Thoracic Tests and Treatments

Tests

If you have a condition or symptom but don’t yet know the cause, your doctor may order tests to gather more information. Common tests include biopsy and state-of-the-art imaging. Once your tests are complete, you and your doctor will discuss the results, confirm your diagnosis and decide on next steps.

You may have one or more of these tests to help your doctor confirm diagnosis:

  • Medical history: We will review your medical history to look for clues that might show what type of lesion or tumor you have and what caused it.
  • Physical exam: Physical examination can sometimes provide additional information about the origin of your tumor or lesion.
  • Imaging studies: For many thoracic cancers, radiological imaging studies are the most valuable initial tool that we have. We will review any prior X-rays, CT scans, PET scans, MRIs, ultrasounds or other scans you have received.

You may be asked to undergo more imaging. Some tumors can be identified successfully based on their imaging characteristics, and others cannot.

  • Biopsy: For most tumors, a biopsy will be required. Biopsies can be performed in our clinic using an ultrasound or CT machine to visualize the tumor, or sometimes in the operating room. Many factors determine the type of biopsy you will receive, but some of the most common factors include the tumor’s location and potential diagnosis.
  • Lab studies: Sometimes sending a blood sample to a Dartmouth-Hitchcock lab for analysis is useful in determining a diagnosis.
  • Endoscopy: Endoscopy is a nonsurgical procedure used to examine the digestive tract, including the esophagus. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can carefully examine pictures of your digestive tract on a color TV monitor.

More information about diagnostic tests

Treatments

There are many types of benign thoracic conditions and types of thoracic cancer. The Comprehensive Thoracic Oncology Program offers a range of treatments. You and your doctor will discuss the best course of treatment for your condition, what you can expect for results, and what you may experience as side effects.

Systemic therapy

  • Chemotherapy uses anti-cancer drugs given intravenously to kill cancer cells that may be in your blood stream. Chemotherapy is sometimes used after surgery to reduce the chance of cancer returning in organs other than the primary site.
  • Immunotherapy activates the patient’s own immune system to attack the tumor cells, by removing the blockade induced by the cancer.
  • Targeted therapy (Precision medicine) uses drugs that affect specific molecules in the cancer cells that are important for the growth of the particular tumor. Prior to selecting such treatment, comprehensive genomic analyses of each lung cancer are performed, so that targeted therapy is individualized based on the composition of the tumor.

Our medical oncologists will meet with you to discuss your treatment options and potential side effects, and will follow you and your progress throughout treatment. Whenever possible, we coordinate treatment through outreach centers closest to your home so you can minimize your travel during therapy.

Interventional bronchoscopy

Combined with a bronchoscope, technologies such as lasers, spray cryotherapy and electrocautery are used to destroy cancer tissue and then remove it. These procedures can allow patients to breathe more easily, decrease shortness of breath and oxygen use and improve your quality of life.

Interventional pulmonology

Our program offers the only interventional pulmonology service in northern New England. Interventional pulmonology provides less invasive methods of diagnosis. Diagnosis of lung cancer is made easier and safer by combining ultrasound and bronchoscopy into an endobronchial ultrasound (EBUS). This technology allows your doctors to get a clearer picture of the lungs for accurate biopsy and diagnosis. EBUS improves "staging", or the extent of a tumor, and so can help avoid unnecessary treatments. We offer advanced care of tumors within the airway using techniques including laser therapy and stenting.

Minimally invasive and robotic surgery

Our thoracic surgeons take advantage of the latest technologies to provide minimally invasive and robotic options that are at the forefront of surgical care. This includes video-assisted thoracoscopic surgery (VATS), robotic video-assisted thoracic surgery (RVATS) and robot-assisted esophagectomy (RAMIE). We specialize in the use of these advanced options for diagnosis, staging and treatment of thoracic malignancies to decrease pain, shorten recovery time and improve outcomes for patients, while advancing surgical practice in cancer treatment, particularly of late stage and complex disease.

Radiation therapy

New technologies are enabling radiation oncologists to use radiation therapy as an alternative to standard surgery. Our team offers state-of-the-art treatment plans for radiation therapy including advanced radiosurgery with Trilogy™. PET-CT scans with hardware that tracks a patient's breathing cycle allow radiation beams to be switched on and off in time with the patient's breath—so the beams hit only the tumor in the lung as it moves. Radiation treatment recommendations can often be coordinated with physicians and hospitals throughout the New England Area.

Specialized gastroenterology

For the care of patients with esophageal cancer, we offer the most advanced techniques, including esophageal ultrasound, laser therapy, stenting therapy, endomucosal resection, and radiofrequency ablation.

Stent therapy

A stent is an important option when removal of tissue alone is not effective, or for late stage lung cancer. A stent is a metal or plastic tube placed in the airway to open a blocked airway or support a weakened one.

Stereotactic radiosurgery with the Trilogy™ system

The Trilogy system combines high definition x-ray and CT imaging with precise radiation delivery so a radiation oncologist can perform radiosurgery in the lung. Treatment is less invasive and can shorten treatment times and reduce side effects.