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Baylor Scott & White Center for Thoracic Surgery Dallas

Baylor Scott & White Center for Thoracic Surgery

  • Awarded lung cancer care

    Baylor University Medical Center, part of Baylor Scott & White Health, has earned a distinguished three-star rating from The Society of Thoracic Surgeons (STS) for its patient care and lung cancer resection outcomes, specifically for its lobectomy for lung cancer care.

Dedicated to excellence in thoracic surgery

 
 

The Baylor Scott & White Center for Thoracic Surgery focuses exclusively on the treatment of non-cardiac chest disease.

Our expert team has pioneered minimally invasive VATS (video-assisted thoracoscopic​ surgery) approaches to lung cancer treatment, as well as robotic surgery for the treatment of many thoracic diseases. Additionally, the center has expertise in minimally invasive treatment of emphysema. The team works closely with the Charles A. Sammons Cancer Center at Dallas to provide access to the latest research and clinical trials.

We work closely with our partners at Baylor Scott & White Center for Esophageal Diseases to bring you comprehensive care and allows for prompt referrals between the two service lines.

Are you at risk?

You can be screened for lung cancer before symptoms start.

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Tools & Resources

Our services are designed with you in mind so managing your healthcare needs is as simple as possible.

  • Patient Forms
  • Appointment Information
  • MyBSWHealth
  • Pay Your Bill
  • Financial Assistance
  • Accepted Insurance
  • Patient Education: Benign Fibrous Tumors of the Pleura
  • Patient Education: Diaphragm
  • Patient Education: Esophageal Cancer
  • Patient Education: Hiatal Hernia Repair
  • Patient Education: Hyperhydrosis
  • Patient Education: Lung
  • Patient Education: Mediastinal Surgery
  • Patient Education: Minimally Invasive Surgery
  • Patient Education: Myasthenia Gravis
  • Patient Education: Pleural Mesothelioma
  • Patient Education: Surgical Treatment Of Emphysema
  • Patient Education: Thoracic Outlet Syndrome
  • Patient Education: Trachea

Patient Forms

To ensure that your visit to our office is as convenient and efficient as possible, we are pleased to offer our registration forms online. The patient registration form may be completed electronically and printed for better legibility or completed manually.

New Patient Registration Forms

Authorization Forms

We do not release your medical information without your authorization.

Appointment Information

What to Bring to Your Appointment

On your first visit, we will begin a permanent record. Please bring any medications you are taking, so that we may accurately determine the dosage and frequency. We will ask you to complete a medical history and registration form. Please bring your insurance card and try to arrive at least 30 minutes early for your first visit. For your convenience, see this checklist of items to bring:

  • A disc with all of your imaging if not performed at Baylor University Medical Center, part of Baylor Scott & White Health
  • A copy of official records sent from your physician’s office or hand-carried
  • Insurance card
  • Completed Patient Registration Forms located in the Patient Forms section

Making Appointments—You may make appointments online or by calling the office. You may click to call us from a mobile device.

Access and Download Patient Forms

​To ensure that your visit to our office is as convenient and efficient as possible, we are pleased to offer our Registration forms online. The Patient Registration form may be completed electronically and printed for better legibility or completed manually.

You can find these forms under Patient Forms.

Emergency Care

If you have an urgent problem, you may call your physician’s office to schedule an appointment. However, if you feel it is a life-threatening emergency, call 911. Do not delay by calling the doctor’s office first.

Prescription Refills

Our preferred method for refilling prescriptions is to have your pharmacist call our office with your name and the prescription you need to be refilled. Because we do not have access to your medical records at night or on weekends, we are unable to refill prescriptions during those times.

Confidentiality

At Baylor Scott & White Center for Thoracic Surgery, we have a strict patient confidentiality policy. Your medical record is strictly private and will not be shared with your employer, friends or relatives without your written permission.

MyBSWHealth

MyBSWHealth is an online tool where you can communicate with your providers, schedule an appointment, access and manage your family’s health.

Pay Your Bill

We offer an easy, secure way to pay your HTPN bill online through MyBSWHealth.

Financial Assistance

At Baylor Scott & White Health, we want to be a resource for you and your family. Our team of financial counselors is here to help. We encourage you to speak to a member of our team at any time – before, during or after care is received.

Accepted Insurance

Baylor Scott & White has established agreements with several types of insurances in an effort to make sure your health needs are covered.

Patient Education: Benign Fibrous Tumors of the Pleura

What Are Benign Fibrous Tumors Of The Pleura?

The pleura is the smooth, pale yellow transparent membrane that lines the thorax and envelopes the lungs. Its function is to protect and cushion the lungs.

The most common tumors that occur in the pleura are malignant (cancerous) forms of mesothelioma caused by exposure to asbestos. But sometimes fibrous tumors unrelated to asbestos exposure can develop in the pleura. These can be either malignant or benign (non-cancerous).

Benign fibrous tumors of the pleura are sometimes called solitary fibrous tumors. They make up approximately 78% to 88% of non-mesothelioma tumors of the pleura. Fibrous tumors of the pleura are much less common than mesothelioma tumors of the pleura.

Benign fibrous tumors of the pleura are confined to the surface of the lung, where they start.

Who Gets Benign Fibrous Tumors Of The Pleura?

These tumors are slightly more prevalent in females than males. Most patients diagnosed with benign fibrous tumors of the pleura are in their 50s and 60s.

What Causes Benign Fibrous Tumors Of The Pleura?

The causes of benign fibrous tumors of the pleura are not known. It is known, however, that exposure to asbestos – the primary cause of mesothelioma tumors – does not cause this condition. Smoking, though discouraged, is also not considered a cause of benign tumors of the pleura.

What Are The Symptoms Of Benign Fibrous Tumors Of The Pleura?

Many patients with benign fibrous tumors of the pleura do not have any symptoms at all, even though these tumors are often very large (up to 40 cm in diameter). Some patients may have these symptoms:

  • Chest pain
  • A persistent cough
  • Shortness of breath

If you notice any of these symptoms in yourself, you should consult your healthcare provider as soon as possible.

How Are Benign Fibrous Tumors Of The Pleura Diagnosed?

If your doctor thinks you may have a pleural tumor, he or she will obtain a chest X-ray or chest CT scan to check for masses. A needle or surgical biopsy will be done to find out if the tumor is benign or malignant.

How Are Benign Fibrous Tumors Of The Pleura Treated?

Even though fibrous tumors of the pleura are not cancer, surgery is still the recommended treatment. Without surgical removal, the tumors have the potential to become malignant. Your healthcare provider can best suggest a plan of treatment to suit your diagnosis.

What Is The Prognosis For Someone With Benign Fibrous Tumors Of The Pleura?

The outlook for a patient with benign fibrous tumors of the pleura is excellent with surgical treatment. Only about eight percent recur after surgery, and these are usually successfully treated with follow-up surgery.

Patient Education: Diaphragm

Conditions of the Diaphragm

  • Diaphragmatic plication for diaphragmatic paralysis
  • Diaphragmatic pacing

The Department of Thoracic Surgery and Lung Transplantation at Baylor University Medical Center, part of Baylor Scott & White Health is dedicated to excellence in the field of thoracic surgery. Surgeons on the medical staff have world renowned reputations in thoracic oncology, minimally invasive surgery, esophageal disorders and lung transplantation. Our advanced treatments provide you with quality outcomes and are coupled with compassionate care.

