At Cleveland Clinic Florida's Maroone Cancer Center, a highly specialized team of physicians cooperates to provide Florida lung cancer patients with coordinated diagnosis and innovative treatment plans. Employing a multidisciplinary approach to manage and treat patients with lung cancer, pulmonologists (lung specialists), pathologists (tissue diagnostic specialists), medical and radiation oncologists (cancer treatment specialists), thoracic (chest) surgeons, and pain management experts collaborate to offer a full spectrum of diagnostic and therapeutic services.
What is Lung Cancer?
Lung cancer is the second most common form of cancer in the United States and the leading cause of cancer deaths. More women die of lung cancer than of breast cancer. While the rate of lung cancer cases appears to be dropping among Caucasian and African-American men, it continues to rise among both Caucasian and African-American women. Ninety percent of lung cancer cases are caused by cigarette, pipe or cigar smoking.
Lung cancer results when abnormal cell growth invades and destroys normal lung tissue. An accumulation of abnormal cells is called a tumor. As a tumor grows, it impairs lung function, resulting in breathing difficulty and decreased oxygen in the blood.
- Florida Lung Cancer Treatment Guide
Testing & Diagnosis
Florida Testing & Diagnosis
Diagnosing Lung Cancer
The Maroone Cancer Center offers a number of testing procedures to diagnose lung cancer. To help find the cause of symptoms, doctors will evaluate patients’ medical history, smoking history, exposure to environmental and occupational substances and family history of cancer. Doctors will also conduct a physical exam and order a variety of tests.
Diagnostic & Imaging
If lung cancer is suspected, the doctor may order a chest x-ray as a first step in diagnosis, which may indicate a mass in the lungs or enlarged lymph nodes. If chest x-ray is normal, additional tests may be conducted if lung cancer is suspected. Because every mass is not cancerous, the additional tests may still be performed.
Low-Dose CT Scan
The low-dose computed tomography (CT) scans are a new testing procedure that can reduce deaths among high-risk patients by as much as 20 percent. A low-dose CT scan combines x-ray views from multiple angles to create a two-dimensional image of a person’s lungs. Physicians review these images for small abnormalities, or nodules.
Computer Assisted Tomography (CT) and Magnetic Resonance Imaging (MRI)
Frequently, a CT scan or an MRI will be performed as a follow-up to an abnormal chest x-ray or to evaluate abnormal symptoms in patients with a normal chest x-ray. CT scanning involves a series of x-rays that create a 3-D view of the lungs, while MRI uses powerful magnets and radio waves to read the signals created by different types of tissues. Both can show the size, shape and location of a tumor. They are very useful tools in determining whether or not the tumor has spread from the lung to other parts of the chest or to other parts of the body.
Positron Emission Tomography (PET) Scans
During a PET scan a very small dose of radioactive chemical, called a radiotracer, is injected into a vein in the arm. The radiotracer travels through the body and is absorbed by the organs and tissues. A scanner detects and records the energy given off by the tracer substance. A PET scan can measure such vital functions as blood flow, oxygen use, and glucose metabolism, which helps doctors identify abnormal from normal functioning organs and tissues.
Integrated PET-CT Scans
A PET-CT scan combines the images from both a PET and a CT scan. As the PET scanner detects signals of actively growing cancer cells in the body, the CT scan creates a three-dimensional picture of the internal anatomy that reveals the location, size and shape of abnormal cancerous growths. The two scans are performed at the same time and on the same machine, creating a more complete image of tumors or any abnormalities.
Autofluorescence Bronchoscopy is a special light that is used inside the lung through a small scope. This light is able to detect suspicious areas of possible cancer in the bronchia tubes that are not clearly seen by standard bronchoscopy.
Biopsy and Tissue Sampling
If diagnostic imaging tests are abnormal, tissue sampling may be conducted to confirm a diagnosis. The doctor may examine mucus in the lungs and will examine tissue from the lung to see if cancer cells are present. A number of procedures may be used to obtain tissue for biopsy.
