Thoracic and Lung Cancer Program

Early detection of lung cancer, when it is most treatable, can be lifesaving. For those at high risk, our Lung Cancer Screening Program offers a low-dose CT scan to detect lung cancer in its earliest stages in those who are at high risk for developing lung cancer. Learn more about lung cancer screening. 

An accurate diagnosis is essential to determining your care path. Our team includes leading radiologists who specialize in diagnostic imaging, interventional pulmonologists who (in addition to surgeons may obtain biopsies), and pathologists who help diagnose cancer by analyzing tissue samples. These doctors use the latest diagnostic tests, including those that can identify the genetic makeup of a tumor, to confirm a diagnosis. We have clinical trials ongoing at the cutting edge of using blood tests to diagnose lung cancer or cancer recurrence earlier than imaging tests can.

If you already have a diagnosis, our team will review your most recent test results. We may recommend further testing to confirm your diagnosis and develop a treatment plan that best matches your needs and treatment goals.

Tests we use to accurately diagnose lung and thoracic cancer and other conditions include:

• Lab tests: Blood and urine tests provide information about the condition and your overall health. You’ll have lab tests frequently throughout your care.
• Imaging: We use a variety of imaging technologies to assess tumors and see whether cancer has spread beyond its original location. The types of imaging tests your doctor may use in diagnosing lung and thoracic conditions include X-ray, ultrasound, MRI, CT scan, PET/CT scan.
• Bronchoscopy: In this test, your surgeon or interventional pulmonologist guides a bronchoscope (a thin, flexible tube with a small camera attached) down your throat into your airways and your lung.  During this procedure, your doctor may collect small tissue samples (biopsies) of the lung, a tumor, or lymph nodes. We have a cutting-edge robotic bronchoscopic device which we believe makes these biopsies more accurate than previously possible.
• Upper GI Endoscopy: In this test, your doctor guides an endoscope (a thin, flexible tube with a small camera attached) down your throat to view your esophagus. During this procedure, your doctor may also collect small tissue samples (biopsy) of the esophagus or an esophageal tumor.
• Mediastinoscopy: Your doctor makes a small incision near your collarbone and inserts a tube equipped with a camera into the mediastinum. In this way, your doctor can collect tissue samples of tumors or lymph nodes.
• Biopsy: This is a small tissue sample that your doctor collects during bronchoscopy, endoscopy, or mediastinoscopy, or with a fine needle inserted into the tumor by a radiologist from outside the chest. A pathologist examines the tissue to check for the presence and type of cancer.
• Genetic testing: Some types of cancer run in families. If you have a family history of cancer, your doctor may recommend genetic testing to determine your risk.

Our doctors often recommend surgery to treat thoracic cancers or tumors. About 80% of the time, we use minimally invasive approaches (either video-assisted thoracic surgery or robotic-assisted thoracic surgery) both of which can help you heal faster and reduce complications. We remove the largest, most complex tumors using open surgery. In this procedure (a thoracotomy), your doctor accesses the lungs through an incision between the ribs.

Whether we use a minimally invasive or open procedure, our surgical teams provide exceptional expertise. Because of our superior surgical outcomes and careful pain management, we are ranked among the best thoracic surgery programs in the country.

Surgical procedures we offer include:

• Esophagectomy: In this procedure, the surgeon removes the lower two-thirds or all of the esophagus, the upper part of the stomach, and all surrounding lymph nodes.
• Lung cancer surgery: This surgery includes several procedures to remove tumors from the lungs. The extent of the removal depends on the tumor size and location. This may be a wedge resection, a lobectomy, a sleeve lobectomy, or a pneumonectomy.
• Lung volume reduction surgery (LVRS): Used to treat severe emphysema, this procedure removes damaged lung tissue to improve your breathing and lung capacity.
• Pulmonary metastasectomy: Surgeons remove metastatic lung tumors, cancer that has spread to the lung from another area in the body.
• Video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS): The surgeries above are most often performed by VATS or RATS. In these minimally invasive procedures, the doctor uses a small video camera and special instruments inserted through small incisions in the chest. We use VATS or RATS to remove most lung tumors, most masses in the mediastinum, for LVRS, for many of our esophagectomies, and to treat hyperhidrosis. About 80% of our procedures overall are performed by VATS or RATS.

Our medical oncologists are cancer specialists who treat cancer using oral or intravenous (IV) medications. We often use cancer medications in combination with other treatments. Types of cancer medication that we use to treat lung and thoracic cancers include:

• Chemotherapy
• Immunotherapy
• Targeted therapy

Stanford Medicine is known worldwide for innovations in targeted therapy, which in many cases, gives doctors another tool for cancer treatment and flexibility in personalizing your treatment path. Targeted therapies seek out specific molecules on or in cancer cells and disrupt their growth or function. Our innovative research in using targeted therapy to treat lung cancer caused by a specific gene mutation (change) helped bring this promising treatment to patient care.  

Radiation therapy uses high-energy X-rays to destroy cancer cells. Our radiation oncologists deliver radiation from outside the body (external radiation) or more rarely via a radiation source surgically placed inside or next to the tumor (brachytherapy).

Types of external radiation therapy include:

• 3D conformal radiation therapy
• Intensity-modulated radiation therapy
• Stereotactic ablative radiotherapy (SABR/SBRT)

SBRT uses guided systems to precisely target beams of radiation and destroy cancer cells while affecting surrounding tissues less. Stanford Medicine physician-researchers developed these technologies, known as stereotactic radiotherapy. This has transformed cancer care around the world by more effectively and safely treating tumors that are considered inoperable. We offer several types of SBRT, including CyberKnife, Trilogy, and TrueBeam, giving our doctors multiple options for treating thoracic cancer in all its forms and stages.  

Interventional radiology can also deliver cancer treatment directly to the tumor. Our interventional radiologists treat some lung cancers using tumor ablation. In this procedure, we use CT imaging to guide a needle to the tumor. The doctor uses cold energy (cryoablation) or heat energy (radiofrequency ablation) to destroy the tumor.

Nuclear medicine uses small amounts of radioactive materials that act as tracers to help diagnose and treat lung and thoracic cancers. Our team of nuclear medicine specialists helped develop peptide receptor radionuclide therapy (PRRT). In this therapy, peptides bind to the surface of lung neuroendocrine tumor cells and emit radiation that destroys the cells. 

Cancer tumors have a specific genetic fingerprint. Our doctors identify this fingerprint and use it to select targeted treatments that will be most effective.  A Stanford Medicine thoracic radiation oncologist pioneered genomic profiling from tumor DNA that is circulating in the blood.

Wellness encompasses more than your physical health to include your psychological and emotional well-being. Our Circle of Care approach focuses on your wellness, surrounding you and your family with the services you need before, during, and after treatment.