Patient Education: Esophageal Cancer

What Is Esophageal Cancer?

The esophagus is the muscular tube of swallowing that connects the throat to the stomach. It passes through the neck and chest until it meets the stomach in the abdomen. Like all cancers, esophageal cancer develops as a result of uncontrolled cell division leading to uninterrupted growth. Cancerous cells begin their growth microscopically, but as they continue to multiply, turn into masses called tumors. These tumors may remain local in the tissue in which they originated or in more advanced cases, invade into surrounding structures or spread throughout the body, known as metastasizing. A cell with the ability to invade or spread is considered malignant or “cancerous”.

Esophageal cancer starts in the inner layer of the esophagus (mucosa) and then grows outward. As the tumor grows, patients develop difficulty swallowing (dysphagia) and eventually chest pain. Men are three times more likely to develop esophageal cancer than women and chronic acid exposure (gastoesophageal reflux disease) is believed to increase risk for its development. While gastroesophageal reflux disease (GERD) is common, most patients with GERD do not develop esophageal cancer. Heavy alcohol and tobacco use is believed to increase the risk for developing esophageal cancer.

There were 18,170 new esophageal cancers diagnosed in the United States in 2014 with 15,450 deaths reported. Esophageal cancer makes up 1% of the cancers diagnosed in the United States. Treatment and survival continue to improve and while overall survival for esophageal cancer is poor, prognosis for early stage cancer is considerably higher.

For more information on esophageal cancer, see

  • Esophagus Cancer
  • Chest Cancer Center

What Are The Symptoms Of Esophageal Cancer?

Esophageal cancer in its early stages has no symptoms and is usually picked up accidentally when evaluating for other problems. As the tumor grows, the most common symptom is difficulty swallowing (dysphagia) with food sticking in the throat or chest. This symptom worsens as the tumor grows and esophagus narrows. If not diagnosed and treated, swallowing becomes more difficult and progresses to the point where a patient is only able to swallow liquids. With decreased caloric intake, a patient loses weight.

How Is Esophageal Cancer Diagnosed?

Swallowing symptoms typically lead to further testing. The first test obtained is typically a barium swallow. Barium is a chalky liquid and when swallowed, outlines the esophagus on x-rays. If an x-ray shows narrowing or irregularity, the concern is raised for esophageal cancer.

Endoscopy

Endoscopy is performed on an outpatient basis. A patient is sedated and a flexible telescope (endoscope) is inserted into the mouth, through the esophagus and directed into the stomach. Esophageal cancer is visible as a growth (tumor) from the wall of the esophagus during endoscopy and samples (biopsies) of the tumor are taken using specially designed instruments inserted through the endoscope. These biopsies are looked at under the microscope by a pathologist who is physician specially trained in diagnosing cancers.

How Is Esophageal Cancer Staged?

Staging allows physicians to understand the extent of a patient’s cancer, helps guide treatment decisions and predict outcomes. Staging used by physicians for esophageal cancer is specific, but a straightforward way to describe staging is shown below:

  • Localized – The lung cancer is confined to the esophagus and has not spread
  • Regional – The esophageal cancer has moved from the esophagus into local drainage basins known as lymph nodes (glands) attached to the esophagus
  • Distant – The cancer has spread (metastasized) to other parts of the body
  • M Stage – (whether or not the tumor has metastasized) and Grade (pattern of the tumor cells aggressiveness under the microscope).

Computed Tomography (CAT) Scan

A CAT scan obtains high resolution images using cross-sectional x-rays of the entire body from chest to abdomen. It is noninvasive and takes only a few minutes perform. These images help determine the size of the tumor and whether it has spread into lymph nodes or other organs. It is useful in staging esophageal cancer.

Positron Emission Tomography Scan

A PET scan is a noninvasive study that involves the injection of a radioactive sugar into the blood. The tracer is safe and rapidly passes out of the body. Cancer cells are more active than normal cells and pick up more of the tracer. During a PET scan, the patient lies in a special scanner with a camera that records the radioactive activity and creates a picture of areas involved by tumor. This test adds information on the stage of the cancer and will be ordered by your physician.

More specifically, esophageal cancer is staged by T stage (depth of the tumor into the wall of the esophagus, N stage (involvement of lymph nodes with cancer cells).

Your physician will inform you of the stage of your esophageal cancer and the best treatment options.

Who Treats Esophageal Cancer?

Esophageal cancer is diagnosed and treated by gastroenterologists (specialists of the gastrointestinal tract), thoracic surgeons (surgeons who specialize in esophageal surgery) as well as medical and radiation oncologists (doctors who treat cancers using chemotherapy or radiation therapy). These doctors work together to choose the best treatment for each patient dependent on the stage of the cancer (how advanced it is) and a patient’s overall medical condition. At the Baylor University Medical Center in Dallas, our team of experts works together to choose the best treatment for you.

How Is Esophageal Cancer Treated?

The most important determinant of a patient’s prognosis is the stage of the cancer (the depth of the tumor into the wall of the esophagus, whether it is localized in esophagus or if it has moved) and a patient’s overall health condition. The treatment most likely to achieve a cure is chosen while being mindful of maintaining the patient’s quality of life.

In most cases, the treatment of esophageal cancer is determined by its stage. Localized cancers are treated by surgery. Regional cancers are treated by a combination of therapies including chemotherapy, radiation and surgery. Distant disease is treated by chemotherapy. Some very early cancers involving just the inner surface lining of the esophagus (mucosa) can be treated endoscopically. Portions of the mucosa are cored out (endomucosal resection or EMR) using specialized instruments. Other therapies to treat these very early cancers are laser, radiofrequency or thermal energy ablative techniques designed to kill the cancer cells and yet spare the remainder of the esophagus. Close endoscopic monitoring is performed to be certain that the cancer does not return. Your doctors will help choose the best treatment for you.

Surgery For Esophageal Cancer

Surgery for esophageal cancer presents the best chance for cure in treating localized esophageal cancer and is considered the “gold standard” against which all other treatments are compared. Surgery for esophageal cancer requires the removal of most of the esophagus. The extent of the surgery is determined by the size and location of the tumor. In order for the patient to be able to eat, the stomach is freed up in the abdomen and connected to the upper portion of the esophagus, above where the tumor has been removed. With time, a patient will be able to resume eating most foods normally and return to good quality of life.

Most surgery for esophageal cancer can now be performed at Baylor University Medical Center using minimally invasive approaches such as VATS (video assisted thoracic surgery) or laparoscopically. Surgery for esophageal cancer should be performed by surgeons with specific training and focus on cancers of the esophagus.

Your surgeon will evaluate your fitness for surgery, whether your tumor is resectable (removable) and discuss the surgical approach (minimally invasive vs larger incisions).

Radiation Therapy

Radiation therapy uses high-energy X-ray beams to kill cancer cells. It can be used alone as primary therapy or in conjunction with other therapies such as chemotherapy or surgery. It can be used to treat patients with advanced cancers to relieve pain and obstruction (blockage) of the esophagus and improve problems with swallowing. Additionally, it can be used to improve cure rates in patients with regional cancers when combined with chemotherapy and or surgery. Patient who have localized cancers but are not medically fit to undergo surgery due to other medical problems are typically treated with chemotherapy or radiation therapy alone. Your expert team at Baylor University Medical Center will work together to choose the best therapy for each patient.