Sputum cytology is a simple test in which the doctor obtains a sample of the mucus in the lungs to examine microscopically. Because it cannot pinpoint the tumor's location, a positive sputum cytology test is usually combined with imaging tests and a tissue biopsy.
Endobronchial Ultrasound (EBUS)
EBUS is a technique where a special, very small scope, with a tiny ultrasound at the tip allows the pulmonologist to perform biopsies in multiple areas. This allows the specialist to minimize the risk of puncturing a blood vessel and allows for better accuracy, since they can see that the needle is placed inside the abnormality with the ultrasound.
Esophageal Ultrasound (EUS)
EUS is a special technique, where a special, scope, with a tiny ultrasound at the tip of the scope allows the physician to perform biopsies in multiple areas. This allows the specialist to minimize the risk of puncturing a blood vessel and allows for better accuracy, since we can see that the needle is placed inside the lesion with the ultrasound.
Transbronchial Needle Aspiration Biopsy
Transbronchial Needle Aspiration Biopsy uses a small scope to go to distant areas in the lung where a small biopsy forceps is used to remove tiny pieces of lung to make the accurate diagnosis of lung conditions in the outpatient setting.
Transtracheal Needle Aspiration Biopsy
EUS is a technique where a special, very small-sized scope, with a tiny ultrasound at the tip allows the pulmonologist to perform biopsies in multiple areas. The lesion is visualized by fluoroscopy (live x-ray) or by bronchoscopy. This allows the specialist to minimize the risk of puncturing a blood vessel and allows for better accuracy, as they can see that the needle is placed inside the area of concern with the ultrasound.
Flexible Biopsy Techniques
Biopsy procedures are performed with very small scopes using sedation techniques that keep patients very comfortable and asleep.
Percutaneous Needle Biopsy
Chest radiologists perform computerized guided biopsy of tumors at multiple areas in the chest reducing the need for surgical biopsies to make a diagnosis. Those procedures are done on an outpatient basis with the patient going home the same day.
Ultrasound Guided Thoracentesis
Ultrasound Guided Thoracentesis removes abnormal fluid from the pleural space between the lung and the chest wall using ultrasound.
CT Guided Biopsy
A CT Guided Lung Biopsy uses real-time CT images to ensure biopsy samples are accurately taken from the desired part of the lung. These biopsy samples are check for adequacy by a pathologist during the procedure to make sure a diagnostic sample is obtained.
A vascular access procedure involves the insertion of a flexible thin plastic tube, or catheter, into a blood vessel to provide a painless way of collecting blood samples for analysis.
A port is a device that allows an easy and reliable way to take blood samples from the veins. The port is implanted under the chest skin and a catheter is connected to it. The catheter is tunneled under the skin to an area near the neck where it enters a vein.
Treatments & Procedures
Florida Lung Cancer Treatment Options
Surgery, radiation therapy, and chemotherapy are used to treat lung cancer. The Maroone Cancer Center at Cleveland Clinic Florida provides patients with the latest surgical and non-surgical treatment options. Treatment is based on the type and stage of the patient’s cancer, where the tumor is located and the patient’s overall health. The Maroone Cancer Center's medical experts offer surgical and non-surgical options.
Non-Surgical Treatment Options
Radiation therapy is a form of high energy x-ray that kills cancer cells. It can be used as a primary treatment, or in combination with chemotherapy (with or without surgery) for curative intent. Radiation also plays an important role in the care of patients with advanced cancer by providing relief from pain, airway obstruction, shortness of breath, or coughing.
Varian Edge™ Stereotactic Body Radiation Therapy (SBRT)
Only a few centers around the world offer Varian Edge technology. The Edge is a state-of-the-art linear accelerator with best in class radiosurgical capabilities. The Edge offers a 6 degrees of freedom treatment couch for accurate patient positioning, real-time tumor motion management, and the highest dose rate available, ensuring fast, precise delivery of high dose radiation.
