Lung cancer is a leading public health problem in the United States today and is responsible for more deaths than any other cancer. Successful treatment of a patient with lung cancer is based on a multimodality, comprehensive thoracic oncology program. At Mount Sinai Hospital all patient needs are addressed according the needs of the individual patient and family.

Diagnostics

A wide spectrum of screening and diagnostic tests are available at Mount Sinai, including:

• Advanced endoscopic techniques designed to detect early lesions and early recurrence.
• A full range of radiological testing, including advanced CT and PET capabilities, as well as innovative MRI technology with ultrasensitive resolution.

Treatments

Mount Sinai offers a broad range of surgical, radiation and chemotherapies to treat cancers at every stage. In addition to standard treatments, innovative therapies include:

• Minimally invasive lung cancer surgery: Mount Sinai faculty who have led national trials in VATS lobectomy are the leaders in minimally invasive surgical approaches in the New York tri-state area. This technique may be the procedure of choice, particularly for patients with small tumor nodules of the lung.
• Photodynamic therapy (PDT): This treatment is designed for patients with unresectable tumors of the airway and esophagus, particularly those patients who experience difficulty breathing or swallowing. PDT – which involves a light-activated drug in combination with a medical laser – is often the palliative treatment of choice
• Laser therapy and stenting for esophageal and lung cancer: As alternative palliative treatments, laser therapy and stenting can have positive results on a patient’s quality of life. Laser therapy may be used to burn away portions of an unresectable tumor of a blocked esophagus or airway. Stenting may be the option of choice following laser therapy, making the effects more durable or, used as a technique to open the airway or esophagus when laser therapy is not a therapeutic option.
• Radiofrequency ablation: This technology permits patients who are not surgical candidates to undergo tumor removal.
• Stereotactic radiosurgery: The Novalis® Shaped Beam Surgery System is the newest treatment in lung cancer armamentarium. The device delivers precise, focused radiation to tumors, minimizing damage to surrounding tissue.
• Brachytherapy: This treatment delivers radiation therapy via implantable seeds and impregnated mesh, an effective therapeutic alternative for patients with breathing compromise.
• Small catheter approach:This technique is useful in the treatment of malignant pleural effusions and usually does not require a hospital stay.
• New approaches for the treatment of patients with mesothelioma

Access to Mount Sinai-led clinical trials, including those designed to stage cancer and employ cutting-edge biologic therapies. Clinical care at Mount Sinai may also draw upon behavioral medicine, genetic testing, and environmental medicine. In addition, Mount Sinai’s aggressive, multimodal approach to advanced tumors gives new hope to patients whom others have diagnosed as incurable.

Coordinated Care

One of the strengths of Mount Sinai's Thoracic Oncology Program is the multi-disciplinary approach to patient care. This team includes:

• Thoracic surgeons
• Medical oncologists
• Radiation oncologists
• Pathologists
• Radiologists
• Pulmonologists
• Gastroenterologists
• Plastic surgeons
• Oncology-dedicated nurses
• Respiratory therapists
• Physical and occupational therapists
• Nutritionists
• Social workers
• Psychiatrists and psychologists

Coordinating information among team members to ensure integrated care for the patient is one of the program's highest priorities.

Follow-up Care

The integrated team approach of the Thoracic Oncology Program makes possible the continuity of care throughout the patient’s treatment, both in the hospital and after discharge.

Whenever possible, standard chemotherapy and radiation treatments take place near patients' homes, thereby improving their quality of life during treatment and making the most of the preexisting relationship between the patient and the referring physician.

When needed, rehabilitation services can also be coordinated, either at Mount Sinai or in the patient's home community. Mount Sinai's expert nutritionists and social workers also offer their specialized services to patients who can benefit from them.

Gastroesophageal reflux disease affects 15 million Americans on a daily basis and up to 100 million per month. A multidisciplinary approach is the most effective way of treating and curing this disease. Our team of caregivers, from many specialties, will diagnose and treat patients who suffer from this disease.

Diagnostics

A variety of tests and technologies are currently available for accurate diagnosis and treatment. These include:

• Ambulatory pH testing
• Manometric analysis of esophageal motility
• Endoscopic visualization
• Ultrasound and biopsy
• Fluoroscopic radiographic analysis

Treatments

• Laparoscopic fundoplication and myotomy
• Endoscopic approach to create a functional sphincter

Coordinated Care

Our team provides an integrated approach to the diagnosis, treatment and follow up of patients who are affected by swallowing and reflux disorders which include:

• Gastroenterology
• Otolaryngology
• Speech and swallowing therapy
• Thoracic surgery
• Medical and Radiation oncology
• Radiology

Follow-up Care

Studies have shown that close monitoring of patients provides earlier and more targeted and effective intervention. Our comprehensive approach includes enrolling patients in a registry that will permit easy followup and permit monitoring of disease change or progression.

