The lung is the most common site for primary cancer worldwide, and smoking tobacco is the leading risk factor. The lung is also a common site of metastases for various malignancies. Metastases occur when a single tumor cell or clump of cells gain access to the blood stream or lymphatic system, travel to a new organ such as the lung, begin to multiply, and then regrow their vascular structure to obtain food. Interventional radiologists can deliver treatments for lung cancer directly to the cancer without significant side effects or damage to nearby normal tissue.
- Coughing that doesn’t go away
- Persistent chest pain
- Shortness of breath, wheezing
- Coughing up blood
- Swelling of the face and neck
- Loss of appetite and weight
Lung Cancer Diagnosis
There are a number of tests that can help in the diagnosis of cancer, including blood tests, physical examination and a variety of imaging techniques including X-rays (e.g., chest X-rays and mammograms); computed tomography (CT); magnetic resonance (MR) and ultrasound. Usually, however, the final diagnosis cannot be made until a biopsy is performed. In a biopsy, a sample of tissue from the tumor or other abnormality is obtained and examined by a pathologist. By examining the biopsy sample, pathologists and other experts also can determine what kind of cancer is present and whether it is likely to be fast or slow growing. This information is important in deciding the best type of treatment. Open surgery is sometimes performed to obtain a tissue sample for biopsy. But in most cases, tissue samples can be obtained without open surgery with interventional radiology techniques.
Lung Cancer Treatments
Tumors need a blood supply, which they actively generate, to feed themselves and grow. As vascular experts, interventional radiologists are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body. In treating cancer patients, interventional radiologists can attack the cancer tumor from inside the body without medicating or affecting other parts of the body by using embolization and radiofrequency heat.
Thermal Ablation Treatments
By the time lung cancer becomes symptomatic, 85 percent of patients are incurable, often due to serious coexisting health conditions or poor respiratory function. Most patients who are diagnosed with non-small cell lung cancer are not surgically resectable at the time of diagnosis. For these patients, minimally invasive interventional radiology procedures can help reduce pain and improve quality of life.
Radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing nearby healthy lung tissue. Thus, this treatment is much easier on the patient than systemic therapy. Radiofrequency energy can be given without affecting the patient’s overall health and most people can resume their usual activities in a few days. It is a safe, minimally invasive tool for local pulmonary tumor control with negligible mortality, little morbidity, short hospital stay, and positive gain in quality of life.
In this procedure, the interventional radiologist guides a small needle through the skin into the tumor. From the tip of the needle, radiofrequency energy (similar to microwaves) is transmitted to the tip of the needle, where it produces heat in the tissues. The dead tumor tissue shrinks and slowly forms a scar. It is ideal for nonsurgical candidates and those with smaller tumors. The FDA has approved RFA for the treatment of tumors in soft tissue that includes the lung.
Efficacy of RFA
Depending on the size of the tumor, RFA can shrink or kill the tumor. Because it is a local treatment that does not harm much healthy tissue, the treatment can be repeated as often as needed to keep patients comfortable. It is a relatively safe procedure, with low complication rates.
By decreasing the size of a large mass, or treating new tumors in the lung as they arise, the pain and other debilitating symptoms caused by the tumors are often relieved. While the tumors themselves may not be painful, when they press against nerves or interfere with vital organs, they can cause pain. RFA is effective for small to medium-sized tumors and emerging new technologies should allow the treatment of larger cancers in the future. RFA is a new treatment that has shown early, promising results, but long-term studies have not yet been completed.
- Is most effective when all the cancer is localized in the lung
- Can be used to treat primary lung cancer and tumors that have metastasized (spread) from other areas in the body to the lung
- Usually does not require general anesthesia
- Relatively low cost
- Is well tolerated. Most patients can resume their normal routine the next day and may feel tired for a few days.
- It can be repeated if necessary
- It may be combined with other treatment options
- It can relieve pain and suffering for many cancer patients
- It has a short hospital stay
- It has few complications
Cryoablation is similar to RFA in that the energy is delivered directly into the tumor by a probe that is inserted through the skin. But rather than killing the tumor with heat, cryoablation uses an extremely cold gas to freeze it. This technique has been used for many years by surgeons in the operating room, but in the last few years, the needles have become small enough to be used by interventional radiologists through a small nick in the skin without the need for an operation. The “ice ball” that is created around the needle grows in size and destroys the frozen tumor cells.
Chemoembolization is a minimally invasive treatment for lung cancer that can be used when there is too much tumor to treat with radiofrequency ablation (RFA), when the tumor is in a location that cannot be treated with RFA, or in combination with RFA or other treatments.
Chemoembolization delivers a high dose of cancer-killing drug (chemotherapy) directly to the organ while depriving the tumor of its blood supply by blocking, or embolizing, the arteries feeding the tumor. Using imaging for guidance, the interventional radiologist threads a tiny catheter up the femoral artery in the groin into the blood vessels supplying the lung tumor. The embolic agents keep the chemotherapy drug in the tumor by blocking the flow to other areas of the body. This allows for a higher dose of chemotherapy drug to be used, because less of the drug is able to circulate to the healthy cells in the body. Chemoembolization usually involves a hospital stay of two to four days. Patients typically have lower than normal energy levels for about a month afterwards.
Chemoembolization is a palliative, not a curative, treatment. Chemoembolization has shown promising early results with some types of metastatic tumors. Although the individual materials used in this treatment are FDA approved, the treatment itself is not approved specifically for intra-arterial therapy of lung tumors.