MDNews - Long Island

surger y fellowship at Mayo Clinic in Minnesota, Dr. McLarty has performed lung resections at Stony Brook for most of the past two decades. Surgery, she says, is the most effective method of curing lung cancer, but only a fraction of individuals diagnosed with the disease, which rarely causes symptoms in its early stages, are surgical candidates. A recent revision to national lung cancer screening guidelines may increase the number of patients who are diagnosed early and, in turn, increase the number of individuals for whom sur- gery is appropriate (see "Casting a Wider Screening Net"). No treatment for lung cancer, including surgery, takes place in a vacuum. "It's important when caring for these patients to not see their disease in isola- tion but as part of their body as a whole, and to be appreciative of the multiple ways that may be available to treat the problem," Dr. McLarty says. "If I were to see a 60 -yea r-old indiv idua l who smokes a nd is found by screening to have a 2-centimeter lung nodule, in the absence of a multidisciplinary ethos, I might resect the nodule. That's my job as a surgeon. However, cancers like this can be insidious and spread in subtle ways. By resecting it, I might miss cancer that has spread to another organ or lymph nodes. That would be a tragedy for the patient because there are better ways to treat this kind of cancer than surgery alone." In this scenario, Dr. McLarty says she would confer with her colleagues about how best to stage the cancer, perhaps send the patient for a PET scan, and ask the multidisciplinary tumor board group to evaluate the results and identify sites of concern for metastasis. The interven- tional pulmonologist might do a procedure to evaluate the lymph nodes for cancer. If disease is present, the patient might be enrolled in a clinical trial. "If the patient responded appropriately to treatment in the trial, then he might be referred back to me for surgery, but this time, with the full, metastatic disease addressed," Dr. McLarty says. "This type of treatment algorithm offers a better chance of cure and a longer life." Patients t y pica l ly enter t he Lung Cancer Program's care through an intake center operated by the Lung Ca ncer Eva luation Center. Most patients are scheduled for evaluation within one week of their initial contact with the center. For their initial appointment, patients see a surgeon or a pulmonologist, depending on the nature of the problem. Either way, obtaining additional clinical perspective is never difficult. "If I see a patient and feel he would benefit from a pulmonologist's input, I can arrange for a colleague to see the patient right away," Dr. McLarty says. "That's also the case if a medical oncologist's opinion is needed. Once our team has developed an initial plan, we schedule the patient's appointments. Next, we discuss preliminary results at the tumor board meeting and arrive at a consensus plan of action, which may include surgery, radiation therapy and/or chemotherapy. We follow post-treatment patients closely for at least five years to catch recurrent disease and ensure patients reach our five-year outcome benchmark." SURGICAL OPTIONS: LOBECTOMY AND MORE Determining candidacy for surgery neces- sitates evaluating a tumor's resectability and a patient's operability. "We look at where the surgical mar- gins would be to ensure we wouldn't be removing a critical structure, such as part of the heart or a key blood vessel," Dr. McLarty says. "If we believe we could cleanly remove the tumor, it's resectable. We also need to ensure the patient is a good operative candidate. The individual would undergo cardiac testing to make sure his heart is strong, and pulmonary func- tion testing to confirm he has adequate pulmonary reserves so that if we were to remove part of his lung, he would still be able to breathe sufficiently." The Lung Cancer Program's surgeons perform several procedures to treat lung cancer by removing all or part of the lung, including lobectomy, segmentectomy, wedge resection and pneumonectomy. Patient Access Representative Daniel Braun registers a patient for an appointment at the Cancer Center. Dr. McLarty with Dr. Keresztes M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 21 0 7

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