Chemotherapy And Targeted Therapies

Chemotherapy uses drugs designed to kill rapidly growing cancer cells while sparing normal ones. Chemotherapy is delivered through intravenous therapy although some recently developed chemotherapy drugs can be given as a pill. Newly developed “targeted” medicines use newly discovered weaknesses in the growth pathways of cancer cells and provide the potential for improved outcomes with less side-effects when compared to traditional IV approaches. All tumors evaluated at BUMC are tested for their unique genetic profile to determine whether they are candidates for treatment using these novel therapies (see link). Chemotherapy is used to treat patients whose tumors have been removed to prevent the recurrence (return) of their cancer and in patients whose tumors have spread (metastasized).

Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD)

Cancers of the esophagus that are limited to its lining can be treated endoscopically in properly selected patients. The minimal morbidity associated with these techniques favors early intervention with the potential for better long-term results and allows faster recovery with virtually no pain.  Patients with esophageal disease are evaluated in a weekly multidisciplinary forum that includes​ surgeons, gastroenterologists, radiologists, pathologists and otolaryngologists in BUMC’s Center for Esophageal Diseases. This ensures patients receive thorough and personally tailored treatment for their disease.

Patient Education: Hiatal Hernia Repair

What is a hiatal hernia?

Any time an internal body part protrudes into an area where it doesn’t typically belong, it is called a hernia. The hiatus is an opening in the diaphragm — the muscular wall that separates the chest cavity from the abdomen. Normally, the esophagus (tube of swallowing) passes from the neck, through the chest and then down through the hiatal passageway to the abdomen where the esophagus joins the stomach. A hiatal hernia is a protrusion of the stomach or other abdominal contents through the hiatus into the chest.

There are two main types of hiatal hernias: a sliding hernia and a paraesophageal hernia (next to the esophagus).

In a sliding hiatal hernia, the stomach and the portion of the esophagus that joins the stomach (gastroesophageal junction) slide up through the hiatus and into the chest. This is the most common type of hiatal hernia. Not all hiatal hernias cause symptoms. A paraesophageal hernia is less common, but can be more problematic. The esophagus and majority of the stomach stay in their normal locations, but a portion of the stomach squeezes through the hiatus and next to the esophagus. With a paraesophageal hernia, there is the possibility of the stomach twisting and possibly strangulating (twisting off its blood supply).

Gastroesophageal Reflux Disease (GERD)

What Is GERD?

Many people with hiatal hernia have no symptoms, but others may have heartburn like symptoms that are related to gastroesophageal reflux disease, or GERD. GERD is caused by the backwash of gastric contents into the esophagus. This backwash causes sypmtoms of burning. Hiatal hernias are thought to predispose to GERD due to the abnormal location of a portion of the stomach in the chest. Although there appears to be a link between hiatal hernias and GERD, one condition does not necessarily mandate the other. Many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia. The symptoms of GERD can easily be mistaken for other disease processes. For example, people with heartburn may experience chest pain that can easily be confused with the pain of a heart attack. On the other hand, patients with a hiatal hernia may have symptoms attributed to it that are in fact related to another process. Therefore, it is critical to undergo thorough evaluation and testing before undergoing any surgery for a hiatal hernia or GERD. Your surgeon will help guide you in making this determination.

What Causes a Hiatal Hernia?

The cause of a hiatal hernia is not entirely known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as from pregnancy, obesity, coughing, or straining during bowel movements may leading to stretching of the hiatus. Obesity may predispose to hiatal hernia and certainly worsens the symptoms of GERD.

Who Is at Risk for Hiatal Hernia?

Hiatal hernias occur more often in women, people who are overweight, and people older than 50.

How Is a Hiatal Hernia Diagnosed?

A hiatal hernia can be diagnosed by chest x-ray, CAT scan or esophagram (a specialized form of x-ray study where a patient swallows barium contrast while x-rays are taken. Additionally, an endoscopy (telescope placed into the esophagus and stomach) may be used to diagnose a hiatal hernia.

How Are Hiatal Hernias Treated?

Most people do not experience any symptoms from their hiatal hernia so no treatment is necessary. Patients with significant symptoms of heartburn should first be treated with antacid medications and modification of their eating habits to avoid foods that predispose to heartburn. If symptoms persist despite antacid therapy or if a patient has difficulty swallowing with food sticking (dysphagia), they should have their hiatal hernia repaired.

Patient Education: Hyperhydrosis

What Is Hyperhidrosis?

Hyperhidrosis is a condition of excessive sweating in the hands (palmar hyperhidrosis), armpits (axillary hyperhidrosis) or feet (plantar hyperhidrosis). This sweating is independent of exercise or heat. It is a benign condition but can have a serious impact on a patient’s quality of life. It occurs in up to 3% of the population. The exact cause of hyperhidrosis is unknown but there may be a genetic component with some families having many members with this condition. It is known that sweating is controlled by the sympathetic nervous system. This set of nerves helps regulate our body temperature by controlling the sweat glands. These nerves are not under a patient’s voluntary control. Hyperhidrosis is an inappropriate control of these glands that leads to excessive sweating.

Types Of Hyperhidrosis

Generalized hyperhidrosis: Affects large areas of the body with excessive sweating, typically in adults whose sweating occurs during both waking and sleeping hours.

Localized hyperhidrosis: These individuals have excessive sweating that occurs in specific parts of the body that markedly impacts their quality of life and self-image.

Palmar: This sweating occurs in the palms of the hands. It can occur spontaneously but can be worsened by stress, anxiety or exercise. The hands become soaking wet which makes it difficult to grasp objects, drive or shake hands. The hands are typically clammy and cool. Over time, patients avoid hand-shaking and become extremely anxious about social environments.

Axillary and Plantar: Patients with axillary (armpit) hyperhidrosis sweat profusely from their underarms causing them to soak their clothes shortly after they dress. This serves as a social embarrassment. Many patients resort to wearing baggy shirts and sweatshirts and change their clothes multiple times a day. Plantar hyperhidrosis is the excessive sweating of the soles of the feet leading to soaked socks and significant foot odor.

How Is Hyperhidrosis Treated?

Antiperspirants: Antiperspirants and topical drying agents are the first line treatment for hyperhidrosis. These are available over the counter or as a prescription (typically aluminum chloride) from your primary care physician or a dermatologist. Other treatment options include iontophoresis. This consists of a daily home treatment of electrical stimulation to the affected area with a portable device.

Botulinum toxin (Botox): Botox treatment involves injecting small doses of the toxin in and around the sweat glands to decrease sweat production. It remains effective for up to 6 months. Repeated injections are required to maintain the effect.

Surgery For Hyperhidrosis

Surgery is an option to treat severe hyperhidrosis in patients who have failed topical therapies. The surgical treatment involves dividing the sympathetic chain which is the nerve that conducts the abnormal stimulation to the sweat glands. The sympathetic chain runs vertically along the ribs and is located about an inch away from the bony spine and is easily identified by the surgeon. Sympathectomy is the operative division of that nerve. The sympathetic chain is typically cut and divided or, in addition, a short portion of the chain is removed.​​

How Is Surgery Performed?

