What role does a pulmonologist play in cancer treatment?

You may know that a pulmonologist specializes in treating diseases like pneumonia and asthma, but these specialized doctors also play a key role in treatment for lung cancer and cancers that have spread to lungs, such as breast cancer, kidney cancer and ovarian cancer. At MD Anderson, our pulmonologists help confirm a cancer diagnosis and determine the disease’s stage as well as if it has spread -- all of which are needed to determine the best treatment plan for our patients.

To better understand the role that these specialists play in cancer care and what you can do to prepare for you appointment, we spoke with pulmonologist George Eapen, M.D. Here’s what he shared.

How is cancer in the lungs diagnosed?

Patients typically learn they may have cancer in a lung during an ER visit, or an appointment with their primary care physician for a persistent cough, shortness of breath or chest pain. The doctor will request scans, and if there’s an abnormality (sometimes called a nodule or a mass), you will see a pulmonologist for a confirmation of diagnosis through biopsy.

What questions will be covered during an initial consultation with a pulmonologist?

We’re looking for clues to help form a diagnosis. We want to know any details you can share about when your symptoms started and anything that makes your symptoms better or worse.

Also, tell us if you’ve undergone sedation before and if you had any difficulties with that experience. We also need to know if you have a history of heart disease or if you’re on a blood thinner. These are all risk factors for complications, so this information helps us be better prepared.

How should a patient prepare to see a pulmonologist?

Bring any prescriptions that you take, as well as any inhalers or sleep apnea devices. Plan to bring someone who can drive you home after the procedure. And write down your questions beforehand. But the most important thing is to come prepared with your records and the timeline of your illness.

How is a nodule biopsied?

Biopsy requires removing a piece of tissue from the nodule. Ideally, we can access the area we need to biopsy through a bronchoscopy, which allows us to reach through the airway into the lung. But if it’s not possible, we may pass a needle through the chest wall into the lung to get the biopsy.

To determine if the cancer has spread, we also typically take a sample of the lymph nodes along the airway as well. A bronchoscopy allows us to biopsy the lung nodule and sample the lymph nodes in the same procedure. We can also test the lymph nodes with a small incision in the lower neck with a procedure called a mediastinoscopy.

Are there risks with a biopsy?

The two main risks are the lung collapsing or excessive bleeding. The lung is lined on the outside by a structure called the pleura. If you tear this lining, air will escape from the lung and accumulate outside in the chest cavity, causing it the lung to collapse. The risk of the lung collapsing is greater with a mediastinoscopy. And although a collapsed lung is a serious event, we typically can  place a small catheter in the pleural space to remove the air and quickly stabilize the lung.

In regards to bleeding, everyone will bleed a little bit when a biopsy is taken; it is very rare that patients bleed so heavily that they require a transfusion or we need to go in and cauterize the area.

What are the next steps if the nodule is cancerous?

At MD Anderson, your case is presented at a multidisciplinary conference that includes pulmonologists, radiologists, radiation oncologists, medical oncologists and thoracic surgeons. At MD Anderson, this conference is comprised exclusively of doctors who specialize in cancers of the lungs, so they have extensive knowledge of how cancer works in this specific part of the body and the most effective treatment options. This team works together to come up with the best treatments and clinical trial options for you. The conference allows different specialties to provide input and expertise on each patient’s care so we can develop the best treatment plan for your specific case.

What’s your advice for patients seeing a pulmonologist?

Ask to see your films. I think it’s very different to actually see something while hearing the explanation than just hearing it from your doctor. I can describe the Mona Lisa to you — the size, the colors, the subject — but you don’t really understand until you see it yourself.

And don’t be nervous. It’s easy to fear the worst. But remember that you’re not alone. You have a dedicated team to help you. Also you’re not going into a closed room — there’s always another door or even a window. Whatever happens, we’re going to be able to manage it.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.