There was a time when a lung cancer diagnosis offered little reason for optimism.
Today, thanks to advances in screening, diagnosis and treatment, physicians are finding cancer earlier, personalizing treatment plans and helping more patients live longer — and in some cases, becoming cancer-free.
"In my lifetime, I'm now able to say that people have been cured of lung cancer," said Dr. Venkatesh Lakshminarayanan, system director of interventional pulmonary medicine at Northside Hospital. "That is a much bigger thing than I could ever expect."
Molecular testing, targeted therapies and immunotherapies are changing how lung cancer is treated.
Finding lung cancer before symptoms appear
One of the biggest challenges with lung cancer is that patients may have few or no symptoms until the disease has progressed. A persistent cough, coughing up blood, unexplained weight loss or new wheezing may eventually appear, but those symptoms often occur later in the disease process.
That's why lung cancer screening has become one of the most important advances in recent years.
Low-dose CT screening for eligible current and former smokers can detect lung cancers when they are much smaller and more treatable, often before symptoms develop. As more patients undergo screening, physicians are identifying tiny lung nodules that may have gone unnoticed in the past.
These nodules are small areas of denser tissue that show up as white spots on a CT scan. They are usually caused by scar tissue, a healed infection that may never have made you sick, or some irritant in the air, according to the American Thoracic Society. But sometimes, a nodule can be early lung cancer.
Diagnosing smaller cancers with greater precision
Detecting a suspicious nodule is only the first step.
Advances in interventional pulmonology have transformed how physicians diagnose lung cancer, often without the need for open surgery. Using robotic bronchoscopy, physicians can navigate deep into the lungs to biopsy lesions that once were difficult or impossible to reach.
The technology combines CT imaging with sophisticated mapping software to create a virtual pathway to a lung nodule. Physicians then guide a robotic bronchoscope through the airways using handheld controls, allowing them to collect tissue from small lesions located near the edge of the lung.
The ability to diagnose increasingly smaller cancers is helping physicians intervene earlier.
"We started with lesions that were about two centimeters," said Dr. Lakshminarayanan. "Now we're diagnosing lesions that are only about eight millimeters."
Personalized treatment begins with the biopsy
Today, biopsies provide much more than a diagnosis.
Once tissue is collected, it can undergo advanced molecular testing to identify the genetic characteristics of a patient's tumor.
Those results help physicians determine which treatment options may be most effective, including surgery, chemotherapy, radiation therapy, immunotherapy or targeted therapies. Molecular testing may also identify patients who qualify for clinical trials evaluating promising new treatments.
Rather than taking a one-size-fits-all approach, physicians can increasingly tailor care to each patient's cancer.
A team approach to every patient
At Northside Hospital, specialists from multiple disciplines work together to evaluate each lung cancer case.
Pulmonologists, interventional pulmonologists, thoracic surgeons, medical oncologists, radiation oncologists, genetic specialists, nutrition experts and nurse navigators collaborate to review imaging, determine the stage of disease and develop individualized treatment recommendations.
For patients, this coordinated approach means decisions are informed by the expertise of an entire care team rather than a single physician. And that partnership includes the patient as well.
What I tell all of my patients, this is not a me decision, this is a we decision. I will never tell them what they have to do," Dr. Lakshminarayanan tells patients. "I can give them all the options of what they can do, but ultimately it comes down to what they want to do, and I'll support them in that."
Looking ahead
Although lung cancer remains the leading cause of cancer-related deaths in the United States, the outlook continues to improve.
Earlier detection through screening, minimally invasive biopsy techniques, advances in surgery and radiation therapy, molecular testing and immunotherapy have all contributed to better outcomes than were possible just a generation ago.
For Dr. Lakshminarayanan, those advances are deeply personal.
Having spent his early career as a laboratory researcher, he has watched scientific discoveries move from the laboratory into the clinic, and now he sees their impact every day in patients who have more treatment options — and more hope.
"The future is bright for interventional pulmonary medicine," he said.
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