The American Cancer Society estimates during 2002 approximately 13,100 new esophageal cancer cases will be diagnosed in the United States (9,800 men and 3,300 women). This disease is about three times more common among men than among women and almost three times more common among African Americans than among whites. Successful care of a patient with esophageal cancer is predicated on a multimodality, fully integrated and comprehensive thoracic oncology program. At Mount Sinai Hospital all patient needs are addressed according the needs of the individual patient and family.

Diagnostics

There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. At one time, squamous cell carcinoma was by far the more common of the two cancers, and was once responsible for almost 90% of all esophageal cancers. However, more recent medical studies show that squamous cell cancers make up only about 50% of esophageal cancers today. Since the entire esophagus is normally lined with squamous cells, squamous cell carcinoma can occur anywhere along the length of the esophagus.

The other common type of esophageal cancer is adenocarcinoma, which starts in glandular tissue. This tissue type does not normally appear in the esophagus except in pre-malignant conditions such as in Barrett’s esophagus, when glandular cells replace an area of squamous mucosa thus predisposing to adenocarcinoma. Mount Sinai offers the widest possible spectrum of screening and diagnostic tests including but not limited to:

• Barium swallow (upper GI series): This procedure involves a series of x-rays of the esophagus. The patient drinks a liquid containing barium, which coats the inside of the esophagus. The barium highlights changes in the esophagus which may be readily seen on x-ray. The radiologist can also see ulcers, scar tissue, abnormal growths, hernias, or areas that block the normal path of food through the digestive system. Using a machine called a fluoroscope, the radiologist is able to see barium moving through the digestive tract, permitting diagnosis of abnormalities in function, such as swallowing disorders.
• Esophagoscopy (also called endoscopy): This is an examination of the inside of the esophagus using a thin-lighted tube called an endoscope. If an abnormal area is found, the doctor can collect cells and tissue through the endoscope for examination by a pathologist.
• Biopsy: A biopsy is a diagnostic test that involves collecting small pieces of esophageal tissue, usually through a needle, for examination under a microscope to assess for cancer cells, tissue changes or other conditions.
• Chest X-ray: This procedure is an x-ray of the lungs, heart, and surrounding tissue.
• CT Scan: A CT Scan is a type of x-ray that uses a computer to take pictures of structures inside the body. A computer analyzes the data to construct a cross-sectional (axial) image. These images can be stored, viewed on a monitor, or printed on film. In addition, three-dimensional models of organs can be created by stacking the individual images, or "slices.”
• Bone Scan: This test, employed by nuclear medicine, is used to identify abnormal processes involving the bone including metastatic tumor, infection or fracture by utilizing radioactive isotope technology which detects areas of increased or decreased bone metabolism (turnover).

Treatments

Staging of the Cancer
Esophageal cancer is staged with a CT scan of the chest and abdomen, endoscopic ultrasound (EUS) and PET scan. Biopsies of the tumor by the EUS are often helpful to determine tumor stage. If the tumor is early stage (typically not involving lymph nodes), then an esophagectomy, or removal of the esophagus, may be appropriate for potential cure.

Surgery
An esophagectomy involves removal of the esophagus and replacement of it with stomach. A successful procedure will remove the malignant tissue and the patient will be able to eat normally. Minimally invasive surgery is performed through small incisions with the use of specially designed instruments and cameras. The minimally invasive esophagectomy (MIE) procedure was developed in the past decade but is only performed at several specialized centers in the nation. The procedure involves laparoscopy and video-assisted thoracoscopic surgery (VATS) to remove the esophagus and replace it with the stomach. Early results of the technique suggest a shorter hospital stay and fewer complications when compared with an esophagectomy done through larger incisions.

Chemotherapy and Radiation
When staging of esophageal cancer reveals involvement of the lymph nodes, then appropriate treatment may be chemotherapy and radiation to shrink the tumor. The esophageal cancer would then be staged again with CT scan, EUS and possibly PET scan to determine whether an esophagectomy could be done to potentially cure the patient.

Palliation of Esophageal Cancer
Approximately half of patients with esophageal cancer are never candidates for an esophagectomy and they may be treated with chemotherapy and/or radiation. The cancer however may cause blockage in the esophagus and make it difficult to swallow. Chemotherapy and radiation may help improve this problem, but minimally invasive endoscopic therapies are also available to improve swallowing. Some of the techniques include endoscopic laser treatment e.g., photodynamic therapy, and endoscopic stent placement. A large study of over 200 patients treated with (PDT) for palliation of dysphagia resulted in improved swallowing 85% of the time.