Surgery for hyperhidrosis is routinely performed by minimally invasive techniques. ETS – endoscopic thoracic sympathectomy (also known as thoracoscopic sympathectomy or sympathicotomy) is the most frequently used method. The operation is performed using a tiny telescope (5 mm) and two small access incisions of approximately the same size. A video-telescope is passed into the chest cavity through one of these incisions. This allows visualization of the sympathetic chain. Through the other incision, instruments are placed to allow the surgeon to divide the chain at the specific level according to the patient’s symptoms. The operation is performed on both sides of the patient. The operation takes approximately one hour to perform and most patients are discharged home the day of surgery. Patients can return to work almost immediately.

Risk Of Surgery

The most common side-effect of hyperhidrosis surgery is compensatory sweating. Compensatory sweating is the report of increased sweating after surgery in an area that was not originally the source of a patient’s complaint. The back, buttocks and thighs are areas most prone to compensatory sweating. While many patients experience some degree of compensatory sweating, it is typically mild and the vast majority of patients are extremely satisfied with the results of their surgery and report improved quality of life. It is very rare for compensatory sweating to be so severe that the symptoms are worse than prior to surgery

Patient Education: Lung

Lung cancer develops as a result of uncontrolled cell division leading to uninterrupted growth. Cancerous cells begin their growth microscopically, but as they continue to multiply, turn into masses called tumors. These tumors may remain local in the tissue in which they originated or in more advanced cases, invade into surrounding structures or spread throughout the body, known as metastasizing. A cell with the ability to invade or spread is considered malignant or “cancerous”.

There is the mistaken impression that lung cancer is a disease that only strikes smokers. This is not the case. While cigarette smoking is the greatest risk factor for the development of lung cancer, an increasing number of patients are developing lung cancer with no history of smoking or smoke exposure.

There were over 224,000 new lung cancers diagnosed in the United States in 2014 with 159,000 deaths reported. It is the leading cause of cancer death. However, new programs aimed at the early detection of lung cancer coupled with innovative treatments hold promise for improved survival in the future. To learn more about lung cancer statistics, see LungCancer.org.

 


How Is Lung Cancer Diagnosed?

Lung cancer in its early stages has no symptoms. Often, it is picked up on an x-ray or CAT scan as an incidental finding. As the diseases progresses, symptoms such as chest pain, shortness of breath, cough and weight loss can develop. Diagnosis typically requires some form of biopsy; a sample of the tissue of concern for cancer. These biopsies can be performed with a needle guided by a CAT scan or by a bronchoscopy (a small camera inserted into the patient’s windpipe through the mouth or nose). Occasionally, a surgical biopsy is required. A biopsy is important to determine whether or not the growth is cancerous and to determine the type of cancer.

 


Lung Cancer Screening

Recent studies have demonstrated that screening patients with risk factors for lung cancer using CAT scans of the chest can pick up lung cancer in its early stages when cure is likely. These studies have demonstrated a significant reduction in death from lung cancer using CAT scan screening. Widespread utilization of this screening technique holds great promise in improving survival from lung cancer.


Who Treats Lung Cancer?

Lung cancer is diagnosed and treated by pulmonologists (lung specialists), thoracic surgeons (surgeons who specialize in lung surgery) as well as medical and radiation oncologists (doctors who treat cancers using chemotherapy or radiation therapy). These doctors work together to choose the best treatment for each patient dependent on the stage of the cancer (how advanced it is) and a patient’s overall medical condition. At the Baylor University Medical Center in Dallas, our team of experts works together to choose the best treatment for you. Use our Physician Finder to search for a specialist.

The most important determinants of how a patient will be treated are the stage of the cancer (whether the tumor is localized in the lung or if it has moved) and a patient’s overall health condition. The treatment most likely to achieve a cure is chosen while being mindful of maintaining the patient’s quality of life.

 


How Is Lung Cancer Staged?

Staging allows physicians to understand the extent of a patient’s cancer, helps guide treatment decisions and predict outcomes. Staging used by physicians is specific, but a straightforward way to describe staging is shown below:

​Stage ​Description
Localizaed The lung cancer is confined to the lung and has not spread
Regional The lung cancer has moved from the lung into local drainage basins known as lymph nodes (glands) attached to the lung
Distant The cancer has spread (metastasized) to other parts of the body
​*


How Is Lung Cancer Treated?

In most cases, the treatment of lung cancer is determined by its stage. Localized cancers are treated by surgery. Regional cancers are treated by a combination of therapies including chemotherapy, radiation and surgery. Distant disease is treated by chemotherapy.

 

Thoracic Surgery For Lung Cancer

Surgery for lung cancer presents the best chance for cure in treating localized lung cancer and is considered the “gold standard” against which all other treatments are compared. Surgery for lung cancer requires the removal of the tumor as well as a surrounding rim of normal lung tissue. The extent of the surgery is determined by the size and location of the tumor. Most surgery for lung cancer can now be performed at Baylor University Medical Center using minimally invasive approaches such as VATS (video assisted thoracic surgery) or robotically (using small incisions and robotically controlled operative arms). To see more about the surgical approaches to lung cancer at BUMC see our T Boone Pickens Center.

Surgery for lung cancer should be performed by surgeons with specific training and focus on cancers of the chest. All our thoracic surgeons at BUMC focus specifically on chest malignancies. To see our team see BUMC Cardiothoracic Surgeons.

Your surgeon will determine whether your tumor is resectable (removable), the extent of the surgery (how much lung needs to be removed with the tumor) as well as the surgical approach (minimally invasive vs traditional larger incisions). Your surgeon works closely with pulmonologists (lung doctors) to determine fitness for surgery and optimize lung function before and after surgery.

 


Radiation Therapy

Radiation therapy uses high-energy X-ray beams to kill cancer cells. It can be used alone as primary therapy or in conjunction with other therapies such as chemotherapy or surgery. It can be used to treat patients with advanced cancers to relieve pain and obstruction (blockage) of the airways, thereby relieving shortness of breath and cough. Additionally, it can be used to improve cure rates in patients with regional cancers when combined with chemotherapy and or surgery. Patient who have localized cancers but are not medically fit to undergo surgery due to other medical problems or poor lung function can be treated with an innovative, high technology approach known as “radiosurgery”. High doses of precisely focused therapy are aimed at tumors to kill tumor cells in the place of surgery. Your expert team at Baylor University Medical Center will work together to choose the best therapy for each patient.

 


Chemotherapy And Targeted Therapies

Chemotherapy uses drugs designed to kill rapidly growing cancer cells while sparing normal ones. Chemotherapy is delivered through intravenous therapy although some recently developed chemotherapy drugs can be given as a pill. Newly developed “targeted” medicines use newly discovered weaknesses in the growth pathways of cancer cells and provide the potential for improved outcomes with less side-effects when compared to traditional IV approaches. All tumors evaluated at BUMC are tested for their unique genetic profile to determine whether they are candidates for treatment using these novel the rapies (see link). Chemotherapy is used to treat patients whose tumors have been removed to prevent the recurrence (return) of their cancer and in patients whose tumors have spread (metastasized).

Patient Education: Mediastinal Surgery

What Is The Mediastinum And What Is Mediastinal Surgery?

