Lung Cancer Specialists in the Greater Philadelphia Area

Our medical oncologists use the latest treatments to care for patients with lung cancer including non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Each patient is given a personalized treatment plan and the support they need throughout their cancer journey.

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Knowing the type of lung cancer is important because it affects the types of treatments that will work best. A medical oncologist, like those here at Consultants in Medical Oncology and Hematology, will recommend a treatment plan based on the lung cancer type, stage, and where it’s located in the lung or in other areas of the body.

You can depend on our experienced cancer care team to guide you through your lung cancer journey. Learn more about how lung cancers are diagnosed and treated so you can make informed decisions about your care.

Diagnosing Lung Cancer

Many tests are used to detect, diagnose, and even stage lung cancer. Tests are also used to learn if cancer has spread (metastasized) to another part of the body from where it started.

When choosing a diagnostic test the doctor will consider:

Size, location, and type of cancer suspected
Your signs and symptoms
Your age and general health
The results of earlier medical tests

In addition to a physical examination and discussion about your family health history, a biopsy is typically performed on the cells extracted from the lungs. The biopsy will determine if there are cancer cells present. The cells are removed in a few different ways including:

Bronchoscopy

This test uses a bronchoscope, which is a thin, tube-like instrument with a light and a lens for viewing, that is inserted through the nose or mouth into the trachea and lungs to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Thoracoscopy

A surgical procedure to check for abnormal areas by looking at the organs inside the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. Typically, an incision (cut) is made between two ribs to insert a thoracoscope into the chest for viewing or for using a tool to remove tissue or lymph node samples that are then checked under a microscope for signs of cancer.

Thoracentesis

This test uses a needle to remove fluid from the space between the lining of the chest and the lung. A pathologist then views the fluid under a microscope to look for cancer cells.

Additionally, the following tests are often used to diagnose and stage both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC):

Laboratory Tests

Includes testing samples of tissue (biopsy), blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time. Typically, a biopsy is the only sure way for the doctor to know if an area of the body has cancer.

Chest X-Ray

An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

CT Scan or MRI of the Brain, Chest, and Abdomen

A series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show more clearly.

PET Scan (Positron Emission Tomography Scan)

A small amount of radioactive glucose (sugar) is injected into a vein, which aims to find malignant tumor cells in the body. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Cancerous cells appear as bright spots on the images taken during the scan. Even if a tumor is not visible, the PET scan results give the oncologist a sense of where the cancer is trying to go.

Sputum Cytology

A microscope is used to check for cancer cells in the sputum (mucus coughed up from the lungs).

Radionuclide Bone Scan

This procedure is used to check if there are rapidly dividing cells in the bone, such as cancer cells. A very small amount of radioactive material is injected into a vein and travels through the bloodstream, where it collects in the bones and is detected by a scanner.

Endoscopic Ultrasound (EUS)

A procedure, called endosonography, in which an endoscope is inserted into the body. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The picture that is formed from the echoes is called a sonogram.

Stages of Lung Cancer

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Knowing the stage helps the oncologist recommend the best treatment options for the patient and even predict the prognosis (chances of survival).

After determining a diagnosis of small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC), additional testing determines if the cancer cells have spread within the chest or to other parts of the body. Information gathered determines the stage of the disease and the treatment plan.

The staging for small cell lung cancer is different from non-small cell lung cancer. Below are the different stage descriptions for the different types of lung cancer.

Small Cell Lung Cancer Staging

The most common way doctors stage SCLC is by classifying the disease as limited stage or extensive stage:

Limited-Stage Small Cell Lung Cancer

In limited-stage small cell lung cancer, cancer is found in one lung, the tissues between the lungs, and/or nearby lymph nodes only.

Extensive-Stage Small Cell Lung Cancer

In extensive-stage small cell lung cancer, cancer has spread outside of the lung in which it began or to other parts of the body.

The TNM system is a more formal system used to describe the stage of lung cancer, however, SCLC is almost always staged as a limited or extensive stage, as described above.

Non-Small Cell Lung Cancer Staging

There are 5 stages for NSCLC: stage 0 (zero) and stages I through IV (1 through 4). The stages are as follows:

Occult (Hidden) Cancer

In this stage, the cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy, or the primary tumor is too small to be checked.

