OncoLog, Volume 58, Number 3, March 2013 Page: 3
This periodical is part of the collection entitled: Texas State Publications and was provided to The Portal to Texas History by the UNT Libraries Government Documents Department.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
tailed map that is integrated with the computed tomography
images.
Navigation bronchoscopy can go much farther into the
lung than EBUS, entering not only the trachea and main-
stem bronchi but also branches as peripheral as fifth-genera-
tion bronchi 2 mm wide. Navigation bronchoscopy facilitates
the bronchoscopist's ability to sample peripheral pulmonary
lesions and complements the role of EBUS for sampling
mediastinal and hilar lymph nodes, allowing for a complete
diagnostic workup and nodal staging of lung cancer with a
single intervention.
Autofluorescence bronchoscopy
Autofluorescence bronchoscopy uses blue light together
with white light to detect changes in the airway that portend
cancer, and this technique can direct biopsies of premalignant
tissue and carcinoma in situ before the disease becomes evi-
dent on noninvasive imaging or with white light broncho-
scopy alone.
To produce autofluorescence, a bronchoscope's light is
filtered to a wavelength of about 400-450 nm; this blue light
causes normal chemical compounds in the airways to reflect
largely green light and premalignant tissue to reflect largely
red light. Unlike other fluorescence methods that require a
photosensitizing compound, autofluorescence requires only
light. Autofluorescence bronchoscopy may be most useful
in patients at high risk of airway cancer and lung cancer
patients who received radiation therapy for positive margins
after resection.
Although adding blue light to conventional bronchoscopy
increases the sensitivity of the bronchoscopy, particularly for
detecting high-grade lesions, this technique may also increase
the rate of false-positive findings. Because autofluorescence
may reveal a large number of areas that look abnormal but
may not all be malignant, another modality called narrow-
band imaging often is used in conjunction with autofluores-
cence bronchoscopy to select the locations that are most
likely to contain malignant tissue. Specific wavelengths of
blue and green light that are absorbed by hemoglobin reveal
hidden blood vessels; a disorganized, tortuous vasculature
suggests malignancy. Lesions with suspicious vasculature in
addition to abnormal fluorescence can then be biopsied.
Managing lung conditions concomitant with cancer
Conditions affecting the lungs-such as toxicity due to
previous treatments, chronic obstructive pulmonary disease,
pleural effusions, and pneumonia-can limit cancer treat-
ment and decrease quality of life. Often, these comorbidities
must be dealt with and respiratory function improved so that
patients can begin or continue cancer treatment. George
Eapen, M.D., an associate professor in the Department of
Pulmonary Medicine, said, "We help patients feel better so
that going into treatment, they have the best shot possible
at a successful outcome.""We can't always cure,
but we can ease patients' concerns
about suffocating and relieve their
suffering."
- Dr. Rodolfo Morice
Pleural effusions, particularly those that recur after thora-
centesis, can be a persistent hindrance to cancer treatment
readiness. A useful method for managing recurring pleural
effusions is the indwelling catheter, which is tunneled under
the skin and inserted into the effusion site. The catheter
keeps the space between the pleura dry and allows the forma-
tion of adhesions to seal the space, eventually preventing
fluid from reaccumulating. Previously, patients with such effu-
sions were hospitalized and treated with sclerosing agents or
repeated thoracentesis; now these patients can drain the fluid
at home and achieve effective symptom resolution. Allowing
patients to drain their own effusions also gives them and their
families a greater sense of involvement in their care. "The
catheter allows patients to reestablish control over their bod-
ies. That sense of empowerment is very important in main-
taining their psychological well-being," Dr. Eapen said.
Another lung comorbidity that commonly occurs with
cancer and may hinder treatment is pneumonia, one of the
top causes of death in patients with lung cancer or leukemia.
Suspected pneumonia presents several diagnostic and treat-
ment challenges: distinguishing inflammation due to a condi-
tion such as chemotherapy toxicity from a disease caused by
a pathogen; deducing whether a pathogen is a virus, bacteri-
um, or fungus; identifying within these pathogenic categories
the particular strain of pneumonia, which will often be a
strain that does not typically affect people without cancer;
and selecting an effective treatment without subjecting the
patient to side effects that may disrupt his or her cancer
treatment.
An experimental technique being studied for identifying
the organisms responsible for pneumonia is to perform whole-
genome microarray analysis on lung cells from the affected
patient (often acquired using bronchoalveolar lavage). Pre-
clinical studies show that pathogens elicit specific host gene
expression responses that can clarify the cause of pneumonia
when other tests are not sufficient. There is hope that this
or similar methods could prove clinically useful in the future
for diagnosis of pneumonia.
In addition to treating specific comorbidities, pulmonolo-
gists help prepare patients for cancer treatment by improving
the patients' cardiopulmonary function. Some patients can
improve their performance status through carefully titrated
[Continued on page 8]www.mdanderson.org/oncolog 3
Upcoming Pages
Here’s what’s next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Periodical.
University of Texas M.D. Anderson Cancer Center. OncoLog, Volume 58, Number 3, March 2013, periodical, March 2013; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth639836/m1/3/: accessed April 23, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.