Recommended reading: Advances in Lung Cancer

this 2012 article by Hannon & Yendamuri explains the newest methods and modalities of treating nonsmall cell lung cancer (NCLC) as well as the importance of accurate staging for diagnosis and evidence-based treatment.

A layperson’s guide to “Advances in Lung Cancer,” by Hannon & Yendamuri

In addition to providing links to the full article text, we have also provided a highlighted pdf version  – with additional notes, links and information contained in this post.

What is staging?

Staging is the diagnostic process of determining how much/ how far cancer has spread.  Staging usually involves several tests and procedures such as PET/CT scans, mediastinoscopy or bronchoscopy (with endobronchial biopsy).  Some of these tests may have been done at the time of initial diagnosis.  Others will be done as part of the work-up after doctors suspect or have diagnosed lung cancer.

More about mediastinoscopy:

Mediastinoscopy as explained by Dr. Carlos Ochoa

WebMd article on mediastinoscopy

when mediastinoscopy is done with a camera, it is called video-assisted mediastinoscopic lymphadenectomy (VAMLA)

Transcervical extended mediastinal lymphadenectomy: is an extended version of a traditional mediastinoscopy, allowing for more extensive lymph node dissection.

article at CTSnet

The jury is still out on whether the newer technologies are superior to traditional mediastinoscopy. The most important thing is for a patient to have a mediastinoscopy-type procedure for accurate tissue diagnosis.  The more lymph nodes sampled – the more accurate the staging.

This procedure may be combined with other procedures like bronchoscopies with needle biopsy (EBUS) to be able to sample more nodes from more locations in the mediastinum.  (Each procedure samples a different area of the mediastinum.)

Why is staging important?

Staging provides doctors and patients with information about the extent of cancer present.  Is the cancer in a small area of the lung alone?  Has it spread to the lymph nodes?  Is there distant metastasis to other organs?

Knowing the answers to these questions will determine the course of treatment (surgery versus chemotherapy alone, surgery plus chemotherapy/ radiation).  Staging also gives us information about anticipated or expected survival – which is important for patients to know when deciding on treatment options.

Lung cancer 101 – article on staging of lung cancer, small and non-small at

Non-small cell lung cancer staging – National Cancer Institute. Also have information about the diagnostic testing used for accurate staging.

Staging is done, now what?

Once the cancer has been staged accurately, doctors can begin to discuss treatment options.  Treatment options can include surgery, chemotherapy and radiation.  Surgery is usually the most effective for early stage cancers (IA to IIIB in most cases).  More advanced cancers may require chemotherapy regimens or palliation alone.

Treatment Modalities discussed in Hannon & Yendamuri:

Brachytherapy – this is a type of radiation treatment that is implanted into the patient at the time of surgery.

American Brachytherapy Society (ABS)

Radiation therapy – has a section on brachytherapy

Single port thoracic surgery – archives for related posts on single port thoracic surgery

Robotic surgery – posts on robot surgery and the DaVinci surgical system.

Dr. Buitrago and robotic surgery – with short YouTube clip

Dr. Mark Dylewski – master of robotic surgery

Dr. Weksler – robotic surgery

The Davinci Robot

Awake thoracic surgery with Dr. Mauricio Velaquez

Palliation – including treatment for malignant pleural effusions

What is palliative care?

Reference article:

Hennon, M. W., & Yendamuri, S. (2012). Advances in lung cancer.  Journal of Carcinogenesis 2012, 11:21.

Dr. Mark Hennon and Dr. Sai Yendamuri  are board-certified thoracic surgeons, and assistant professors of thoracic surgery at the State University of New York – Buffalo.  They currently practice at the Roswell Park Cancer Institute in Buffalo, New York.

Using social media & technology to promote specialty practice

Cirugia de Torax and the role of social media in the promotion of specialty practice.

“Using social media & technology to promote specialty practice” is the title of the abstract submitted (and accepted) for presentation at the American Academy of Nurse Practitioners (AANP) national conference in June 2012.  As part of this presentation, we will be talking about and presenting information about the Cirugia de Torax website and associated social media.  We will be presenting information about the evolution from the first post last spring, to the development of our first (and basic) Android app to more sophisticated applications such as the STS General database application.

