St. Clair Health provides expert thoracic surgeons close to home to support patients through some of their most difficult times. Thoracic surgery focuses on the chest organs, including the heart, lungs, esophagus, and trachea. With technological advances, it has increased the safety and availability of these complex surgical procedures. St. Clair’s Thoracic Surgery team works closely with medical oncologists and radiation oncologists affiliated with UPMC Hillman Cancer Center, radiologists, pathologists, and nurse navigators. Frequent collaborative discussions occur with this team of experts to help guide patient care and treatment through every step.

Types of Adult Thoracic Cancers

• Chest Wall Tumors where a tumor may grow in the chest (thoracic) cavity that is enclosed by the spine, ribs and sternum (breast bone).
• Esophageal Cancer in which malignant (cancer) cells form in the tissues of the esophagus.
• Lung Cancer develops when normal lung cells change, or mutate, in a way that alters their natural growth and death cycle, resulting in unregulated cell division that produces too many cells.
• Mediastinal Tumors, both benign and malignant (cancerous) are rare but do occur. The mediastinum contains the heart, thoracic aorta, trachea (airway), esophagus (swallowing passage), thymus gland, and lymph nodes.
• Mesothelioma is a tumor of the tissue that lines the lungs, stomach, heart, and other organs.
  Cancerous (malignant) mesothelioma is the most common form, usually affecting the lungs.
• Pulmonary (Lung) Nodules is an abnormal growth that forms in a lung.
• Thymoma Tumors are a type of rare cancers that can form in the cells that cover the outside surface of the thymus. The thymus is a small organ that lies in the upper chest above the heart and under the breastbone.

Diagnostic Tools

Diagnostic tools are tests or procedures that are used to determine if an area is benign or malignant. It may take several of these tests to get a precise diagnosis and this process is critical in creating a personalized care plan for the patient. It is our goal to guide each patient through the process and determine best next steps. 

Imaging

• CT scans, which use X-rays to create cross-sectional images of the chest. 

• MRI scans, which use radio waves and strong magnets to create detailed images of soft tissue. Like CT scans, they can produce detailed images of the tissue in the chest cavity. They are most often used to see if lung cancer has spread beyond its initial site.

• PET scans, which use fluorodeoxyglucose (FDG) injected into the body to illuminate cancer cells. It’s also useful in determining if cancer has spread beyond the initial site. 

• PET/CT scans, which combine the technology of both to give the doctor an even more detailed image.

Other Tools

• Biopsies are the most common tool to obtain tissue for diagnosing lung cancer. 
• Endobronchial Ultrasound (EBUS) is a kind of bronchoscopy with an ultrasound probe that can send sound waves throughout the chest cavity, allowing doctors to look at the area on an ultrasound monitor. 
• Mediastinoscopy is a surgical procedure that requires general anesthesia. An incision is made in the neck so that a lighted instrument called a mediastinoscope can be inserted to examine the area between the lungs known as the mediastinum. 
• Navigational Bronchoscopy is a biopsy done by passing a tube called a bronchoscope through the patient’s mouth or nose, down into the trachea (windpipe) and then into the lungs where the suspicious nodule is located. This allows doctors to see inside the lungs of a patient.
• Video-Assisted Thoracoscopy (VAT) allows the doctor to see where the nodule is located, as well as the surrounding area. 
• Wedge Resection is surgery is used to remove a triangular section of tissue, including a nodule or tumor. It may be used as a diagnostic procedure to determine if a suspicious nodule is cancerous. 

Surgical Oncology 

• Thoracotomy
  This is an incision on the side of the chest and follows the curve of your ribs. It typically involves dividing some of the muscles of the chest wall and uses an instrument to gently spread between two ribs to provide the surgeon access to the lung. The muscles are repaired when the incision is closed.
• Minimally Invasive / Robotic Surgery
  This approach typically involves 1 to 4 small incisions to access the inside of the chest. The surgeon uses a camera to visualize the lung and special instruments to perform the surgery. This is known as thoracoscopy or video-assisted thoracoscopic surgery (VATS) and can also be done with the assistance of a surgical robot.

Medical Oncology

Medical Oncology uses chemotherapy, immunotherapy, and targeted drug therapy to focus on specific mutations and to eliminate cancer cells. Chemotherapy is typically part of the treatment for lung cancer. This is because the cancerous cells have usually already spread by the time it is found, so other treatments such as surgery or radiation therapy would not reach all areas of cancer. 

Radiation Oncology

Radiation therapy uses powerful energy sources, such as X-rays and protons, to eliminate cancer cells. It might be used to shrink a large cancer before an operation so that it can be removed more easily. When surgery isn’t an option, radiation therapy might be used to relieve symptoms, such as pain. Sometimes radiation is combined with chemotherapy.

Survivorship Resources/Patient Education

Although cancer doesn’t have to define you, the disease changes your life in a number of ways. You’ll have to deal with the immediate and long-term physical effects of treatment, ongoing screening and monitoring, new concerns about staying healthy and a wide range of emotions.

This post-treatment period is called survivorship. While survivorship varies from patient to patient, there are some common concerns that often affect cancer survivors. We encourage you to follow up with your specialist and team for local recommendations regarding survivorship resources and support programs.