Chemotherapy is a type of cancer treatment that uses medication to destroy cancer cells. It is also used to stop, slow the growth or shrink cancer cells. Chemotherapy is often administered through catheters and ports.
State of the Art Infusion Unit
Cleveland Clinic Florida’s state of the art infusion unit is available for chemotherapy and biologics treatments. The infusion unit is fully staffed with highly trained oncology doctors, nurses and pharmacists and features semi private areas with individual televisions.
Laser Bronchoscopy for Tumor Destruction
Laser Bronchoscopy uses a laser to destroy airway tumors or lesions as well as eliminate obstructions in the bronchial tubes that cause shortness of breath.
Airway Stent Placement for Narrowing of the Airway
Stents are small cylindrical expandable tubes, very similar to the types used by cardiologists to open up arteries in the heart. They are used to open bronchial tubes that are occluded or narrowed due to infection, tumors or scar tissues.
Electrocautery Bronchoscopy for Destruction of Lesions and Removal of Polyps
Electrocautery bronchoscopy uses electric currents to destroy benign and malignant tumors in the bronchial tubes. It also helps to open up obstructed airways and to stop bleeding.
Argon Plasma Coagulation
Argon Plasma coagulation uses mild electric currents to destroy benign and malignant tumors in bronchial tubes, open up obstructed airways, and stop bleeding.
Balloon Dilation for Tracheal and Bronchial Stenosis
Balloon dilation for tracheal and bronchial stenosis uses small balloons to dilate bronchial tubes. The procedure passes the balloons through small bronchoscopes. The procedure is similar to angioplasties performed by cardiologists, except that it is done on the bronchial tubes.
Photodynamic therapy uses an injection of a special chemical in the blood that is absorbed by cancer cells in the lungs. After the chemical is given, special light is used to activate the chemical absorbed inside the tumor cell, destroying the tumor cell but not affecting the healthy ones. This can be very useful in early stages of cancer to prevent further growth.
PleurX Catheter Placement
This treatment involves placement of a pig-tail catheter in the pleural spare when fluid continues to re-accumulate, especially in patients with malignant pleural effusions.
Brachytherapy places a small catheter in the lung so radiation can be given inside the bronchial tube. This is utilized in patients with central tumors or tumors inside the airway, as well as patients who have received large doses of external radiation.
Cryotherapy uses cold energy and freezing temperatures to treat bronchial lesions.
Foreign Body Aspiration or Inhalation and Removal
Foreign body aspiration and removal removes accidentally inhaled foreign bodies such as food, insects and others from the airway with little baskets or other tools.
Surgical Treatment Options
Minimally Invasive Surgery
Video Assisted Thorascopic Surgery
Video assisted thorascopic surgery is a minimally invasive surgical procedure used to diagnose and stage lung cancer as well as remove cancerous and benign tumors. During VATS a tiny camera with a light source is inserted through a small incision in the ribs. A second small incision is used to insert special instruments between the ribs and into the chest cavity.
This is a procedure similar to laparoscopy but when performed in the chest, it is called pleuroscopy or video thoracoscopy. A small instrument with a camera is inserted into the chest cavity through a very small incision allowing the physician to do diagnostic and therapeutic procedures inside the chest.
A lobectomy is the surgical removal of a large section of lung. It is the most common surgery performed to treat lung cancer. Lobectomy has been traditionally performed during thoracotomy surgery. During thoracotomy surgery, an incision is made on the side of the chest between the ribs. The ribs are then spread apart so the surgeon can see into the chest cavity and remove the tumor or affected tissue.
A mediastinoscopy is a surgical procedure that allows the surgeon to examine the inside of the upper chest between and in front of the lungs (mediastinum). A small cut is made in the neck just above the breastbone or on the left side of the chest next to the breastbone. Then a thin scope (mediastinoscope) is inserted to remove tissue for biopsy or to examine and evaluate tumors in the middle chest.