The mediastinum is an anatomic description of the central portion of the chest. Mediastinal surgery represents any procedure performed within this area. The mediastinum is surrounded by the breastbone in front, the spine in back, and the lungs on each side (Figure). The types of surgery range from small procedures performed to diagnose disease processes as well as more significant operations necessary to remove larger tumors that grow in this region.

Why Is Mediastinal Surgery Needed?

Many types of growths (tumors) occur in the mediastinum. These can range from non-cancerous (benign) to cancerous (malignant). It can sometimes be difficult to distinguish between benign and malignant conditions. Obtaining a piece of the tumor (biopsy) can differentiate between benign and malignant growths and allow appropriate treatment. Some benign and many malignant tumors are best treated by surgical removal (resection) although this varies by the type of tumor. Some tumors are best treated by chemotherapy or radiation therapy and do not require removal. Your surgeon will help guide you in this decision. Some diseases such as Myasthenia Gravis, a disease affecting a patient’s strength and vision, can be treated by removal of the thymus gland which resides in the mediastinum.

Who Is A Candidate For Mediastinal Surgery?

Most tumors that grow in the mediastinum should be biopsied or removed. Most biopsies can be performed with minimally invasive techniques and rapid recovery. Almost all patients are candidates for biopsy while candidacy for resection depends on the size of the tumor, its location, relationship with other structures in the chest and a patient’s overall medical condition.

What Tests Are Performed Before Mediastinal Surgery?

Your surgeon will perform a thorough history and physical exam. Breathing tests are generally performed (pulmonary function tests). Blood tests are drawn that can give clues to the cause of some tumors. Additionally, imaging is performed including but not limited to:

  • Chest x-ray
  • Computed tomography (CT) scan of the chest
  • Magnetic resonance imaging (MRI) of the chest

Your surgeon will determine if additional preoperative tests are necessary based on the findings of these studies and your medical history.


Biopsy

A biopsy is the removal of a sample of tissue for examination under the microscope by a pathologist, a physician trained in examining this tissue. The following are biopsy techniques:

  • Percutaneous biopsy – Performed by a radiologist, this procedure is completed using a computed tomography (CT)-guided needle biopsy while a patient is awake but sedated. During the procedure, a needle is placed between the ribs to sample the mass.
  • Mediastinoscopy with biopsy – Performed under general anesthesia, mediastinoscopy is a minimally invasive method to examine the mediastinum and sample tissue. A mediastinoscope (small lighted instrument approximately an inch in diameter) is inserted through a small incision at the base of the neck or between the ribs in the front of the chest. Mediastinoscopy accurately and safely diagnoses almost all tumors and is typically performed on an outpatient basis.
  • Thoracoscopic biopsy (Video-Assisted Thoracic Surgery) – A procedure performed in the operating room under general anesthesia, this procedure uses video-assisted technology that maximizes visualization while minimizing trauma. A thoracoscope (small video-scope) and specially designed instruments are inserted through small incisions between the ribs to biopsy masses and sometimes remove them completely.

Surgical Resection

Some tumors of the mediastinum require complete removal. Techniques to remove them include:

  • Sternotomy – Division of the breastbone, identical to what is performed in open-heart surgery . A sternotomy allows access to the entire chest cavity including the heart, great vessels and lungs, and may be necessary to remove larger tumors and masses.
  • Thoracotomy – An incision between the ribs. Similar to a sternotomy, this procedure allows wide access to the right or left chest and removal of large tumors that are localized to one side or the other.

Minimally Invasive Surgery

Some tumors of the mediastinum are amenable to less invasive approaches. This depends on the type, size and location of the tumor. Minimally invasive approaches include:

Video-assisted thoracic surgery (VATS) is a procedure that uses video-assisted technology to minimize trauma and speed recovery. A small camera is inserted between the ribs and two other instrument “ports” utilized to manipulate and remove the tumor.

Robotic Surgery Robotic surgery utilizes robotic technology to minimize surgical trauma. The surgeon works at a console next to the patient in the operating room that provides visualization of the inside of the chest and control of highly responsive robotic arms. Advantages include 3-D technology to visualize and fine robotic dexterity to manipulate and remove tumors. Your surgeon will discuss with you and choose the best approach for your tumor.

Patient Education: Minimally Invasive Surgery

Baylor Scott & White Center for Thoracic Surgery at Baylor University Medical Center leads the field in minimally invasive thoracic surgery. Using small incisions and less traumatic techniques, patient recovery is greatly improved.

Some of the benefits of minimally invasive thoracic surgery include:

  • Faster recovery and return to normal activities
  • Shorter hospital stay
  • Lessened pain and decreased need for pain medications
  • Improved cosmesis
  • Diminished blood loss

Our surgeons at BSW​ Center for Thoracic Surgery at Baylor University Medical Center use video-assisted thoracic surgery (VATS) and robot-assisted technology to approach most tumors in the chest and abdomen.

Minimally Invasive Techniques:

Video-Assisted Thoracic Surgery (VATS)

This technique involves inserting a surgical camera (thoracoscope) through a small incision between the ribs. Once inside the chest, the surgeon has the ability to inspect the entire chest cavity. Specially designed instruments are inserted through similar “key-hole” incisions called “ports”, to allow the surgeon to manipulate the lung and other structures and remove areas of concern. Narrow surgical staplers can be inserted through these ports to obtain biopsies and remove portions of the lung. Tissue is then placed into a specially designed retrieval bag and removed through the same ports, avoiding need for conventional large incisions.

Robotic Thoracic Surgery

Surgeons at Baylor University Medical Center perform select surgery of the chest and abdomen using the Intuitive da Vinci® Surgical System. This technique allows exceptional control of instruments and superior visibility using 3-D visualization technology. The surgeon controls the robot’s movements from a console in the operating room next the patient. The improved visualization and dexterity allows our surgeons to perform complex procedures that were previously only possible through large incisions. Your surgeon will discuss with you whether you are a candidate for robotic surgery.

Lung Cancer Surgery

In the past, surgeons needed to spread between the ribcage and make large incisions to remove lung cancers. However, technology and surgical technique has evolved that allow equivalent operations to be performed through small incisions and without rib spreading. Surgical procedures for lung cancer are grouped into the following categories.

  • Wedge resection: Removal of the tumor along with a rim of normal tissue surrounding the cancer. Most appropriate for very small tumors that are located peripherally (toward the surface of the lung).
  • Lobectomy: Removal of the entire lobe of the lung that contains the cancer. There are three lobes that compose the right lung and two that compose the left lung. The artery, vein and airway (bronchus) of the lobe are dissected out and divided and drainage basins of the lung (lymph nodes) removed. This is the standard operation for most lung cancers and in most circumstances, lobectomy provides the best likelihood that the tumor will not return (recur).
  • Segmentectomy: Removal of the anatomic portion of a lung called a segment. Each lobe is composed of smaller segments. This also involves a systematic approach to the artery, vein and airway supplying the segment of lung harboring the cancer with the removal of lymph nodes. A segmentectomy is appropriate for smaller tumors.
  • Pneumonectomy: Removal of the entire lung. Performed only when other lung sparing techniques are not possible.

Your surgeon will discuss which option is best for you dependent on the location and size of your tumor, what other medical conditions you have and how good your lung function is.

