Lung Cancer
The physicians of NewYork-Presbyterian Cancer Centers are world leaders in the fight against lung cancer, and are committed to improving early detection, treatment, prognosis, and quality of life for patients with lung cancer.
Early diagnosis, effective surgery, integrated care, and close follow-up have improved the outlook for patients at each stage of the disease. The Cancer Centers offer patients the latest in detection techniques, state-of-the-art technology, surgical innovation, and access to groundbreaking trials. Patients also receive comprehensive care. In fact, each week, the centers hold multidisciplinary meetings with representatives from radiology, pathology, thoracic surgery, radiation oncology, pulmonary medicine, medical oncology, and support services to address individual cases and develop tailored treatment regimens. This integrated approach to care has been shown to improve patient outcomes.
Diagnostic Innovations
Curing lung cancer is dependent on finding it as early as possible. NewYork-Presbyterian Hospital is at the forefront of research and technology in its use of a low-dose CT scan that is helping to detect a tumor long before it would appear on an X-ray. CT scans produce both horizontal and vertical cross-sectional images of the body making it easier to visualize any developing tumors. The low-dose CT used for screening takes less than 20 seconds of scanning time and requires only slightly more radiation than a chest X-ray. Researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center conducted the first clinical study of this early detection technique. The Early Lung Cancer Action Program (ELCAP) screened 1,000 high-risk people and of the lung cancers found, 80 percent were diagnosed in the earliest, most curable stage. Further studies have shown that if lung cancer nodules are detected and removed at this early stage, the five-year survival rate can exceed 70 percent. When lung cancer is detected at a later stage, the survival rate is much lower.
Not only does the new screening method improve a patient's chance for a cure, it also compares favorably in cost to other widely accepted cancer screening methods, according to a recent study based on data from ELCAP. CT screening is currently recommended for men and women over the age of 60 who have a smoking history equivalent to 10 pack years (smoked one pack a day for 10 years, 2 packs a day for 5 years).
At NewYork-Presbyterian Hospital/Columbia University Medical Center, the Kreitchman PET Center offers a whole-body PET scanner, which can differentiate between benign and malignant lesions and also detect unsuspected metastases. Under CT- scan guidance, small, suspicious lung lesions may either be biopsied or excised using minimally invasive techniques.
Therapeutic Excellence
Advances in Surgery
Surgeons at both NewYork-Presbyterian/Columbia and NewYork-Presbyterian/Weill Cornell are leaders in minimally invasive lung cancer surgery, which is often an option for patients with early-stage lung cancer. The procedure remains the same as a conventional operation, the difference being the size of incision. Researchers theorize that this approach will yield better results because the body's immune system can focus on fighting the tumor instead of working overtime to recover from the trauma of a major operation. Robotic tools are also being developed to assist in these minimally invasive surgeries.
Endoscopy to Ease Airways
A team of surgeons and pulmonologists use endoscopic techniques – lasers, stents and photodynamic therapy – to clear passageways and improve the breathing of patients with advanced-stage lung cancer.
Experimental Therapies
The clinicians at NewYork-Presbyterian Cancer Centers are continually investigating new therapies that may improve the outcomes for patients with lung cancer. Through the Cancer Centers, patients have access to important clinical trials.
Preoperative Chemotherapy/Radiation
For patients with mid- to advanced-stage lung cancer, doctors at NewYork-Presbyterian Cancer Centers are exploring the use of a combined modality therapy of higher-dose chemotherapy and radiation to reduce tumor mass prior to surgery. Selected chemotherapy agents and more precise radiation techniques help keep the patient healthy, yet safely reduce the tumor prior to surgery. A study currently underway also looks at using preoperative chemotherapy on early-stage patients.
High-Dose Gated Radiation
NewYork-Presbyterian Cancer Centers will soon conduct a pilot study on delivering higher dose radiation, yet minimizing the toxicity of the treatment on healthy cells in patients with non-small cell lung cancer, the most aggressive type. Using a new PET CT scanner that combines the technology of PET and CT scans in a single machine to more precisely identify the tumor area, doctors will employ "gated radiation" therapy. This technology can pinpoint a radiation beam despite tumor movement during the breathing cycle. Doctors use an apparatus that monitors a patient's breathing cycle and activates the beam only when the tumor is in range, sparing healthy tissue.
Cox-2 Inhibitors
NewYork-Presbyterian/Weill Cornell was recently the first to show that a COX-2 inhibitor may boost the effectiveness of chemotherapy in the treatment of cancer, particularly non-small cell lung cancer (NSCLC). Patients treated with celecoxib, a COX-2 inhibitor, administered in conjunction with paclitaxel and carboplatin, two common chemotherapeutic agents, had lower levels of intratumoral prostaglandin E2 (PGE2), a molecule associated with tumor growth, when compared to treatment with chemotherapy alone. Additionally, the treatment is shown to be feasible and safe. An upcoming multicenter trial will examine changes in tumor size and survival rates for NSCLC patients treated with chemotherapy alone vs. chemotherapy plus a COX-2 inhibitor.