Video Assisted Thorascopic Surgery (VATS)
Video-assisted lobectomy is less invasive than traditional thoracotomy. During VATS lobectomy, three 1-inch incisions and one 3- to 4-inch incision is made in the chest to provide access to the chest cavity without spreading the ribs. A thorascope (small video camera) and surgical instruments are inserted into the incisions. Images transmitted by the thorascope and projected onto a computer monitor guide the thoracic surgeon while performing the lobectomy. While the outcomes are comparable to traditional lobectomy, this technique reduces a patient’s hospital stay to about 3 to 4 days and the patient experiences a more rapid recovery with less pain. Cleveland Clinic is one of the few centers in the nation with significant experience in video-assisted thorascopic surgery.
This is a surgical procedure to remove the cancerous part of the lung and part of the bronchus (airway) attached to it. The ends of the remaining bronchus are rejoined and reattached to the remaining lobe. This procedure spares the healthy portion of the lung.
Limited or Wedge Resection
A limited or wedge resection is a surgical procedure to remove a wedge-shaped portion of the lung, including the tumor and a surrounding margin of healthy tissue. This procedure is performed as an alternative to lobectomy.
A pneumonectomy removes one whole lung when the cancer cannot be treated by removing a smaller portion.
Smoking Cessation Program
According to the 2014 Surgeon General’s Report, most cases of lung cancer are due to cigarette smoking. Patients who have been diagnosed with lung cancer or those who wish to end their nicotine addiction can work with professionals at Cleveland Clinic Florida’s Smoking Cessation Program to quit smoking.
Cleveland Clinic Florida’s Smoking Cessation Program uses the S.M.A.R.T. Quit approach to help patients overcome nicotine addition. The S.M.A.R.T. approach is as follows: Strategy: Develop a program tailored for each patient’s success. Motivation: Encourage patients to make a pact with themselves to keep trying. Awareness: Teach patients about nicotine addiction, withdrawal and triggers. Reasons: Help patients compare pros and cons and identify their top reasons to quit. Tobacco-Free Life: Help patients set a date; then commit to living without tobacco.
How the program works
A Cleveland Clinic Florida certified smoking cessation specialist l helps patients understand nicotine addiction and how to quit. The specialist develops a personalized treatment plan that includes one-on-one support and a variety of resources. The smoking cessation program runs 3 to 6 months and meets biweekly and monthly.
Though everyone’s addiction is unique, a combination of behavioral therapy and medication has been proven to dramatically increase the chance of success. Research from Pfizer reports a 44% quit rate in 12 to 6 weeks.
Treatment programs may include:
- Prescribed medications
- Over-the-counter medications
Alternative treatment options
Because each person’s smoking habit is unique, every treatment is personalized. Treatments focus on the physical and emotional withdrawal symptoms that may arise, and also aid in relaxation. Hair-thin needles are superficially inserted into a combination of points in the ears and body believed to influence organs and energetic pathways associated with smoking. Targeting these acupuncture points calms the mind and reduces withdrawal symptoms and nicotine cravings.
A drug-free, non-invasive treatment in which a laser is used to target energy points throughout the body, causing the release of serotonins and endorphins. Laser therapy helps detox the body, flushing out harmful substances, and reduces the craving for nicotine.
A treatment intervention that induces the client into a relaxed state. The clinician then provides post-hypnotic suggestion for relief from symptoms. A trance is a natural occurring state, so anyone can be hypnotized. Only a light to medium state of hypnotic trance is necessary for effective therapy.
- Behavioral therapy
- Reading material
- Web-based programs
- Individual or group counseling
Patients should contact their insurers to find out of smoking cessation is a covered benefit. For more information on Cleveland Clinic Florida’s smoking cessation program or to talk with a specialist about quitting, please call: 954.659.5978. To enroll, patients need a prescription for Smoking Cessation (SC) from their physician.
To schedule a consultation or appointment, call 877.463.2010.
Cleveland Clinic Florida’s unique model of medicine brings together a multidisciplinary team of specialists to provide patients the best treatment options and care.