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Treatments

If a carcinoid tumor is caught early, complete removal and cure (by surgical resection) is possible. Depending on the size and location of the tumor, resection (or removal) may involve removing part of the lung or bronchial tube, or it may only require local excision (or removal) of the abnormal tissue. Occasionally, laser or photodynamic therapy is used with surgery. After the procedure, patients are monitored in the intensive care unit to make sure they are ready to be discharged.

Surgical Resection

Surgical resection uses surgery to remove abnormal tissue, such as mediastinal, neurogenic, or germ cell tumors, or thymoma. Surgery may provide a cure in some cancer cases, when the tumor is discovered early. The physician will recommend one of the following types of resection, depending on the diagnosis. In the case of cancer, the type of resection will be based on the tumor location, size, and type, as well as the patient’s overall health prior to diagnosis.

Sternotomy

The surgeon makes an incision in the center of your chest and separates the sternum (breastbone). The surgeon then locates and removes the tumor.

Thoracotomy

Thoracotomy involves the surgeon making an incision in your side, back, or in some cases between your ribs, to gain access to the desired area.

VATS

VATS stands for video-assisted thorascopic surgery. This minimally invasive alternative to open chest surgery greatly reduces patient’s pain, recovery time and risk for infection. When using VATS, the physician makes tiny incisions in the patient’s chest and inserts a thorascope (a fiber-optic camera) as well as surgical instruments. As the physician turns the thorascope, its views are displayed on a video monitor to guide surgery. The surgeon has no need to stress or cut ribs, because all movements are performed at the tip of the instrument, at the point of contact with the cancerous tissue.

Robotic-Assisted Mediastinal Tumor Resection

The surgeon uses a computer-controlled device that moves, positions, and manipulates surgical tools based on the surgeon's movements. The surgeon sits at a computer console with a monitor and the camera provides a three-dimensional view of the heart that is magnified ten times greater than a person's normal vision. The surgeon's hands control the robotic arms to perform the procedure.

How to Prepare

It is important to follow any physician instructions to prepare for surgery. These instructions generally include:

  • Refraining from eating or drinking anything after midnight on the night before
  • Bringing all medications to the hospital
  • Arriving one hour prior to surgery time

The patient may have a pre-admission appointment one to two weeks beforehand, in which they will have routine blood testing, any heart imaging, such as an electrocardiogram, and consultation with the anesthesiologist.

If possible, patients are encouraged to do some mild physical activity such as walking, and eat a balanced diet, leading up to their scheduled surgery. In the week before, they should:

  • Limit alcohol consumption to one to two glasses per day.
  • Stop using tobacco.
  • Make a list of all medications taken and bring it with them. Include prescription and over-the-counter medications, herbs, supplements, aspirin, and corticosteroids.

What to Expect

On the day before the procedure, the patient should receive a call from the hospital. They will be given information about the day of the procedure, including where to go and when to arrive. Patients should leave any jewelry, credit cards, or other valuables at home, and wear comfortable clothes.

When the patient arrives, he or she will be taken to a pre-surgery area to measure their temperature, blood pressure, pulse, and listen to their heart and lungs. An intravenous (IV) line will be placed in their arm, so that medications and fluids may be administered before, during, and after the procedure.

Surgery may take several hours. Family members may wait in the Family Waiting Room, located on the 2nd floor, room 2501 in the Newton Pavilion.

Recovery

After surgery, patients are taken to the Post Anesthesia Unit and monitored for any changes in blood pressure, heart rate and breathing. An IV line will remain in their arm to keep them hydrated and administer pain medication, if necessary. If a breathing tube was inserted during surgery to control breathing, it may remain in place for a brief time. The patient will likely have one or two tubes placed during surgery to drain fluids for several days.

Before the patient is discharged, the physician or nurse will instruct how to care for their incision. Gradually, over the course of a few weeks, patients will regain their strength and be able to return to work and participate in physical activity. Patients should always take their medicine exactly as prescribed and call their doctor if they have questions or notice any of the following:

  • Bleeding
  • Infection
  • High temperature
  • Allergic reaction, such as redness, swelling, trouble breathing
  • Pain

Photodynamic Therapy

Photodynamic therapy (PDT), also called photoradiation therapy, phototherapy, and photochemotherapy, has existed for about 100 years and is a type of cancer treatment that uses light to kill abnormal cells. A special drug called a photosensitizer or photosensitizing agent is circulated through the bloodstream.

After the agent has been absorbed by the cancer, usually over a period of a few hours to a few days depending on the drug used (this is called the drug-to-light interval), the tumor is exposed to a special kind of light. The light and the agent create an active form of oxygen that destroys cancer cells. PDT is thought to potentially also destroy tumor-feeding blood vessels and stimulate the immune system to attack the cancer cells.

PDT is currently approved by the Food and Drug Administration to treat or relieve the symptoms of esophageal cancer and the most common form of lung cancer, called non-small cell lung cancer. A handful of photosensitizers are approved, and the clinical team will determine the best one for each patient, depending on their specific diagnosis. PDT light sources range from laser and pulsed light to blue light and red light.

PDT is a promising treatment for certain types of tumors and because in some cases it can cure cancer. It is also:

  • Less invasive and quicker than surgery and other procedures
  • Leaves little to no scarring and has no long-term side effects
  • Can be targeted very precisely to cancerous cells
  • Can be repeated many times at the same site.

Treatment can make the eyes and skin especially sensitive to light for six weeks or so, however. Patients should avoid direct sunlight and bright indoor light during this period. Because the basis of phototherapy is light, its treatment is limited to areas on or just below the skin. Newer, more sophisticated photosensitizing methods are in development.

Side effects are rare, but may include:

  • Burning, swelling, or pain on or below the skin's surface
  • Coughing
  • Trouble swallowing
  • Painful breathing
  • Shortness of breath

How to Prepare

It is important that patients follow any instructions given to them by their physician, to prepare for surgery.

What to Expect

Each session of PDT is relatively simple. Upon arrival, patients receive either a photosensitizer drug then and wait a few minutes or hours until it has concentrated in the tumor, or they may have the drug administered and return days later for phototreatment. For phototreatment, the patient will lie on a comfortable examination table, and an anesthesiologist administers local or general medicines to control pain and relax the patient. Then the appropriate type of light is activated over the tumor in a strong, targeted beam. The procedure may take a few minutes or up to two hours.

Recovery

Recovery from PDT is typically quite easy. Patients may experience some dryness or mild burning on the skin, but other effects are uncommon. Gentle skin products such as Vaseline can be helpful. Patients should avoid the sun, as sensitivity will be increased for a time following PDT; even a few minutes of sun exposure can sometimes cause discomfort. It is important to follow the doctor's instructions regarding medications and physical activity, but most likely patients will be able to return to their normal activities right away.

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