The disease is rightly frightening. But, recent advances are significant enough to restore hope and encourage early diagnosis of lung cancer. Establishment already renowned in the field of cardiology, the Arnault Tzanck Institute (IAT), in Saint-Laurent-du-Var, has set up, under the impetus of its general manager, Michel Salvadori, a global care offer , calling on specialists in the field of diagnosis as well as treatment and follow-up of lung cancer. Meeting with the medical team of the Thorax unit of the IAT, made up of pulmonologists, radiologists, surgeons and anesthetists-resuscitators, all members of the Multidisciplinary Consultation Meeting (RCP) which will decide on the care of patients.
How are lung nodules spotted?
In several ways: either as part of screening in smokers followed for chronic pathologies, such as COPD. Either completely randomly, during a CT scan performed for another reason, or even during the assessment of cardiac surgery [l’établissement a une forte activité dans ce domaine, Ndlr].
The following?
If these nodules are larger than 10 mm, additional investigations are carried out without delay: PET Scan (examination to assess the activity and extent of cancerous tumours), fibroscopy or bronchial echo-endoscopy (depending on the location of the lesions) to specify the nature of the nodule and assess the degree of extension of a potentially serious disease.
Aren’t these examinations at risk of complications?
The removal of lesions under scanner (and under light anesthesia) is very efficient and involves little risk. However, this risk is not zero and this is the reason why these examinations are carried out within the framework of a short hospital stay. It is fundamental to secure all acts in collaboration with thoracic surgeons and resuscitators.
What regarding situations where the identified lesions are small?
In this case, a new scan is performed four months later, to assess the doubling time of the lesion. If it is short – which means that the lesion progresses quickly – a puncture is made for analysis. Otherwise, we maintain a follow-up.
When an anomaly is identified in the lungs, does it always indicate the presence of cancer?
No, in the vast majority of cases, these “abnormal” images correspond to benign lesions, scars from an old infection such as tuberculosis, or even concentrations of pollutants in the lungs. But imaging alone cannot distinguish these benign abnormalities from tumoral lesions.
When and how does surgery take place?
When the anatomopathological examination confirms the existence of a tumoral lesion – and the intervention can be envisaged – the operation will consist in resecting the tumor and the neighboring lymph nodes. Depending on the extension of the lesion, the surgeon removes one of the five lung lobes (lobectomy) or, exceptionally, the entire lung. But the goal is to be as minimally invasive as possible, aided by video-assisted surgery and robotic surgery. Thanks to the DaVinci Xi robot, the followingmath of this complex surgery becomes simpler; postoperative pain and complications are significantly reduced.
It remains that it is a major surgery, which requires, to guarantee its safety, to have a resuscitation service nearby.
Alternatives?
In specific indications, validated by CPR, interventional radiologists can offer innovative radiofrequency tumor ablation procedures.
1. The team includes Dr Olivier Castelnau, oncopneumologist, Dr Guy Boyer, interventional pulmonologist, Dr Sébastien Novellas, interventional radiologist, Drs Marc-Paul Francisci and Daniel Pop, thoracic surgeons, and Dr Ghyslaine Vellutini, resuscitator.