Coordinated Care

One of the strengths of Mount Sinai's Thoracic Oncology Program is the multi-disciplinary approach to patient care. This team includes:

• Thoracic surgeons
• Medical oncologists
• Radiation oncologists
• Pathologists
• Radiologists
• Pulmonologists
• Gastroenterologists
• Plastic surgeons
• Oncology-dedicated nurses
• Respiratory therapists
• Physical and occupational therapists
• Nutritionists
• Social workers
• Psychiatrists and psychologists

Coordinating information among team members to ensure integrated care for the patient is one of the program's highest priorities.

Follow-up Care

The integrated team approach of the Thoracic Oncology Program makes possible the continuity of care throughout the patient’s treatment, both in the hospital and after discharge.

Whenever possible, standard chemotherapy and radiation treatments take place near patients' homes, thereby improving their quality of life during treatment and making the most of the preexisting relationship between the patient and the referring physician.

When needed, rehabilitation services can also be coordinated, either at Mount Sinai or in the patient's home community. Mount Sinai's expert nutritionists and social workers also offer their specialized services to patients who can benefit from them.

In addition to those already mentioned, Mount Sinai provides treatment for a number of other lung conditions, including:

• Mesothelioma
• Chest wall tumors
• Thymomas
• Germ cell tumors
• Neurogenic tumors
• Cancer of the trachea
• Mediastinal tumors
• Tumors metastatic to the lung, including sarcomas

Diagnostics

A wide spectrum of screening and diagnostic tests are available at Mount Sinai, including:

• Advanced endoscopic techniques designed to detect early lesions and early recurrence.
• A full range of radiological testing, including advanced CT and PET capabilities, as well as innovative MRI technology with ultrasensitive resolution.

Treatments

Mount Sinai offers a broad range of surgical, radiation and chemotherapies to treat cancers at every stage. In addition to standard treatments, innovative therapies include:

• Minimally invasive lung cancer surgery: Mount Sinai faculty who have led national trials in VATS lobectomy are the leaders in minimally invasive surgical approaches in the New York tri-state area. This technique may be the procedure of choice, particularly for patients with small tumor nodules of the lung.
• Photodynamic therapy (PDT): This treatment is designed for patients with unresectable tumors of the airway and esophagus, particularly those patients who experience difficulty breathing or swallowing. PDT – which involves a light-activated drug in combination with a medical laser – is often the palliative treatment of choice
• Laser therapy and stenting for esophageal and lung cancer: As alternative palliative treatments, laser therapy and stenting can have positive results on a patient’s quality of life. Laser therapy may be used to burn away portions of an unresectable tumor of a blocked esophagus or airway. Stenting may be the option of choice following laser therapy, making the effects more durable or, used as a technique to open the airway or esophagus when laser therapy is not a therapeutic option.
• Radiofrequency ablation: This technology permits patients who are not surgical candidates to undergo tumor removal.
• Stereotactic radiosurgery: The Novalis® Shaped Beam Surgery System is the newest treatment in lung cancer armamentarium. The device delivers precise, focused radiation to tumors, minimizing damage to surrounding tissue.
• Brachytherapy: This treatment delivers radiation therapy via implantable seeds and impregnated mesh, an effective therapeutic alternative for patients with breathing compromise.
• Small catheter approach: This technique is useful in the treatment of malignant pleural effusions and usually does not require a hospital stay.
• New approaches for the treatment of patients with mesothelioma

Access to Mount Sinai-led clinical trials, including those designed to stage cancer and employ cutting-edge biologic therapies.

Clinical care at Mount Sinai may also draw upon behavioral medicine, genetic testing, and environmental medicine. In addition, Mount Sinai’s aggressive, multimodal approach to advanced tumors gives new hope to patients whom others have diagnosed as incurable.

Coordinated Care

One of the strengths of Mount Sinai's Thoracic Oncology Program is the multi-disciplinary approach to patient care. This team includes:

• Thoracic surgeons
• Medical oncologists
• Radiation oncologists
• Pathologists
• Radiologists
• Pulmonologists
• Gastroenterologists
• Plastic surgeons
• Oncology-dedicated nurses
• Respiratory therapists
• Physical and occupational therapists
• Nutritionists
• Social workers
• Psychiatrists and psychologists

Coordinating information among team members to ensure integrated care for the patient is one of the program's highest priorities.

Follow-up Care

The integrated team approach of the Thoracic Oncology Program makes possible the continuity of care throughout the patient’s treatment, both in the hospital and after discharge.

Whenever possible, standard chemotherapy and radiation treatments take place near patients' homes, thereby improving their quality of life during treatment and making the most of the preexisting relationship between the patient and the referring physician.

When needed, rehabilitation services can also be coordinated, either at Mount Sinai or in the patient's home community. Mount Sinai's expert nutritionists and social workers also offer their specialized services to patients who can benefit from them.