We will also be presenting statistics – website visits, numbers of subscribers, numbers of applications downloaded, emails received as well as where our readers come from.  So I wanted to take a moment to thank everyone who has made this project a success;  to all of the surgeons and thoracic surgery specialists (nurse practitioners, physician’s assistants, nurses, etc.) that invited me into their operating rooms, made time in their schedules for interviews, phone calls, and answered my many emails.

Thank you to all of my readers – especially the medical / nursing students and patients out there that requested or suggested topics or articles.  (I never knew how fascinated we all are with RATS (robot-assisted thoracoscopic surgery) until I started receiving all of those emails.  So thank you for the gracious and generous feedback.

Lastly, if you are in Orlando, Florida area this June – I’d like to invite you to stop by and introduce yourself. (I’ll be posting more details as the date nears.)

K. Eckland

Update: 23 June 2012

27th AANP conference

Social Media Handouts – with information about Cirugia de Torax and other web blogs, websites, and social media by health care professionals (primarily nurse practitioners).

What is Fast Track Thoracic Surgery?

walk as if your life depended on it..

Today we are taking about one of my favorite topics, Fast Track Thoracic Surgery –  which is a fancy name for trying to streamline the surgical experience to prevent complications and shorten the time to discharge.  It’s an on-going process, and many of the things that were once just ideas “What if we extubated people in the operating room?” are now standard practice.   But ten years ago, most people stayed intubated and on the ventilator overnight after surgery..

A lot of the techniques mentioned in the literature that we’ve included (links) here is now the current standard of treatment,(and these articles are just a few years old – which shows how quickly things can change) such as:
– VATS procedures versus open surgery,
– early extubation in the operating room,
and the one we are going to focus on,
early mobilization (that’s walking, in plain English) but since all of this ‘early mobilization’ (or getting out of bed and walking right as early after surgery as possible) falls on you, the patient – it’s important that we explain why we are asking you to do all these things that are the absolutely the last thing you want to do after you’ve been operated on..

We’ve already discussed this another article, but since ‘early mobilization’ is one of those things that absolutely, truly makes a huge difference, but so often get missed; because the patient doesn’t feel receptive to the idea after surgery, the surgeon doesn’t mention it during his visits, and the nurses are too busy to encourage you (because it means more work for them anyway) – so we are going to revisit the concept.

So, you want me to get out of bed and walk around, just after surgery?  But I am tired, sore, and I have all this stuff (IVs, chest tubes, urinary catheter) attached to me..

I know, I know – I wouldn’t want to do it either – but wanting to – and finding the strength and motivation to do it even when you really don’t want to – are two different things..  And you should know by now, I absolutely wouldn’t ask you to do it, if it wasn’t critically important.

But these low-tech things*, such as walking, and using an incentive spirometry really do make a huge difference – and yes, in some cases, a difference between life and death (from respiratory complications, etc.).  So not only do I want you to walk – I want to you do it a couple times a day – at least three, and I want you to enlist your friends and family to help.  (If I were there, I would be coming by to help you untangle all the equipment, make sure your behind is covered in your robe, and push your IV pole, while we chatted about other stuff – but in all likelihood – I’m not going to be there, so we better just get you moving anyway.)

And I want you to keep going – keep walking, even after discharge, when you get home.  Don’t plop down on the couch or bed with the remote – keep doing all the walking, coughing/ deep breathing exercises, and using your incentive spirometer..  Keep it up until you see your doctor at your follow up appointment..

At that appointment – particularly if you had a lobectomy, or a large piece of lung taken out – be sure to ask him about a prescription of pulmonary rehabilitation, if you didn’t get one a few weeks before surgery, or when you were discharged from the hospital.

* I had a couple of patients in the past who expressed surprise that things like walking, not computer-based technology were the main driving force between rapid recovery and the development of complications.  “There’s not some machine to do this?”
“Nope, just those legs you were born with..”

I’m not making fun, it’s just that it sounds far too simple for people to believe..which is why even though it sounds so obvious to you here, it’s one of the things I have to go over with people several times before and after surgery.
But, really, it is that simple.. Get up and walk like your life depended on it.  It does.

Now in some of these articles, ambulation and pre-operative management get just a passing mention;- but remember, these articles are written by surgeons, not nurses.. They’d rather talk about surgery, not ‘physiotherapy’.  But even so, they do take time to mention it – because it is important..

I’ll be updating this article with new references every so often.