What to Expect
The patient's first visit to the Thoracic Oncology Clinic may take from several hours to the better part of the day. Patients may be scheduled to see doctors from thoracic surgery, medical oncology, radiation oncology, or pulmonary medicine. In addition, they may have tests and meet with nurses, a patient counselor, a patient education specialist, a social worker or other support service providers.
The new patient's physician visit(s) and tests are normally scheduled before noon so that detailed information about the case is available for the noon treatment planning conference. During this conference, program members thoroughly review and discuss each new case and work as a team to develop a treatment plan.
After the treatment planning conference, patients meet with their primary thoracic oncology program physician. A primary physician is chosen for each patient according to the patient's diagnosis and treatment plan. While this physician will work with other team members, s/he will personally manage the patient's care to ensure that the patient receives individualized care and attention. During this meeting, the physician will discuss the treatment plan developed by the program team and answer any questions that the patient might have. The patient may be offered the opportunity to participate in a clinical research trial if it appears that this would be a good option. If surgery is required, a date will be set. Patients requiring chemotherapy will be instructed as to what to expect and how to manage care at home.
If, after being evaluated by a radiation oncologist radiation treatment is planned, the treatment, procedures and side effects will be explained. The patient may be scheduled for simulation. This process involves using x-ray images to plan radiation treatment so that the target treatment area is precisely located and marked. After simulation, a radiation therapist gives the patient the date and time when treatment will begin.
Diagnostic Procedures and Treatment Information
The Thoracic Oncology Program offers the most up-to-date advances in diagnostic tools, surgical techniques, and medical and radiation therapies. We aim to provide the highest quality, most advanced care to our patients in an efficient manner to achieve a high level of patient satisfaction.
Diagnostic biopsy techniques available include:
- Transbronchial biopsy
- Fine needle aspiration
- Thoracoscopic biopsy with CT-guided localization
- Accurate staging of lung cancer is important and is accomplished by mediastinoscopy, anterior mediastinotomy or thoracoscopic node sampling.
UNC is one of only a few institutions in the Southeast to have a Light-Induced Fluorescence Endoscope (LIFE), a revolutionary tool that enables physicians to detect areas of abnormal tissue. LIFE allows us to study the natural history and molecular biology of premalignant lesions.
UNC is one of a dozen institutions in the country being equipped for CT-Fluoroscopy. This technology provides real-time image reconstruction and display of the CT image on a monitor, allowing for more rapid and accurate needle and catheter placement for purposes of biopsy and drainage.
UNC pioneered the development of CT-based three-dimensional (3D) imaging for radiation treatment planning. Unlike traditional treatment planning, 3D imaging allows radiation oncologists to view a tumor from all angles on a digitally reconstructed radiograph. This makes tumor targeting much more precise and reduces the amount of radiation delivered to normal tissue. Furthermore, 3D imaging can be used on previous diagnostic scans from other institutions through image registration, another technology pioneered at UNC. This can be invaluable in determining original tumor size and location and can save the cost of another CT.
Surgery remains the main treatment for non-small-cell lung cancer. Most surgical procedures are performed through muscle-sparing incisions or through tiny ports via video-assisted surgery. We perform standard surgical procedures such as lobectomy and pneumonectomy. We also perform more complex procedures for patients with low lung capacity and tumors that have spread to the chest wall. Some patients with locally advanced lung cancers can be offered a chance for cure with a combined-therapy treatment that begins with chemotherapy and radiation therapy. These treatments are followed by surgery. This surgery may include implantation of catheters that allow for later localized radiation therapy.
Many patients with esophageal cancer are referred to the Thoracic Oncology Program. Patients whose disease has not spread to distant sites first undergo chemotherapy and radiation therapy, usually with marked improvement in their ability to swallow. The treatment is completed by surgery to remove any remaining tumor.
Our program offers expertise in a wide range of interventions for airway problems caused by cancer. Laser treatment and bronchial artery embolization are used to control bleeding. For patients at risk of airway obstruction due to inoperable cancer, we reduce the tumor during bronchoscopy and place stents. This helps keep the patient's airway open, often for years. Alternatively, we may implant catheters that allow for later localized radiation therapy.
Laboratory research is an important component of the Thoracic Oncology Program. The emphasis is two fold: to identify clinical problems which may have solutions in the laboratory and to translate laboratory findings back into the clinical setting to improve patient care. Program members are using advanced molecular biology research techniques to try to bridge the gap between the biology of tumors and patient care.
The nurse coordinator follows patients with the managing physician through all of their care at UNC. She ensures continuity in the patient's care if s/he needs to see multiple cancer specialists and receive different types of treatment. Letters will be sent to the patient's local physician within 48 hours of the first visit to inform him/her of the patient's treatment plan and status.