The division of thoracic oncology primarily treats patients with all thoracic malignancies such as tumours of the lung, oesophagus, mediastinum and chest wall. It also serves patients with pulmonary metastases from other cancers. Most patients require multidisciplinary treatment. Based on the latest available evidence, the patient is offered surgery (including minimal invasive surgery to improve operative outcomes) or a combination of chemotherapy/radiation therapy and surgery. In the near future, patients will also be able to participate in clinical trials.
For cancer of the oesophagus and cardia, surgery is the standard of care for medically fit patients. Patients with locally advanced disease are downstaged with chemotherapy or a combination of chemo and radiation therapy and are then re-assessed for surgery. Patients with advanced cancer and poor general condition are palliated with a self-expanding stent.Oesophageal surgery is one of the most complex procedures, best performed by a specialist in a well-equipped centre. The surgeon in this division performs oesophagectomy using the minimally invasive surgical technique which has the potential to improve the operative outcomes.
Surgery provides the best chance of cure for early stage lung cancer. Surgical options include lobectomy, sleeve lobectomy and pneumonectomy. In patients with compromised lung function, segmentectomy or wedge resection is an option in selected cases. To improve the operative outcome, surgery can be performed using the video-assisted thoracoscopic technique in cases where indicated. Mediastinal adenopathy is not a contraindication for surgery as many of these patients can be downstaged by induction chemotherapy. Patients with locally advanced cancer, such as those with invasion of the chest wall, vascular structures and tracheo-bronchial tree, can be considered for aggressive surgical approaches. Patients with advanced stage disease are treated with a combination of chemotherapy, radiation, pleurodesis and are provided supportive care, including management of cancer pain.
The division is capable of performing complex surgical procedures for lung pathology, including VATS. The centre can also treat small lung cancers with precise radical radiation in patients with compromised lung functions.
Tumours of the mediastinum are rare and require skilled radiologists and surgeons for proper diagnosis, staging and treatment. The centre has facilities for image-guided biopsy, mediastinoscopy, transbronchial biopsy and thoracoscopy for diagnosis and surgical management. Thoracoscopic thymectomy is a good approach for the treatment of myasthenia gravis when surgery is indicated. It does away with sternotomy and reduces hospital stay.
Chest Wall Tumours
Surgery is the treatment of choice for sarcoma and is also indicated in round cell tumours after chemotherapy. Resection of multiple ribs requires reconstruction with mesh and cement.
Patients with pulmonary metastases are candidates for surgery if the primary is controlled or controllable and is the only site of metastases. Patients with solitary metastases can be managed with VATS. Those with bilateral metastases can be managed with the clamp shell approach.
Tumors of the Airway (Trachea and Bronchus)
These tumours can be treated by surgery when indicated and many others can be managed endoscopically with laser or thermal excision-fulguration. Tumours which are advanced are treated with radiation (including intraluminal) therapy.
This is a relatively rare tumour. Most patients present with advanced stage disease and are treated with chemotherapy (pemetrexate/platinum). In patients who have limited or localised disease, pleuro-pneumonectomy is the preferred treatment.
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