Stage 0 (Carcinoma in Situ)

Abnormal cells are found in the innermost lining of the airways. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ (localized).

Stage I Lung Cancer

A stage I lung cancer is a small tumor that has not spread to any lymph nodes. Stage I is divided into 2 substages based on the size of the tumor:

Stage IA:
Stage IA tumors are 3 centimeters (cm) or less in size. Stage IA tumors may be further divided into IA1, IA2, or IA3 based on the size of the tumor.

Stage IB:
Stage IB tumors are more than 3 cm but 4 cm or less in size.

Stage II Lung Cancer

Stage II lung cancer is divided into 2 substages:

Stage IIA:
Stage IIA cancer describes a tumor larger than 4 cm but 5 cm or less in size that has not spread to the nearby lymph nodes.

Stage IIB:
Stage IIB lung cancer describes a tumor that is 5 cm or less in size that has spread to the lymph nodes within the lung, called the N1 lymph nodes. A stage IIB cancer can also be a tumor more than 5 cm wide that has not spread to the lymph nodes.

Stage II tumors can often be removed with surgery, but often additional treatments are recommended.

Stage III Lung Cancer

Stage III lung cancers are categorized as either stage IIIA, IIIB, or IIIC. The stage is dependent on the size of the tumor and which lymph nodes the cancer has spread to. Stage III cancers have not spread to other distant parts of the body.

Stage IIIA (1):
The cancer has spread to the lymph nodes on the same side of the chest as the main lung tumor. The tumor has one or more of the following features:

The tumor is 5 centimeters or smaller.
It has grown into the main bronchus but is not in the carina.
It has grown into the innermost layer of the membrane that covers the lung.
It is partially clogging the airways.

Stage IIIA (2):
The cancer has also spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung. These lymph nodes are on the same side as the cancer. The tumor has one or more of the following features:

It is larger than 5 centimeters but not larger than 7 centimeters across.
It has grown into the chest wall, the inner lining of the chest wall, the phrenic nerve, or membranes of the sac surrounding the heart.
There are 2 or more separate tumor nodules in the same lobe of a lung.

Stage IIIA (3):
The cancer may or may not have spread to lymph nodes within the lung and/or around the area where the bronchus enters the lung. Any affected lymph nodes are on the same side of the chest as the primary cancer. The tumor has one or more of the following features:

It is larger than 7 centimeters across.
It has grown into the space between the lungs, heart, large blood vessels near the heart, trachea, esophagus, voice box, diaphragm, backbone or breastbone, or the carina.
There are 2 or more separate tumor nodules in different lobes of the same lung.

Stage IIIB (1):
The cancer has spread to lymph nodes near the collarbone, and/or has spread to lymph nodes on the other side of the body from the primary tumor. The tumor has one or more of the following features:

It is larger than 3 centimeters but not larger than 5 centimeters across.
It has grown into the main bronchus but is not within the carina.
It has grown into the innermost layer of membrane that surrounds the lungs.
It is partially clogging the airways.

Stage IIIB (2):
The cancer has spread to lymph nodes around the carina or in the space between the lungs. These lymph nodes are on the same side as the main lung tumor. The tumor has one or more of the following features:

There are 2 or more separate tumor nodules in the same lobe of a lung.
It has grown into the space between the lungs, heart, large blood vessels near the heart, trachea, esophagus, the voice box, diaphragm, backbone, breastbone, or the carina.

Stage IIIC:
The cancer has spread to lymph nodes near the collarbone, and/or has spread to lymph nodes on the other side of the body from the main tumor. The tumor has one or more of the following features:

There are two or more separate tumors in the same lobe or a different lobe of the lung with the primary tumor.
It has grown into the chest wall, the inner lining of the chest wall, the phrenic nerve, membrane surrounding the heart, large blood vessels near the heart, trachea, esophagus, diaphragm, the breastbone or backbone, or the carina.

Stage IV Lung Cancer

Stage IV NSCLC is categorized as either stage IVA or IVB. Cancer can be any size and may or may not have grown into nearby structures or spread to the lymph nodes.

Stage IVA:
Cancer has spread within the chest and/or has spread to 1 area outside of the chest.