Patient Education: Myasthenia Gravis

What is myasthenia gravis?

Myasthenia gravis (MG) is a neuromuscular disease caused by a disorder in the immune system. It occurs in approximately 14-20 patients out of 100,000. In people with MG, the immune system produces abnormal antibodies that prevent the muscles from appropriately receiving signals from the nerves that tell them when to relax or contract. This causes muscle weakness and symptoms that can include double vision or blurred vision (eye muscle weakness), drooping eyelids (eyelid muscle weakness), difficulty with speaking and swallowing (throat muscle weakness) and weakness of the limbs.

When the immune system acts against healthy tissue in an inappropriate manner, it is called an autoimmune disorder, with “auto” meaning “self. MG is considered to be a neuromuscular autoimmune disease.

Myasthenia gravis is most common in young women and older men, but people of any age or either sex can get it.

What causes myasthenia gravis?

Scientists do not completely understand what triggers the autoimmune reaction in MG, but they do know that the thymus gland plays an important role in the disease.

The thymus is a small gland that lies in the front (anterior) portion of the central chest, beneath the breastbone, and extends into the lower part of the neck. It is most important early in life during immune system development. A baby’s thymus gland weighs between .7 and 1.1 oz. The gland continues to grow and by puberty weighs 1.1 to 1.8 oz. The thymus gland’s importance in immune development is felt to dissipate by puberty and diminish in size. Over time, fat replaces the majority of the gland.

Tumors of the thymus gland are called thymomas. Around 10-15 percent of people with MG have a thymoma. Another 60%, however, will have other abnormalities of the gland including thymic hyperplasia (an enlarged gland). The original association between the thymus gland and MG was made back in the early 1900’s when surgeons observed that removal of a thymoma resulted in improvement in the patient’s myasthenic symptoms. Based on this observation, surgeons began removing the thymus gland in myasthenic patients without thymic tumors and noted a similar response.

How is myasthenia gravis diagnosed?

The diagnosis of MG is usually made by a neurologist (a physician expert in diagnosing and treating neurologic disorders. Infusion of a specific medication (edrophonium chloride) under close observation should cause improvement of a patient’s symptoms if the patient has MG and therefore confirm the diagnosis. Additionally, blood tests can be performed that may demonstrate the presence of an antibody against acetylcholine receptor (AchR) and muscle-specific receptor tyrosine kinase (MuSK). This can help confirm the clinical diagnosis.

How is myasthenia gravis treated?

Once the diagnosis of MG has been confirmed, a treatment plan by your neurologist is developed with the goal of reducing the number of antibodies causing the disease and/or improving the communication between the nerves and muscles.

This results in improvement in muscle strength and symptoms. Medical treatment options include:

  • Medicines that suppress antibody production or improve nerve signal transmission. Cholinesterase inhibitors such as pyridostigmine bromide (Mestinon) and neostigmine bromide (Prostigmin) are the most commonly used inhibitors. Corticosteroids and other immunosuppressive therapies are also effective.
  • Plasmapheresis, a procedure that removes antibodies from the blood
  • High-dose intravenous immune globulin (IVIG); the infusion of normal antibodies from donated blood to temporarily modify the immune system

Surgery for Myasthenia Gravis

The surgical treatment of MG is thymectomy (complete removal of the thymus gland). Thymectomy should be performed by a thoracic surgeon with specific expertise in removal of the thymus gland for MG. Theoretically, this removes the source of abnormal antibody production.

The role of and indications for thymectomy are debated. However, in general, thymectomy is recommended for all patients with thymomas and for patients under 60 who have mild to moderate muscle weakness due to MG. Thymectomy is not generally recommended for patients with MG that affects only their eyes (ocular MG).

Thymectomy appears to be most effective when it is performed 6 to 12 months after the onset of symptoms and therefore it is important to talk to your doctor early in your diagnosis about this option. Your surgeon and neurologist will choose the best treatment for you.

Results of Thymectomy

Individual response to thymectomy varies depending on a patient’s age, response to prior medical therapy, severity of disease and duration of symptoms. In general, 70 percent of patients have complete remission or significant reduction in medication needs within a year of the procedure. The other 30 percent of patients who have thymectomy experience no improvement in their symptoms. Data suggests that patients who have thymectomy are two times as likely to experience remission compared to medical treatment alone.

How is thymectomy performed?

Thymectomy can be performed by several different surgical techniques:

Transsternal Thymectomy:

In this procedure, an incision is made in the skin over the breastbone (sternum), and the breastbone is divided (sternotomy) to expose the thymus. This incision is commonly used for open heart surgery. The surgeon removes the thymus through this incision as well as any residual fat in the center of the chest which may harbor thymic cells. This approach is usually reserved for patients with a large tumor of the thymus (thymoma) in addition to MG.

Robotic Thymectomy And Video-Assisted Thorascopic Thymectomy (VATS):

These minimally invasive techniques use several tiny incisions in the chest and are used in most operations for MG at the Center for Thoracic Surgery at Baylor University Medical Center. Robotic thymectomy is preferred for MG. A camera is inserted through one of the incisions and the surgery is performed with video guidance. The surgeon removes the entire thymus using specially designed surgical instruments inserted through one inch long incisions. In a robotic-assisted procedure, the surgeon uses robotic arms with fine dexterity to perform the surgery. Visualization using 3-D technology using robotic techniques is outstanding. Minimally invasive approaches result in less post-operative pain and more rapid recovery.

Your surgeon will choose the best approach for you.

 

References/Suggested Reading

Patient Education: Pleural Mesothelioma

Mesothelioma is a rare form of cancer in which tumors form in the lining of the chest (pleural mesothelioma) or the abdomen (peritoneal mesothelioma). Rarely, it can affect the outside covering of the heart (pericardial mesothelioma).

What Is Pleural Mesothelioma?​

Pleural mesothelioma is cancer that affects the lining of the lungs and chest wall. It is rare, with about 3000 new cases diagnosed in the United States per year.

What Are The Symptoms Of Pleural Mesothelioma?

Symptoms Of Pleural Mesothelioma May Include:

  • Shortness of breath
  • Chest wall pain
  • Cough
  • Fever
  • Sweating
  • Fatigue
  • Weight loss
  • Trouble swallowing
  • Hoarseness
  • Generalized weakness

What Causes This Type Of Cancer?

Exposure to asbestos is strongly linked to mesothelioma and is felt to be the primary cause in most cases of the cancer. This exposure can usually be linked to a patient’s work-place or home. Asbestos is a naturally occurring mineral that was once widely used as a component of insulation due to its remarkable fire and heat resistance. It was used in factories, shipyards, building construction, automobile brakes and clutches until it became clear that exposure to microscopic asbestos fibers could cause cancer.

Most asbestos use was discontinued in the United States in the 1970s and 1980s although some homes and buildings constructed before this time do still contain asbestos. Almost all cases of pleural mesothelioma can be linked to asbestos exposure. Family members of those who worked with asbestos are at risk due to secondhand exposure to asbestos fibers carried home on clothing. It can take decades between the initial exposure to asbestos and the development of mesothelioma


How Is Mesothelioma Diagnosed?

