rudy Lackner, MD

Important strides are being made in the way we screen, diagnose and treat lung cancer. New screening guidelines, in addition to new diagnostic and treatment techniques, are helping doctors find lung cancer earlier and treat it more efficiently, says Rudy Lackner, MD, thoracic surgeon at Nebraska Medicine.

Nebraska Medicine not only offers low-dose CT scan lung cancer screenings, but provides a full spectrum of lung cancer care by a team of surgeons, oncologists, radiologists, nurses and others dedicated to the treatment of lung cancer. Studies show that the chance for long-term survival improves when the medical team involved is dedicated to lung cancer treatment.

Lung cancer screening guidelines published in the Journal of National Comprehensive Cancer Network (NCCN) recommend that individuals age 55 to 74 that have smoked a 30-pack history should be screened with low-dose CAT scan. The guidelines were developed after a study sponsored by the National Cancer Institute and published in the New England Journal of Medicine indicated that screening can reduce lung cancer mortality by 20 percent.

"A CAT scan can detect lung cancer nodules in stage IA when the cure rate can be as high as 90 percent or more," says Dr. Lackner. "With traditional X-rays, approximately 75 percent of lung cancer cases are found in stage III/IV, when cure rates drop to 5 percent and lower."

"The most challenging aspect of this screening is determining what should be done if nodules are found," says Dr. Lackner. "This is where our expertise comes into play. We have a long track record of performing lung cancer screenings and treating lung cancer patients."

"Whether we biopsy the patient will depend on factors such as the size of the nodules and whether the nodules are increasing in size and multiplying," says Dr. Lackner. "About 50 percent of the population will have lung nodules from exposure to things like fungus or respiratory tract infections, but only 2 percent of these individuals will have cancerous nodules."

Nebraska Medicine lung cancer team uses a new minimally invasive biopsy technique called electromagnet navigation bronchoscopy – a computer-guided system that allows physicians to take multiple biopsies and determine immediately if they are cancerous. The biopsies are large enough to allow for mutation analysis and the development of customized chemotherapy. This procedure can also be used for pleural dye marking of nodules for surgical wedge resection, placement of fiducial markers for sterotactic radiotherapy and therapeutic insertion of brachytherapy catheters into malignant tissue.

"With this new technique, we can start therapy the very next day as opposed to a week or two later," says Dr. Lackner. "In the past, we would have to wait for the biopsy results, followed by an outpatient surgery procedure to stage the tumor." At the time of the diagnosis, Dr. Lackner says they can also perform an endobronchial ultrasound, a procedure that can be performed during the bronchoscopy to stage the lung cancer. "It allows us to view regions of the lungs and surrounding chest area that have traditionally required more invasive surgical procedures to evaluate," says Dr. Lackner. "If the lymph nodes are negative but the tumor is positive for cancer, we can perform surgery to remove the cancer at the same time. No one else in the area is doing it this way."

Nebraska Medicine lung cancer team also treats some of the sickest and most complicated patients that other hospitals won't treat. "Because of our experience and dedicated expertise, we are comfortable treating the elderly as well as high-risk patients who have had other complications like heart disease, lung disease or other medical problems."

"We're the only ones in the area who routinely perform surgery on stage III lung cancer patients after chemotherapy and radiation," he says. "We also have an active program for performing minimally invasive lobectomies and segmentectomies."

The lung cancer team also includes a certified tobacco treatment specialist who can provide one-on-one smoking cessation counseling. "I tailor the program to the patient's needs and past experiences," says Jill Selzle, PA-C, certified tobacco treatment specialist. "Studies show that pharmacological therapy and behavior modification alone are effective, but the combination of counseling and medication provides more effective results."

Lung cancer is the most common cause of cancer deaths in both men and women in the United States and is the most preventable. It causes more deaths in women than breast, cervical, uterine and ovarian cancers combined. "I am hopeful that this new screening, combined with new diagnostic and treatment techniques will help turn those statistics around," says Dr. Lackner.

Dr. Lackner works side-by-side with Apar Kishor Ganti, MD, a hematologist/oncologist specializing in lung, head and neck cancers, Karin Trujillo, MD, who with Dr. Lackner, are the only thoracic surgical oncologists in Nebraska with practices limited to cancers of the chest. The other members of his team dedicated to the care of lung cancer patients include oncologists Anne Kessinger, MD and Alissa Marr, MD, radiation oncologist Weining (Ken) Zhen, MD, pathologist William West, MD and radiologist Matthew DeVries, MD.

To learn more, make a referral or connect with a member of Dr. Lackner's team call 402-559-5600 or visit us online at NebraskaMed.com/Cancer/Lung-Cancer.

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