Omar Awais, DO, is the chief of thoracic and cardiovascular surgery at UPMC Mercy. He specializes in minimally invasive and robotic surgery and all aspects of thoracic surgery with a focus on thoracic oncology including lung, mediastinal, esophageal, and gastroesophageal cancers. Below, he discusses recent advances in lung cancer and treatment options.
What are the stages of lung cancer? What are the best treatment options for each stage?
Lung cancer is the number one cause of cancer-related death in the United States with 200,000 cases per year, and it kills more patients than breast, prostate, colon, and pancreatic cancers combined. As a thoracic surgeon, it’s my job to work with the team to help diagnose and determine if the patient needs surgery.
We work in collaboration with other team members including pulmonologists, cardiologists, medical oncologists, and primary care physicians. Our approach at UPMC is to give you a comprehensive evidence-based treatment of your lung cancer based on your clinical stage.
Clinical stage is determined using various imaging such as CT scan, PET scan, brain MRI, and specific tools to sample lymph nodes such as an endobronchial ultrasound (EBUS).
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Stage 1 and stage 2 lung cancer is confined to a lung, but in stage 2 cancer, the lymph nodes inside the lung are also compromised. In stage 3, multiple lymph nodes may be positive outside the lung, whereas in stage 4, the cancer has spread to other parts of the body such as the liver, bone, or brain.
For stage 1 and stage 2 lung cancers, surgery is the best option if the patient’s cardiopulmonary status is healthy, leading to the best long-term survival rate. For stage 3 lung cancer, a multimodality approach in collaboration with medical and radiation oncologists is preferred. In certain situations when you’ve isolated metastasis to the brain or other organs, we are still able to remove the primary lung cancer with an improved survival rate.
What is a robotic bronchoscopy?
A robotic bronchoscopy is a tool that helps us biopsy lung nodules deeper in the lung with more accuracy in order to detect your lung cancer early. Developed in 2018, a navigational robotic bronchoscopy can use the patient’s CT scan to create a virtual image of the airway to the target lesion, like a GPS system. This then allows us to navigate the bronchoscope precisely to the target nodule using a handheld controller.
Once at the target lesion, the robot arms can stabilize the bronchoscope, which allows us to safely and accurately biopsy the tumor with various tools. This technology allows us to get further in the lung and target smaller nodules with more precision to detect lung cancer early.
Our goal is to get a proper diagnosis, get ample tissue for molecular testing, and properly stage you so you can move forward with the treatment of your lung cancer. One of the benefits of using navigation robotic bronchoscopy in the operating room is that we can stage your lymph nodes under one anesthetic procedure, allowing for shorter times from diagnosis to treatment.
What is a pneumonectomy?
A pneumonectomy is removing the entire lung itself, which is rarely done today. This procedure occurs only in very specific clinical situations with central tumors of the lung. A pneumonectomy was the standard of care for early-stage lung cancer in the 1950s and 1960s, but now we commonly practice removing part of the lung, such as a lobectomy.
In other situations when the lung function is compromised due to emphysema, a segmentectomy, which is removing a section of a lobe of the lung, and wedge resection, which is removing a triangle-shaped lung tissue, can be performed. This allows us to perform the same oncologic operation while leaving as much lung as possible for you to breathe.
Is thoracic surgery a minimally invasive surgery?
Traditionally, most thoracic surgery was done open, but in the last 20 years performing the same operation using small incisions is becoming the preferred approach. This is because with open, bigger incisions patients experience more pain, a longer hospital stay, and a longer recovery time. Some studies have also suggested that there is an improved survival rate when you have your lung cancer removed using a minimally invasive approach. Despite our preferred minimally invasive approach in certain situations, an open approach may still necessary due to safety of the operation.
Cancer Care, Closer to Home
Patients can see Dr. Awais at the UPMC Outpatient Center on Clairton Boulevard. In addition to seeing patients in West Mifflin, he has office hours at UPMC Mercy, the UPMC Outpatient Center in Bethel Park, and UPMC at Oxford Drive in Monroeville. To learn more or schedule an appointment, please call 412-232-5665.
When you are facing cancer, you need the best care possible. UPMC Hillman Cancer Center provides world-class cancer care, from diagnosis to treatment, to help you in your cancer battle. We are the only comprehensive cancer center in our region, as designated by the National Cancer Institute. We have more than 70 locations throughout Pennsylvania, Ohio, and New York, with more than 200 oncologists – making it easier for you to find world-class care close to home. Our internationally renowned research team is striving to find new advances in prevention, detection, and treatment. Most of all, we are here for you. Our patient-first approach aims to provide you and your loved ones the care and support you need. To find a provider near you, visit our website.