The diagnosis of mesothelioma begins with a thorough history and physical exam. During the physical exam, your doctor will look for signs of fluid accumulation within the chest which is common with pleural mesothelioma. If the history or physical suggests mesothelioma, imaging, blood tests as well as other procedures may be ordered.

Imaging

  • Chest X-ray– A chest X-ray may show thickening or calcium deposits in the lung lining, fluid accumulation within the chest or changes to the lungs themselves secondary to asbestos or tumor growth
  • Computed tomography (CT) scan– This cross sectional X-ray of the chest gives a more detailed map of the location of the tumor and any potential regions of spread.
  • Positron emission tomography (PET) scan– This non-invasive test involves the injection of radioactive sugar into the blood. Because cancer cells take up more sugar when compared to normal cells, a special camera that picks up the radiation creates a picture of the area where cancer is located.
  • Magnetic resonance imaging (MRI) scan– MRI scans are non-invasive tests in which radio waves created by powerful magnets produce a detailed picture of the body. MRIs can clarify the extent and location of tumor.

 


Tests Of Fluids And Other Tissues

  • Cytology– Mesothelioma often causes irritation of the lining of the chest leading to fluid accumulation known as a pleural effusion. Your doctor may draw fluid out of your chest with a needle and look for cancer cells within this fluid. Examination of this fluid for cancer cells under the microscope is known as cytology.
  • Needle biopsy– Larger samples of tissue that line the chest can be drawn out using a needle that is guided using CT scan imaging. This tissue, known as a needle biopsy, is then examined under the microscope for cancer cells.
  • Surgical biopsy– In some cases, more tumor tissue must be obtained to make a diagnosis. This can typically be done minimally invasively using VATS (video-assisted thoracic surgery) and a single incision about 1 inch in length. Patients are typically discharged on the same day as surgery. Results of this biopsy are close to 100% accurate

What Treatments Are Available For Mesothelioma?

Although there is not yet a known cure for mesothelioma, there are several treatment options available that are aimed at extending and improving a patient’s quality of life. These options vary dependent on the stage of the cancer (how advanced it is), a patient’s age and overall medical condition as well as the tumor’s histology (how aggressive the tumor appears under the microscope). Mesothelioma can be difficult to treat given the fact that it is often discovered after it has spread throughout the body. However, for patients with disease that is still localized within the chest, a combination of surgery, chemotherapy and radiation may be of benefit.

What Treats Mesothelioma?

Because mesothelioma is a rare disease, it is important that you choose a team of physicians with experience treating mesothelioma. The team at the Chest Cancer Research and Treatment Center has extensive experience in treating mesothelioma. This team is composed of medical oncologists (doctors specialized in diagnosing and treating cancers), radiation oncologists (doctor specialized in giving radiation treatments to kill cancer cells) and thoracic surgeons (doctors who specializes in operating on organs inside the chest), all with the most up to date techniques in treating this disease.

Surgery For Mesothelioma

Surgery is most commonly performed when disease is in its earlier stages (localized to the chest). The purpose of surgery is to remove all cancer from the chest. Types of surgery include.

  • Pleurectomy – Complete removal of the covering of the lungs and the lining of the chest
  • Extrapleural pneumonectomy – Removal of one lung along with the lining of the chest, the diaphragm (muscle of breathing) and pericardium (outside covering of the heart).

Radiation or chemotherapy may be used as follow-up to surgery to kill any invisible cancer cells. This form of treatment is known as adjuvant therapy (given after surgery). Your chest surgery should be performed by a specialized thoracic (chest surgeon) with expertise treating pleural mesothelioma. All thoracic surgeons in the Department of Thoracic Surgery at Baylor University Medical Center have extensive experience in surgery for mesothelioma. Your thoracic surgeon will determine whether you are a candidate for surgery and whether tumor is removable. Some tumors cannot be removed due to their location or if the cancer has spread. If you are not a candidate for surgery, chemotherapy may be recommended or you may be offered a clinical trail through the Chest Cancer Research and Treatment Center.

 


Are There Resources Available?

See the following websites:

Patient Education: Surgical Treatment Of Emphysema

Lung volume reduction surgery (LVRS) is a procedure performed to remove abnormal lung tissue in patients with significant shortness of breath due to chronic obstructive pulmonary disease (COPD). The diseased lung does not allow for normal air movement, resulting in air trapping and over-inflation of the lung. Removal of the diseased tissue allows for the more normal lung tissue to expand and improve air exchange.

For select patients, LVRS has been demonstrated to improve breathing ability, exercise capacity, and quality of life. Results depend on the location of the disease area within the lung as well as the patient’s exercise capability and ability to tolerate surgery. Several tests are necessary to determine if a patient would benefit from this procedure, including:

  • Chest x-ray and computed tomography (CT) scan
  • Pulmonary function test (PFTs)
  • Arterial blood gas​
  • Six-minute walk test
  • Electrocardiogram and echocardiogram

Pre-operative evaluation by a multidisciplinary team including a pulmonologist, respiratory therapist and thoracic surgeon is necessary to determine candidacy. The multidisciplinary team at Baylor University Medical Center in Dallas has extensive experience evaluating patients for LVRS. Cessation of smoking is mandatory and all patients must complete an extensive pulmonary rehabilitation program prior to surgery.

LVRS must be performed by a thoracic surgeon with extensive experience performing this procedure in order to assure optimal outcomes. All surgeons in Baylor Scott & White Center for Thoracic Surgery ​have extensive experience performing this procedure.

LVRS is typically performed in on both lungs at the same time using video-assisted thoracoscopic surgery (VATS). VATS is a minimally-invasive technique that is performed through 2-3 small incisions between the ribs and utilizes a high-definition video camera to work inside the chest without making a large incision, dividing the breastbone or spreading the ribs. This results in decreased pain after surgery and a quicker recovery. An epidural catheter is often placed by the anesthesiologist to further decrease post-operative pain.

The camera is inserted through one incision and a specialized stapler is inserted through another incision to remove the diseased lung. The procedure is then repeated on the opposite lung. One or two drainage tubes are left in each side of the chest to remove fluid and air which typically accumulate after lung surgery; once drainage of fluid and air has ceased, the tubes are removed and the patient is discharged home, which is typically 7-10 days after surgery.

Complications of LVRS include bleeding, infection including pneumonia, persistent leakage of air from the lung tissue, and death. For appropriately selected patients, these risks are low and outcomes are excellent, with improved exercise capacity and increased long-term survival. Alternatives to LVRS include no surgery, continued medical management and pulmonary rehabilitation.

New in 2019, surgeons at Baylor Scott & White Center for Thoracic Surgery now offer endoscopic lung volume reduction surgery. In appropriately selected patients, small valves can be placed in the airway without incisions to reduce the size of the emphysematous lung. This technique is known as endoscopic lung volume reduction surgery.

Patient Education: Thoracic Outlet Syndrome

What Is Thoracic Outlet Syndrome?​

Thoracic outlet syndrome is produced by compression of the nerves and vessels in the area behind the collarbone.  Pain and swelling of the neck, shoulder and arm are common symptoms.

Presentation depends on the structure that is mainly affected by the compression.  Patients can present with neurogenic, venous or arterial compression.​

This condition can affect patients of any age.  It is common among people who perform over-the-head activities where repetitive motions of the arm and shoulder are carried out.  Also, compression can occur from trauma in the area, the presence of an extra rib, obesity, or anatomical variation of the first rib.

