Slowly, with every movement carefully planned, the scope snaked its way into the narrow airways deep in the lungs.
Dr. Faisal Khan, a pulmonologist with the Center for Respiratory and Sleep Medicine with Franciscan Health, guided the device through the patient. His target was a suspected growth in a small crevice of the lungs that had showed up on a scan.
He followed the precise route to the troublesome spot, aided by three-dimensional body images and a magnetic field that made movements less than a millimeter possible.
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“Up until a few years ago, the biggest hurdle was reaching the peripheral regions of the lungs,” Khan said. “Now, you have a live location of where you are in the lung. You coordinate that with the procedure you’ve already planned.”
Five years ago, finding out if a concerning growth that far into the lungs was cancerous would have been impossible. But a combination of new technologies has allowed the medical community to better identify, test and treat lung cancer.
The technique is called electromagnetic navigation bronchoscopy, and it works by creating a digital map into the smallest folds of the lungs, giving doctors a safer and more effective way to examine potentially cancerous growths in the airways.
Sections of the lungs that had been impossible to reach traditionally, or at least extremely difficult to get to, are now accessible. That means cancer can be diagnosed sooner, and the odds of successfully treating it go up, Khan said.
“If we can get a diagnosis on that isolated spot, we can actually cure the patient by taking it out and sending them to a surgeon,” he said. “The earlier you take out the cancer, the better your chances of surviving the disease are.”
Barbara Martin considers herself lucky that her lung cancer was discovered in the first place.
The Bargersville resident had no symptoms — her breathing was normal, there was no pain and she’s never had issues with her lungs in the past.
But throughout her life, Martin has suffered from calcium deposits in her veins, particularly in her legs. To better improve the flow of blood, stents have been implanted at the most afflicted veins.
Periodically, she goes in for scans to ensure the stents are working as they should.
Martin had been experiencing some pain in her legs in June and went to the doctor to check what may be the problem. Her lower body was scanned, and accidentally, the imaging included the lower portion of her lungs.
That’s how the concerning growth was discovered.
“When that scan came back and they saw that, I was immediately set up with the Cancer Center,” she said.
In the U.S., lung cancer is responsible for 25 percent of all cancer deaths. More people die each year from it than from breast, prostate and colon cancers combined, according to the American Cancer Society.
A majority of lung cancers form, incubate and expand in the periphery of the lungs.
“Typically, in the early stages of the cancer, when it would be best to treat it, it doesn’t give off any symptoms because is it a small growth,” Khan said. “Patients don’t have the signs, and by the time it grows enough to give symptoms, it’s already a late-stage cancer.”
In 75 percent of the cases, by the time the cancer exhibits noticeable signs, it has already reached the later stages of development.
“Lung cancer mortality is so high because by the time it presents, it’s Stage 3 or 4 cancer,” Khan said. “Stage 3 or 4 cancer, you’re talking more control than cure. Your best chance is if you can diagnosis it early on.”
The lungs present a significant challenge for medical teams hoping to gain a clearer picture of potential health problems.
Previously, the only way to get a biopsy of a potential lung cancer was by passing a large needle through the outside of the chest into the lungs, risking the potential of puncturing the lungs.
A surgeon could also open up the lungs to access the spot, which is much more invasive and risky.
The most common tool in finding lung cancer is a bronchoscope, which is inserted into the lungs and navigated through the maze of sacs and passages within the organ.
A standard bronchoscope can range from sizes of 2 millimeters to 6 millimeters — the size of the tip of crayon to the width of a pencil eraser.
The scopes are tiny by conventional standards but too large to effectively move through the maze within the lungs.
“The airways as we go into the lungs split into right and left. Then they branch off like branches of the tree, and each successive branch gets narrower and narrower,” Khan said. “The scope can only go so far. Beyond a certain airway branch, it cannot go.”
Traditional bronchoscopes can only effectively work in the central region of the lungs. Because of that, surgeons and physicians have been unable to visually see the entirety of the airways.
That is particularly troublesome when dealing with lung cancer such as Martin’s, Khan said.
Scans revealed a potentially cancerous spot in her lower left lung, while a slightly smaller growth was found opposite it on the upper right side. After Martin’s diagnosis, it was recommended she see Khan.
He explained to Martin how difficult it would be to try and get a sample from both sections.
“You’re still invading the lung area, but it would be hard to get the tool back up and get a second sample,” Martin said.
Eventually, they opted to go with the electromagnetic navigation bronchotomy. With the new system, doctors can collect samples from multiple sites on the lung. That wasn’t possible previously, Khan said.
“For a patient, it’s a one-stop deal, where they get the diagnosis and staging at one time. It’s faster, quicker, and you get easier, quicker answers to move along with the treatment,” he said.
The new system allows physicians reach the most narrow recesses of the lungs with a viewing and surgical tool called a bronchoscope. Physicians start with a computerized tomography scan of the lungs, using x-rays taken at different angles to create a cross-section of the organ.
If what could be a cancerous spot appears on the scan, Khan can load it into the new system to create a three-dimensional map of the lungs and the airways.
With that map loaded into the navigation system, physicians identify exactly where the lesion is located. They create a virtual pathway to it, providing pinpoint directions of how to reach the concerning area of the lungs.
“It’s kind of like the GPS on your car, with all of the information about local roads and everywhere you need to go,” Khan said.
The initial research allows physicians to have a clear plan heading into the actual bronchotomy procedure. Patients lay on a magnetic board, and sensors are placed on their chest.
The bronchoscope, with a catheter to detect the magnetic field the patient is on top of, is inserted into the body. Minute tools passed through the scope allow for physicians to take biopsies of concerning growth.
In Martin’s case, the biopsies identified the growths as Stage 4 lung cancer.
Chemotherapy started in late July, in an effort to keep the tumors from growing and spreading. The plan called for about five sessions of medication every three weeks, before another scan would determine the effectiveness of the treatment.
“It wasn’t what I hoped for, obviously. But my brain is cancer-free, so I can do the treatments that we’re doing now,” she said. “Hey, it’s better than a kick in the head.”
Martin has accepted that her disease has no cure. But by starting treatments now, it can ideally be contained. The cancer had not spread throughout her body, and she’s thankful that it was discovered before nothing could be done.
She had seen what can happen when cancer grows unabated.
Martin’s husband died of mesothelioma in 2002. By the time he started seeing symptoms and saw a doctor, the cancer had riddled his lungs.
Seeing the diagnostic abilities that doctors had when he was sick, versus what they’ve been able to do for her, is striking.
“They weren’t able to do anything like this,” she said. “They could do surgery to be sure what it was, but they didn’t have the efficiency of what they could do for me.”