The NS-LIJ Division of Pulmonary and Critical Care Medicine in conjunction with the Department of Thoracic Surgery and Division of Interventional Radiology have developed a collaborative program including interventional bronchoscopy and endobronchial therapy for the treatment of patients with tumors or other diseases in the windpipe (trachea) or bronchial tubes. Rigid or flexible instruments (bronchoscopes) are use both for diagnosis and treatment of diseases of the airways and lungs
The patient is placed on a table and picture slices are taken by moving the table. Injecting a dye (contrast solution) into a vein enhances this examination. You should inform the radiologist if you have had previous allergic reactions to shellfish or dye or you take oral medications for diabetes or if there is a problem with the kidneys. This technique permits the discovery of very small tumors 10 mm or less. It also gives valuable information on the relation of a cancer to other vital structures in the chest. It may also be use to guide a specialized interventional radiologist in biopsy or treatment of lung tumors.
Bronchoscopy is carried out all for diagnostic and treatment purposes. A rigid or flexible instrument is inserted into the airway and allows the physician to see the voice box, windpipe and bronchi. More commonly a flexible bronchoscope is used after topical anesthesia and some sedation either inserted through a nostril or the mouth. Rigid instruments always require general anesthesia. Flexible bronchoscopy is usually performed as and ambulatory procedure and does not require hospitalization. It can be repeated as necessary and permits visualization of small airways. It allows for retrieval of diagnostic material several techniques. These include bronchoalveolar lavage and (BAL) where small amounts of saline are use to wash bronchial tubes and the lung tissue beyond. Actual biopsies of the bronchial tubes were lung can be obtained by small brushes, forceps devices, and needles. These can be evaluated for tumor and infection as well as other diseases.
The most commonly used laser for treatment of airway blockage by tumor is a Neodymium-YAG laser. The energy from this laser can be piped through flexible fibers guided by a flexible fiberoptic bronchoscope. The treatments can be carried out those with local anesthesia and some sedation or in some circumstances under general anesthesia. The aim of this treatment is to remove obstructing tumor in the airway. This treatment will very rarely cure a cancer but it can increase quality of life significantly and also reduce the risk for hospitalization.
NS-LIJ pulmonary division can provide Photodynamic Therapy (PDT) a treatment which destroys cancerous cells in patients with lung cancer. Following the administration of a photosensitive drug retained preferentially in cancer cells, a specific laser light is delivered through a flexible bronchoscope to activate the drug and destroy the cancer cells. Photodynamic Therapy can improve the quality of life of patients with airway cancer by shrinking tumors inside the trachea and bronchi.
High dose brachytherapy is a form of internal radiation therapy uses a source of a high radiation dose to the tumor in or surrounding a bronchial tube while sparing adjacent normal lung tissues. The radiation source is at the tip of a very thin metal wire automatically delivered through a thin plastic tube placed by a fiberoptic bronchoscope. The treatments last only a few minutes and are usually not repeated more then two or three times. Brachytherapy is often combined with standard external beam irradiation, and serves as a "boost dose" to the site of suspected or known cancer.
A promising alternative to surgical removal of some lung tumors is eliminating the tumor cells using heat. The technique, called radiofrequency ablation (RFA), is performed at NS-LIJ by specially trained interventional radiologists and is much less invasive than open surgery. Guided primarily by computed tomography (CT) scanning, a small needle electrode is inserted through the skin and directly into the tumor tissue. Radiofrequency energy consisting of an alternating electrical current in the frequency of radio waves is passed through the electrode. The energy causes the tissues around the needle electrode to heat up, killing nearby cancer cells. At the same time, heat from radiofrequency energy closes small blood vessels and lessens the risk of bleeding. RFA usually causes little discomfort. It is usually done as an outpatient procedure that does not call for general anesthesia. RFA can be an effective means of pain relief when a tumor invades the chest wall. It may also be used to decrease the size (debulk) of a lung tumor either too large to remove surgically or in a patient who cannot tolerate surgery. Reducing the tumor in size so may allow the remaining tumor cells to be more easily eliminated by chemotherapy or radiation therapy. The recovery time you generally much quicker than surgery and usually guided not require a hospital day.
The purpose of airway stenting is to relieve dear breathlessness due to airway obstruction caused by tumor or scarring (strictures) not suitable for surgery. The stents are usually placed by fiberoptic bronchoscopy with additional guidance by specialized x-ray devices (fluoroscopy). Techniques have been developed to manage benign and malignant lesions involving the central airway (trachea) and bronchial tubes. The stent may be made of plastic, covered were uncovered metal wire.
