By Stephen Spotswood

HOUSTON — Patients with lung cancer or other diseases where tumors are beginning to obstruct their central airway have a long, hard road ahead. As the tumor continues to grow, taking in oxygen becomes more and more difficult.

If the obstruction is left alone, shortness of breath worsens, and the prospect of more serious complications, such as post-obstructive pneumonia, increases. What usually follows is admission to the hospital for increasing doses of oxygen, treatment with antibiotics and sometimes even morphine to relieve  dyspnea.

At the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston, physicians are honing the use of advanced, minimally invasive techniques to create better outcomes for these patients and avoid those long hospital stays.

In a photo from the Houston VA website, Roberto Casal, M.D. poses with patient Clara Traylor. Photo by Quentin Melson, Public Affairs Specialist

Better Diagnostic Techniques

A relatively new field, interventional pulmonology  uses advanced diagnostic and therapeutic tools to manage patients with lung cancer and other diseases that block central airways.

Left untreated, obstructions, “leave patients with no quality of life whatsoever and keeps them away from their loved ones,” explained Roberto Casal, MD, MEDVAMC’s Bronchology Lab director and the physician spearheading the hospital’s interventional pulmonology (IP) efforts.

Casal came to MEDVAMC from the MD Anderson Cancer Center, which prepared him for dealing with aggressive lung cancer cases. “Training at MD Anderson was a perfect match for my job at the MEDVAMC,” he said. “Unfortunately, most cases I see are of malignant origin. That training has given me the knowledge and experience I need to deal with these cases.”

Dealing with these cases involves employing varying techniques to better examine tumors and to unblock airways and allow patients to breathe on their own.

One procedure with  the biggest impact to the department in recent years is the use of endobronchial ultrasound (EBUS). A bronchoscope with an ultrasound transducer at the tip is used to take biopsies from areas near the patient’s windpipe.

“EBUS allows us to accurately and safely sample any mediatinal structure, particularly lymph nodes,” Casal said. “EBUS has rapidly replaced mediastinoscopy for staging of lung cancer in centers with high EBUS expertise, such as ours. Not only are we avoiding a more invasive and surgical procedure, but we are reducing the absolute number of invasive procedures required for diagnosis and staging of lung cancer.”