Thoracic Oncology Program
Area of interest
As a thoracic surgeon in the division of cardiothoracic surgery at the University of North Carolina, I have an interest in the treatment of malignancies of the foregut and chest. My past basic science research work has been focused on the molecular targeting of pathways responsible for malignant transformation in esophageal cancer, and my clinical research has focused on improving the surgical care of patients with lung cancer and esophageal cancer.
In a series of publications, my co-workers and I have reported on clinical lung cancer staging, the importance of lymph node dissection in lung cancer, and the role of surveillance programs in high-risk patients with indeterminate pulmonary nodules. To succinctly summarize the body of work, we have shown that occult lymph node metastasis is a clinically relevant problem in patients with early stage lung cancer. Patients with small tumors, who are deemed to not have any nodal involvement of cancer be modern radiology techniques have 10-15% incidence of nodal involvement. This impacts survival, and raises important questions on the role of surgical treatment. Less invasive, limited resection may not be an appropriate strategy in many patients. Furthermore, we have demonstrated that the current radiographic guidelines to deem pulmonary nodules as non-malignant may be inaccurate. In our experience, many patients with an indeterminate nodule require greater than 2 years of follow-up before a malignancy manifests. This work has implications for public health, and screening recommendations for patients at high risk of lung cancer. Most surprisingly, we observed that these tumors which had been followed in a surveillance program were liable to present with an advanced stage, despite small tumor size.
At UNC I am planning on extending my previous work in early stage lung cancer. I propose to begin a clinical program to evaluate patients at high risk for lung cancer. By assessing patients with incidentally discovered indeterminate lesions I want to improve our understanding of early stage lung cancer not only from the clinical management perspective, but also from a tumor biology standpoint. With our radiologists, I am working on designing a protocol to study the timing, and technique to follow patients with indeterminate nodules. I have started to identify basic science colleagues interested determining biomarkers which may prove useful in identifying which of those patients with a suspicious nodule actually develop cancer.
Awards and Honors
2007 American Association of Thoracic Surgery Traveling Fellow
2006 American College of Surgeons National Finalist, Resident Award for Exemplary Teaching.
2006 Eugene Bricker, MD Resident Teaching Award, Washington Univ, Dept of Surgery
2006 Resident of the Year -- Teaching Award, Washington University School of Medicine
2006 Citation for Medical Student Teaching, Washington University School of Medicine
2004 Samuel A. Wells, Jr., MD Resident Research Award, Washington Univ., Dept of Surgery
2003 Citation for Medical Student Teaching, Washington University School of Medicine
2002 Citation for Medical Student Teaching, Washington University School of Medicine