The lung cancer specialists at the OHSU Knight Cancer Institute use the most advanced tests and therapies to diagnose and treat your cancer.

• Your care team will use molecular analysis to pinpoint your type of lung cancer and effective therapies.
• Our specialists work as a team to make sure every option and clinical trial is considered for your care.
• Our surgeons are experts in minimally invasive surgeries that preserve more of your lung and speed your recovery time.

Diagnosing lung cancer

Depending on symptoms or concerns, your primary care doctor could refer you to a pulmonologist (a lung and respiratory doctor), an oncologist (cancer doctor) or a thoracic (lung and chest) surgeon.

Lung cancer testing

• Biopsy: Your doctor removes a small piece of tissue or fluid from your lung or nearby organs. A doctor called a pathologist checks the tissue or fluid under a microscope for cancer cells.

• Fine-needle aspiration biopsy: A thin, hollow needle and syringe are used to remove fluid and tissue so they can be checked for cancer cells. The needle is guided with an ultrasound or CT scan.
• Core biopsy: A larger needle is used to extract more tissue.
• Endoscopy: Your doctor uses an endoscope — a thin, flexible, lighted tube with a video camera attached — to find and remove tissue so it can be checked for cancer.
• Bronchoscopy: Tissue is removed through a thin tube placed in your lungs.
• Thoracentesis: If you have fluid buildup around your lungs (pleural effusion), your doctor can use a needle to remove it and have it checked for cancer cells.
• Sputum cytology: Mucus coughed up from your lungs (sputum) is checked under a microscope for cancer cells.

Imaging: If cancer is found, scans might include:

• CT scan: A computed tomography scan uses X-rays to create detailed pictures of areas inside the body. This allows doctors to see the size and location of any lung tumor.
• PET scan: For a positron emission tomography scan, a small amount of radioactive material is injected to highlight cancer cells. The scan shows cancer that may have spread from the main tumor to another part of the body. Sometimes a PET scan is combined with a CT scan.
• MRI scan: Doctors use magnetic resonance imaging scans to see the size and location of a lung tumor. An MRI can also show if the lung cancer has spread to the brain or bones.

Treatments

Your treatment options will be based on your lung cancer type and stage, your general health and other factors.

Radiation therapy

Radiation therapy uses high-energy beams to shrink or destroy tumors. Most OHSU lung cancer patients have four to six weeks of radiation, combined with chemotherapy, to shrink tumors before any surgery. Radiation therapy can also be given during or after surgery. Types include:

• Stereotactic body radiation therapy: A machine sends a precisely focused beam to the tumor. The Knight Cancer Institute is the only Portland-area medical center with the extremely precise Novalis Tx radiosurgery system.
• Intensity-modulated radiation therapy: Computers and 3D images from CT scans help target tumors more accurately to lessen radiation to surrounding organs.
• Image-guided radiation therapy: Doctors use this therapy to track a tumor precisely. They adjust radiation to breathing and movement of the bladder and bowels. This limits exposure to healthy tissue.

Chemotherapy

Chemotherapy uses medications to kill cancer cells or to stop them from growing. It may be given as a pill or as an infusion (slow drip) into a vein or your spine.

• Before surgery: Chemotherapy given before surgery (neoadjuvant chemotherapy) can shrink a tumor or its spread.
• After surgery: Chemotherapy given after surgery (adjuvant chemotherapy) can kill cancer cells circulating nearly anywhere in your body.
• For advanced cancer: Chemotherapy can help control pain or other symptoms.

Surgery

Surgery removes cancer and nearby lymph nodes where cancer could spread. Your care team will recommend the best surgery based on your tumor's size and location as well as your overall health.

We use minimally invasive and lung-sparing techniques when possible, with tiny video cameras and surgical instruments. This offers less tissue damage and removal, less pain, faster recovery and usually fewer complications.

• Wedge resection or segmentectomy: A small wedge-shaped piece of lung is removed. This surgery removes less tissue than a lobectomy.
• Sleeve lobectomy: A lobe and part of its bronchus (the air passage that connects the lung to the windpipe) are removed. The remaining lobe or lobes are reconnected to the remaining bronchus.
• Thoracoscopic lobectomy: A thin tube with a camera is inserted into your chest through small incisions between your ribs. OHSU surgeons Mithran Sukumar and Paul Schipper pioneered this technique.
• Open lobectomy: Doctors use a chest incision to remove one lung lobe (the right lung has three lobes, the left two).
• Pneumonectomy: An entire lung is removed, leaving one healthy lung.

Immunotherapies

These promising therapies stimulate the body’s immune system to slow tumor growth. OHSU’s lung cancer team has found that they help many patients live longer and more comfortably with fewer side effects.

How they’re given: They may be given by pill or by IV, sometimes in combination with other treatments. Some are available through clinical trials. Your care team will talk with you about whether a trial is right for you.

Clinical trials

We offer access to leading-edge clinical trials to test new ways to detect, diagnose and treat lung and other cancers. This offers patients the chance to try treatments that are otherwise not yet available.

Support services

OHSU provides many support services to help you and your family. They include:

• Rehabilitation: Our rehabilitation experts can help you manage short- and long-term effects of cancer and cancer treatment.
• Palliative care: Our palliative care team can help you and your family manage symptoms as well as difficult decisions. You do not need to end cancer treatment or be terminally ill to receive these services.
• Cancer social workers: Our social work team can provide counseling, education and other services to help you and your family cope and manage conflict. They can also help with issues such as transportation and lodging.
• Other services: Find links to additional support services, including pastoral care, acupuncture for cancer and our resource center for cancer patients.

Learn more:

• Non-Small Cell Lung Cancer Treatment, National Cancer Institute
• Small Cell Lung Cancer Treatment, National Cancer Institute
• Treating Non-Small Cell Lung Cancer, American Cancer Society
• Treating Small Cell Lung Cancer, American Cancer Society