Gene Therapy
Researchers at NewYork-Presbyterian/Columbia are studying synthetic DNA molecules, or antisense molecules, that target specific genes. So far, studies show two of the molecules can be safely delivered in patients with lung cancer. The use of gene chips is another emerging technology, which identifies patterns in the genetic profile of lung cancer and may be used to predict which early-stage patients are at risk for recurrent cancer.
Growth Factors
NewYork-Presbyterian/Weill Cornell and NewYork- Presbyerian/Columbia have also studied an epidermal growth factor receptor, tyrosine kinase inhibitor, as more effective, less toxic agents to treat lung cancer.
Immunotherapy
Immunotherapy involves activating the body's own immune system in the fight against cancer. The role of the immune system in preventing infection is well established, and it is thought that the immune system may also play a pivotal role in the prevention and treatment of cancer, similar to the polio and smallpox vaccines. Two lung cancer vaccines trials, conducted by physicians at NewYork-Presbyterian/Weill Cornell, are near completion, and results will be analyzed soon.
Prevention Advances
NewYork-Presbyterian Cancer Centers offer a variety of specialized programs for the prevention and early detection of lung cancer. Our physicians know that providing assistance for smoking cessation, combined with public education to discourage tobacco use and to reduce exposure to industrial air pollutants, are the most effective ways to prevent lung cancer. They are leading the way to help people stop smoking and to end their dependence on nicotine. In addition, our researchers are developing new screening techniques that they hope will dramatically improve the detection of lung cancer among people at high risk. Specific cancer prevention and research programs for lung cancer are described below.
For additional information about prevention and early detection programs for lung cancer,
call 1-877-NYP-WELL.
NewYork-Presbyterian Hospital Cancer Prevention Program
1-877-NYP-WELL
The Cancer Prevention Program helps individuals who are seeking primary prevention services and cancer screening.
Early Lung Cancer Action Program (NY-ELCAP)
1-866-693-5227
www.nyelcap.org
Physicians here have developed a pioneering technique for the early detection of lung cancer using low dose computerized tomography (CT) scans to find tiny tumors much sooner than can be found with an X-ray. They are now leading NY-ELCAP – a multi-institutional registry of several medical centers that together will assess the potential benefits of CT screening and determine whether such early detection may improve the prognosis for people at high risk for lung cancer. If you qualify for the research study, the screening CT scan is free. If you are not eligible for the study, but have ever smoked and are interested in being tested, you will be required to pay for the service.
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NewYork-Presbyterian/
Weill Cornell
Smoking Cessation Program
(212) 746-5726
This program provides both individual and group sessions to help people stop smoking
and end their dependence on nicotine. Patients are offered counseling so they may
understand and change their behaviors, pharmacologic treatment to ease the discomfort of
nicotine withdrawal, and follow-up to prevent relapse.
Division of Pulmonary/
Critical Care Medicine
(212) 746-2258
 www.nycornell.org
The division's research efforts are currently focused on genetic medicine. Its physicians
are working to develop strategies for understanding and modifying gene expression that
might eventually be applied to the treatment and/or prevention of human disease. One
group of projects, under the name of Gene Therapy for Cancer, studies the coding of
enzymes that may convert certain drugs into active therapeutic agents within the human
body.
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NewYork-Presbyterian/
Columbia
Department of Behavioral Medicine
(212) 305-9985
The Department of Behavioral Medicine conducts individual and/or group treatment
using scientifically supported medical interventions to help smokers quit. Sessions are
held at:
NewYork-Presbyterian/Columbia
622 West 168th Street - 16th floor
Midtown Office
595 Madison Avenue at 57th Street
Columbia's Eastside Offices
16 East 60th Street
Smoking Cessation Clinic
(212) 543-5905/5590
nypisys.cpmc.columbia.edu
The Smoking Cessation Clinic continually runs trials of new treatments for helping
smokers. These clinical trials, funded by the federal government or pharmaceutical
companies, are provided at no cost to eligible participants. The duration of most
programs is 7-12 weeks. The clinic also serves as a resource for treatment providers and
researchers in the field of tobacco dependence.
Tobacco Cessation Clinic
(212) 305-9054
www.cumc.columbia.edu
The Tobacco Cessation Clinic, which is held at the Columbia University School of
Dental and Oral Surgery, offers a multidisciplinary approach to those who use tobacco
and want to quit. The program targets tobacco use as a physical addiction to nicotine, a
habitual addiction, and a social behavior.
Division of Pulmonary, Allergy and Critical Care Medicine
Located at the Jo-Ann F. LeBuhn Center, the Pulmonary Division provides treatment,
conducts research, and trains pulmonary specialists. The division's researchers are
developing and using molecular techniques to identify people who may be at high risk for
lung cancer. While smoking is a major risk factor, other data suggest that inherited
genetic factors and environmental factors could influence an individual's susceptibility to
lung cancer. Understanding the clinical importance of these factors is the objective of
several studies being conducted by this division in collaboration with the School of
Public Health, the Department of Radiology, and the Department of Pathology.
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