Stage IVB:
Cancer has spread outside of the chest to more than 1 place in 1 organ or to more than 1 organ.

Your CMOH oncologist and care team will use your staging test results to create the most effective treatment plan that will be tailored to meet all of your needs. Treatment for lung cancer can include one or a combination of treatments, including chemotherapy, targeted therapy, immunotherapy, surgery, and radiation therapy.

Different types of treatment are available for patients with lung cancer. Some treatments are standard (currently used treatments), and some are being tested in clinical trials. A clinical trial is a cancer research study meant to help improve current treatments or obtain information on new treatments for patients with a particular type of cancer. If eligible, patients may want to think about taking part in a clinical trial.

View Clinical Trials

Surgery to Remove Lung Cancer

Surgery is most commonly used to treat early stages of NSCLC. While it can be an option for some early-stage SCLC, it is rarely used as the primary treatment since SCLC has usually spread past the lungs at the time of diagnosis. Lung cancer surgery can involve removing a portion of the lung or the entire lung through procedures including:

Lobectomy:
The removal of an entire lobe of the lung

Segmentectomy:
Removal of the portion of the lung where the cancer developed

Wedge resection:
Removal of a tumor and some of the normal tissue around it

Pneumonectomy:
The removal of the whole lung

Even if the doctor removes all of the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that may remain. Treatment that is given after surgery to lower the risk of the cancer coming back is called adjuvant therapy.

Radiation Therapy for Lung Cancer

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. The way radiation therapy is given to lung cancer patients depends on the type and stage of the cancer being treated. There are two types of radiation therapies:

External Radiation Therapy:

The use of a machine outside the body to send radiation toward the cancer.

Internal Radiation Therapy (Brachytherapy):

The use of a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. This is usually done through a bronchoscope— a procedure called endobronchial brachytherapy— but it may also be done during surgery. Prophylactic cranial irradiation (radiation therapy to the brain to reduce the risk that cancer will spread to the brain) may also be given. This is primarily only used for small cell cancer that has moved into the bronchial area.

Lung Cancer Medical Oncology Therapies

Treatments using medication are used to destroy cancer cells. Medications are often given through an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of medication therapies used for lung cancer include:

Chemotherapy
Targeted therapy
Immunotherapy

Chemotherapy for Lung Cancer

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. The way the chemotherapy is given depends upon the type and stage of the cancer being treated.

Targeted Therapy for Lung Cancer

Targeted therapy uses drugs or other substances to attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy does. Monoclonal antibodies and tyrosine kinase inhibitors are the two main types of targeted therapy being used to treat advanced, metastatic, or recurrent non-small cell lung cancer.

Late-stage lung cancer patients, or those with recurring lung cancer, are more likely to have biomarker testing to identify if a genetic mutation is present that indicates one of the drugs can be used that targets cells with the specific cancer-causing genetic mutation.

Because of this, non-small cell lung cancer patients may go through some testing for genetic mutations in the cancer cells, called biomarker testing or genomic testing. Biomarker testing looks for changes in the DNA that may have been caused by exposure to things in the environment known to harm the lungs. The type of genetic mutation that’s found will direct the first line of treatment that’s recommended.

There are currently FDA-approved targeted therapies for NSCLC tumors showing the following genetic mutations:

EGFR
KRAS
ALK
ROS-1
NTRK
MET
RET
BRAF V600E
PDL-1

A different lung cancer treatment approach will be recommended for patients who test negative for biomarkers. They may also be eligible for a clinical trial that identifies treatments based on other biomarkers found outside of those with an established targeted therapy.

Immunotherapy for Lung Cancer

Immunotherapy, also called biologic therapy, uses drugs to help the body’s immune system kill cancer cells. There are several classes of immunotherapy drugs that work in different ways. The immunotherapies currently available to treat lung cancer all belong to a class called checkpoint inhibitors.

Find a Lung Cancer Specialist in the Greater Philadelphia Area

The specialists at Consultants in Medical Oncology and Hematology work with you to ensure you are recommended the most effective lung cancer treatment plan. We encourage you to take the time to evaluate your options and choose the cancer care team you feel the most comfortable with. Contact us today at our convenient locations including Broomall and Glen Mills, Pennsylvania.