11-29-23 PTL - Flipbook - Page 18
18 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, November 29, 2023
Lung cancer, continued
from page 4
copy (internal X-ray), and a biopsy is
performed. During the procedure, the
patient is comfortably sedated with anesthesia.
*Endobronchial ultrasound (EBUS)
uses ultrasound technology in combination with bronchoscopy to visualize
structures outside of the airway walls.
This enables interventional pulmonologists to sample the lymph nodes, small
areas of tissue that contain white blood
cells that fight infection, and at the same
time, perform mediastinal staging to
determine the stage of the cancer.
*Rapid onsite cytology evaluation
(ROSE) – immediately following the biopsy, pathologists appear at the bedside to
confirm the size and scope of the tissue
sample in real time. They can confirm
the lesion is cancerous and confirm that
the sampling is adequate for sequencing
and detecting mutations and alterations.
This eliminates the need to perform subsequent biopsies to secure more tissue.
“Many centers do not have the capability where the pathologist comes to
the patient’s bedside at the time of
biopsy and provides a preliminary review
to determine if there is a lesion in the
sample and that the sampling is adequate for further testing,” Dr. Sachdeva
explains. “This is an example of our multidisciplinary partnership that ultimately
provides timely, patient-centered care
through establishing an early diagnosis
and the capability to begin treatment
much sooner.”
Thoracic surgery and robotic options
The University of Maryland Medical
System’s multidisciplinary thoracic
oncology program offers robotic surgery,
a minimal invasive approach to surgical
treatment of early-stage lung cancer.
The thoracic surgeons collaborate
with interventional pulmonologists at the
University of Maryland using the localization techniques offered with robotic
bronchoscopy to mark small or difficult
to find lung nodules so that they may be
surgically removed. By marking the lung
lesion just prior to the surgeon making
their first surgical incision, the time to
identify and remove some of the hard-tosee or -feel lesions may be significantly
reduced, leading to less time asleep in
the operating room.
“Interventional pulmonologists can
help pinpoint the area by marking it
with a special dye that allows me to see
exactly where to go to take a small piece
of the lungs,” explains thoracic surgeon
Shelby Stewart, M.D., who serves as
assistant professor of surgery at the
University of Maryland Medical Center
and program director for the integrated
and independent thoracic surgery residency training programs. “Some nodules
are soft and not solid, and not easily
defined, and that helps us know exactly
where to find the nodule.”
The multidisciplinary team approach
for thoracic oncology at the University of
Maryland ensures that the most meaningful diagnostic procedure is specified
based on the input of the full team, keeping patient’s needs upfront, Dr. Sachdeva
explains. Based on this input, a patient
may be advised to undergo a biopsy
with interventional pulmonary medicine
before considering surgery, advised to
go straight to surgery without an interventional pulmonary procedure or have a
combined procedure with both interventional pulmonary medicine and thoracic
surgery on the same day.
Robotic surgery for lung cancer
Although robotic equipment has been
in use for over a decade, there have
been marked improvements since their
introduction.
“The speed at which we can secure
the tissue is faster,” Dr. Stewart explains.
“And we are able to remove segments of
the lung using smaller and smaller incisions, leading to a faster recovery and
less time in the hospital.”
There are essentially many short-term
benefits to using the robotic equipment.
The surgery is considered less invasive
as the incision is smaller, blood loss
is less, and pain is reduced. Patients
resume activity sooner and return to
work in less time. The procedure time
is about the same as traditional surgery,
and ultimately, long-term results are similar.
Dr. Stewart is one of a few surgeons
at the University of Maryland who utilizes robotics to perform a majority of her
procedures – nearly 100%, she says –
including advanced procedures like lung
resections.
Photo courtesy of University of Maryland Medical Center
“The robot is beneficial as a surgical
option because there is less blood loss,
less pain, less time in the hospital and
shorter time returning to normal activities,” she says. “To me, that’s huge.”
Multidisciplinary approach to care
An advantage to seeking care at
University of Maryland facilities, beyond
the expertise of the providers, is the
commitment to multidisciplinary care.
Oncology care team partners – medical
oncology, radiation oncology, pulmonology, thoracic surgery and radiology –
collaborate and openly communicate to
determine the best recommendations for
care. The patient is always at the center
of treatment planning.
“We provide patient-centered, valuebased care,” Dr. Sachdeva explains. “We
are partners in the patient’s journey, from
the time we diagnose to the execution
of the treatment. We are basically shepherding the patients’ care as part of their
care team, ensuring that they get much
needed tests and treatment in a timely
manner.”
Dr. Sachdeva is open to intervening
on behalf of the patient to optimize their
lung health. “Whether it be medications,
pulmonary rehab, emotional support or
having a peer-to-peer discussion, we
are here to ensure the best care and
the greatest chance for recovery for our
patients.”
Ask for screening
There is no shame in asking for a lung
cancer screening. “Patients who have
a prior history of smoking should not
feel guilty or stigmatized,” Dr. Sachdeva
attests. “They should reach out to our
lung cancer screening program or their
personal physicians to ask for a lung
cancer screening CT scan. This way, we
can diagnose the lung cancer sooner and
it gives them the highest chance of cure.”
Treatments have evolved over the last
decade, making a significant difference
in the management and treatment of
patients with lung cancer, even for those
with advanced stage cancers. “This is
certainly a very exciting time for us as
physicians,” Dr. Sachdeva states. “Now
we can diagnose patients earlier and
provide treatment to reach a cure.”