Imaging and the Treatment of Lung Cancer
The Role and Importance of Non-Invasive Imaging and Diagnostics in the Detection and Treatment of Lung Cancer:
One of the advents of modern medicine has been the development of several novel techniques used for diagnosing, staging, and evaluating lung cancer for treatment. Many of these studies are non-invasive imaging techniques; others require some degree of physical exertion or effort to determine the patient’s level of risk for surgery. The aim of diagnostic testing seems so esoteric to patients they are often reluctant or apathetic to have them done. The outcomes of these exams can significantly alter patient care strategy and warrant explanation to the patient in a way they can understand. The following measures are necessary steps in the continuum of patient care, and with cooperation between the medical provider and the patient; levels of patient care thought previously unattainable seem within reach.
Non-invasive imaging techniques, such as PET Scans, CT Scans, and MRI’s are typically the way lung cancer is detected. Patients with shortness of breath, cough, non-cardiac chest pain, and discomfort are typically sent for some kind of imaging of the chest. In many cases these scans give rise to suspicious looking lesions or masses which warrant involvement from an oncologist or thoracic surgeon. In other situations a lung mass or lesion may be detected incidentally, that is, it is discovered while investigating another illness. Each one of these studies is useful for detecting different characteristics of lung cancer.
-PET (positron emission tomography) imagery works when a patient is injected with a radioactive sugar based solution which is taken up and metabolized by highly active cells. This radioactive element is able to be detected by a machine which is able to render a series of 2-D or 3-D images of the patient. PET scans are important in detecting cancer as the hallmark of many forms of cancer is that the cells divide rapidly and cause destruction of surrounding tissue. This prolonged cell division is a process called metastasis.
-CT (computerized tomography) or CAT (Computerized Axial Tomography) is a method of imaging that compiles a series of x-rays to construct an image. CT scans function to help identify masses of densely packed cells that are nestled among less dense tissue, such as that found in the lungs. CT scans are also useful in detecting the shape of a mass. Determining the shape of a mass is an important step in staging and prospective treatment of lung cancer.
-MRI (Magnetic Resonance Imaging) is an imaging technique that uses magnetic fields to resonate the water molecules within the patient’s body. The importance of this technique is that it allows a distinction to be made between tissues of similar density, allowing the physician to determine if there is a mass and if it is malignant. MRIs can also be useful in detecting vasculature (blood vessels) in and around a lung mass prior to a prospective surgery.
-PFT’s (pulmonary function tests) allow the physician to evaluate the level of pulmonary health a patient has and may precipitate the use of pre-operative therapies involving steroids or bronchodilators. This set of tests also acts as one of the best predictors of post-operative pulmonary complications by indicating whether the patient can survive with the lung resected.
-Cardiac Stress Tests are either conducted as exercise (treadmill) stress or nuclear stress test that can help determine how a patient will function as they undergo surgery. During this test the patient is placed on a treadmill and their heart rate, electrical activity, and blood flow are measured continuously to demonstrate whether a patient will tolerate surgery with appropriate risks for morbidity and mortality. Another variation of this test uses chemicals that mimic the stress the body endures during physical exertion if it is unsafe for the patient to exercise.
Each one of the respective tests is beneficial for different reasons. The advent of these new diagnostics coupled with novel methods of treatment are allowing patients to be more effectively identified and treated for lung cancer. With some 215,000 new cases of lung cancer diagnosed in 2008, the news of effective treatment can’t come soon enough, especially considering that over 20,000 patients per year who are diagnosed with lung cancer have never smoked.
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