Ziv Gamliel, MD, chief of thoracic surgery at MedStar Franklin Square Medical Center
At The Angelos Center for Lung Diseases, our multidisciplinary team has vast experience treating patients with thoracic cancer and related conditions, including:
- Benign and Malignant Pleural Conditions
- Esophageal Cancer
- Lung Cancer
- Mediastinal Tumors
- Metastatic Disease to the Lungs
- Tumors of the Chest Wall
Thoracic Cancer Surgery
Our thoracic surgeons use the latest research and technologies to treat patients with thoracic cancers. Such treatments range from outpatient surgeries (such as bronchoscopy) to complex surgeries requiring overnight or longer hospital stays (including thoracotomies to remove a lung) to a variety of minimally invasive chest surgeries that use smaller incisions and lead to faster, easier recovery with less risk of infection. Other surgeries performed at MedStar Health to treat thoracic cancers include:
- Chest wall resections involve removing a portion of the ribs and the muscles of the chest wall to treat a tumor. It is performed when the tumor comes from the chest wall or when a lung cancer grows into the chest wall. The procedure may or may not require the assistance of a plastic surgeon for additional reconstruction.
- Video-assisted thoracic surgery (VATS) is a minimally invasive procedure, during which your MedStar Health doctor examines the pleural space. While the patient is under general anesthesia, your doctor will use a thoracoscope, inserted through two small incisions. Your doctor may remove the fluid and examine it for potential malignancies and other conditions. Depending on your condition, your doctor may use this technique in removing a portion of the lung. Learn more about VATS for treating cancers of the lung and chest wall.
The pleura is a double-layered membranous structure that wraps around the lungs and lines the chest wall. The thin space between these two layers is known as the pleural cavity, which is filled with pleural fluid to ease the layers’ shifting as the lungs move during breathing.
Three types of conditions can affect the pleura:
- Pleural plaque: When asbestos fibers enter the lungs they cause the pleura to become thick and scaly and harden
- Pleural tumors: Benign and malignant tumors can grow in the pleura.
- Pleural effusion: Various benign and malignant conditions can cause a build-up of pleural fluid in the pleural cavity.
Exposure to asbestos is the greatest risk factor in developing pleural conditions.
Most of the time, pleural conditions are found on a chest X-ray. Symptoms of pleural conditions may include:
- Chest pain
- Breathing problems
When a patient presents with symptoms that might suggest pleural conditions, your doctor will use several diagnostic methods to make an accurate diagnosis. These may include:
- Bronchoscopy: Bronchoscopy allows the doctor to check your lungs and airways with the use of a tube passed through your mouth or nose. It allows for viewing of the lungs and airways to detect cancer and also allows for a biopsy needle to remove a piece of tissue for analysis if cancer is suspected. The test is typically performed by a thoracic or chest surgeon or a pulmonologist.
- Thoracentesis: A needle is inserted into the chest and a small portion or all of the fluid is drawn out. This fluid is examined for potential malignancy and other conditions.
- VATS: While you are under general anesthesia, a videoscope is inserted through two small incisions. Your doctor will remove fluid and/or lung tissue and examine it for potential malignancies and other conditions. This procedure usually requires an overnight stay in the hospital. Learn more about VATS for treating cancers of the lung and chest wall.
- Thoracotomy: Your thoracic surgeon will open the chest with an incision and remove any abnormalities or lymph nodes for further examination in the lab.
- Thoracoscopy: Thoracoscopy uses a thin tube called a thoracoscope for viewing the organs. Also used to remove tissue for testing, the tube can be inserted through a small incision made between the ribs.
Your treatment will depend on the diagnosis. In some instances, the treatment will be directed at controlling the symptoms. In other cases, the treatment will be aimed at treating the underlying condition.
The mediastinum is the central portion of the chest between the lungs. Any growth found in this cavity is referred to as a mediastinal mass. These abnormalities can be malignant (cancerous) or benign.
As the cancer begins, there may be no noticeable symptoms. Abnormalities of the mediastinum are typically found on CT scans taken for other reasons. However, symptoms may include:
- Chest pain
- Persistent cough
- Night sweats
- Unexplained weight loss
When a patient presents with symptoms that might suggest a mediastinal abnormality, your doctor will use several diagnostic methods to make an accurate diagnosis, which may include:
- Endobronchial Ultrasound: An advanced diagnostic technology that provides real-time imaging of abnormalities inside the chest. These procedures are so effective, they can sometimes eliminate additional phases of testing. The real-time technology used in endobronchial ultrasounds has a long learning curve, and few physicians are prepared to perform them. However, MedStar Franklin Square thoracic surgeons are well-trained to perform these procedures accurately.
- Mediastinoscopy: Your thoracic surgeon will make an incision at the top of the breastbone, and insert a thin, lighted tube to see inside the chest. Any abnormalities or possibly affected lymph nodes will be removed for further examination in the lab.
- Mediastinotomy: A small incision is made into the side of the breastbone and a biopsy is taken of the suspicious mass. This is usually done under general anesthesia on an outpatient procedure.
Surgery, chemotherapy, and radiation are the primary treatment types for mediastinal tumors, depending on the type of tumor and if it has spread.
Metastatic disease to the lungs occurs when cancer spreads from other parts of the body through the bloodstream or lymphatic system to the lungs. Although the cancer now exists in the lungs, doctors do not classify it as lung cancer because it did not originate in the lungs.
Doctors at MedStar Health may recommend the following to treat metastatic lung disease:
- Surgery to remove tumors in the lungs
- Radiation therapy
- Placing stents inside the airways
Chest wall tumors can be benign (non-cancerous), or malignant (cancerous). Many malignant chest wall tumors are called sarcomas, cancerous cells that arise from your bone, muscle, or other soft tissues.
- Bumps or abnormal growth on the chest area
Depending on the size of your tumor, location, and other criteria, your MedStar Health thoracic surgeon may recommend a biopsy or removing the tumor in one surgery. Your thoracic surgeon will recommend a minimally invasive approach when possible, as this decreases the amount of pain experienced, recovery time, and the number of complications.
For a physician referral, please call 844-411-LUNG.
For more information about our clinical trials, please call 443-777-7364.
MedStar Franklin Square Medical Center
The Angelos Center for Lung Diseases
9103 Franklin Square Drive
Baltimore, MD 21237
Adjacent to the Weinberg Cancer Institute.