What Are The Symptoms?

Neurogenic

Venous

Arterial

- tingling of arm and hands

- weakness

- muscle wasting

- numbness

- weak grip

- swelling and heaviness of arm and hand

- bluish discoloration

- dilation of veins of the arm and chest

- Cold feeling of arm and hand.

- pain and numbness

- loss of pulses

​ 

How Is It Diagnosed?​​

Diagnosis of thoracic outlet syndrome requires a good interview with the patient followed by a detailed physical exam.  During the physical exam, the goal is to replicate the maneuvers that elicit those symptoms.​

Additionally, X-rays of the neck and chest can evidence the presence of an anatomical variation or the existence of an extra rib.  In cases of venous or arterial compression, venograms and arteriograms help us identify the area impinged and plan the appropriate treatment.  Treating the clot only with medications to dissolve it and blood thinners most of the time results in recurrence. If there is vein compression, surgery is recommended to relieve the impingement. 

Patient Education: Trachea

The trac​hea is the windpipe which transports air from the mouth to the lungs. It is connected above in the neck to the larynx (“Adam’s apple”) and below in the chest it divides into the left and right bronchi which connect to each lung. The surgeons in the Department of Thoracic Surgery at Baylor University Medical Center diagnose and treat a variety of diseases affecting the trachea.

​Benign conditions include:

  • Tracheal stenosis: narrowing of the trachea, most commonly following intubation (breathing tube placement) or previous surgery
  • Tracheal inflammation: associated with systemic diseases such as Wegener’s granulomatosis

Malignant conditions include:

  • Tumors of the airway
  • Cancer of adjacent organs causing compression or invasion of the trachea

Tracheal Stenosis

Tracheal stenosis is narrowing of the trachea. Babies can be born with this condition, but most adult cases develop due to the growth of scar tissue during a period of prolonged intubation (breathing tube placement) or following tracheostomy, a surgically-created opening in the neck for breathing. The trachea can also be externally compressed by other structures, most commonly tumors of the thyroid gland and esophagus.

Tracheal Inflammation

Several autoimmune disorders and infections can cause inflammation of the trachea which functionally blocks air flow similar to tracheal stenosis. These include Wegener’s granulomatosis, sarcoidosis, and amyloidosis. It can also occur as a side effect of radiation therapy to the head, neck, or chest for other conditions.

Tumors Of The Airway

Tumors that arise in the trachea and bronchi are much more uncommon that tumors of adjacent structures that involve the trachea.

Benign tracheal and bronchial tumors include:

  • Carcinoid tumors: these tumors grow much more commonly in the bronchi than the trachea. They occur most often between the ages of 40-60 years, are not associated with smoking, and can produce hormones that cause other systemic symptoms in the heart and gastrointestinal tract.
  • Papillomas: these tumors are benign growths associated with human papillomavirus (HPV). They often grow in groups, referred to as papillomatosis, and can carry the risk of transforming into squamous cell carcinoma.
  • Chondroma: these tumors grow from the cartilage portion of the airway and are very rare.
  • Hemangioma: these are tumors of the blood vessels of the airway and can cause significant bleeding if rupture or during surgical manipulation.

Malignant tracheal and bronchial tumors include:

  • Squamous cell carcinoma: this most common type of tracheal tumor usually grows in the lower part of the trachea. Smoking is the main risk factor, and these tumors tend to grow quickly and cause bleeding and shortness of breath.
  • Adenoid cystic carcinoma: much less common, these tumors grow slowly and are not associated with smoking.

 

Cancer Of Adjacent Organs

Cancer of the structures around the airway can affect the passage of air through the trachea. These include:

  • Thyroid gland: benign goiter as well as cancer of the thyroid gland can compress the trachea in the neck or chest region and cause shortness of breath.
  • Esophagus: the food pipe sits directly next to the trachea. Cancers of this organ can (1) grow into the airway; (2) develop abnormal communication with the airway (fistula) and (3) treatment of this condition with radiation therapy or stents can damage the airway.
  • Lung: the lung is directly communicating with the airway at the level of the bronchi, but tumors of the upper part of the lung as well as abnormal lymph nodes in the chest can compress the trachea and cause symptoms.

Diagnosing Diseases Of The Trrachea

Diseases of the trachea are evaluated using a combination of non-invasive and invasive tests.

Non-Invasive Testing Includes:

  • Pulmonary function testing determines how much air can be breathed in and out and helps classify types of airway and lung diseases. It can also be used to assess the muscles of the chest wall and mechanics of breathing.
  • Ultrasound uses sonography to see inside the body. It is particularly useful for assessing the thyroid gland when it is abnormally large and impinging on the trachea.
  • CT (computed tomography) scan uses x-ray images to create virtual images of the inside of the body. It is essential in the diagnosis of airway and lung diseases. Advanced 3-D reconstructions are particularly useful in planning treatment for airway conditions.
  • PET (positron emission tomography) scan uses an injected dye to assess metabolic activity and detect the likelihood of cancer.

Invasive testing includes:

  • Endoscopy: fiberoptic tubes that are inserted through the mouth or nose and relay a high-definition image to the operator allowing direct visualization inside the body. Bronchoscopy includes endoscopic evaluation of the larynx, trachea, and bronchi. This can be augmented with endobronchial ultrasound (EBUS), which allows sonographic visualization of the tissue around the airway, most specifically the lymph nodes. EBUS is essential in diagnosing and staging tumors of the trachea, lungs, and esophagus.
  • Biopsy: tumors of the airway or surrounding structures can be biopsied at the time of endoscopy, or rarely at a separate appointment through the skin. Biopsy samples are evaluated under the microscope by our pathologists, and rare cases are further reviewed at an interdisciplinary tumor board.

Treating Diseases Of The Trachea

Diseases of the trachea are complex and require a multidisciplinary approach. The Department of Thoracic Surgery at Baylor University Medical Center coordinates care between our thoracic surgeons, interventional pulmonologists, head and neck surgeons, radiologists, anesthesiologists, and pathologists to determine the optimal strategy for each individual patient.

Treatments range from the administration of medication (such as chemotherapy) or radiation, to endoscopic interventions, to open surgery. Our physicians are constantly trialing new products and techniques to stay on the cutting edge of tracheal medicine, and often will provide therapy to patients deemed untreatable at other centers.

Endoscopic interventions can be performed for definitive treatment of many conditions or for palliation of symptoms. They can typically be performed through a tiny fiberoptic camera (flexible bronchoscope), but occasionally require a larger metal scope (rigid bronchoscope); either way, no incisions are made and side effects are minimal. These interventions include:

  • Tumor resection: some tumors can be partially or completely removed through a scope with no open surgery necessary. This can be done mechanically, or with the aid of argon beam or laser therapy.
  • Dilation: tracheal stenosis or compression by an external structure can be relieved by pneumatically dilating the blocked area with a balloon, which can result in temporary or permanent resolution.
  • Stents: placement of metal or silicone stents within the area can keep the constricted area open. This can be performed as a temporary or permanent measure, and allows for symptom relief while other treatments are administered, such as chemotherapy or radiation.

Surgery

Open tracheal surgery is complex, and requires a specialized center and a highly trained team. The surgeons in the Department of Thoracic at Baylor University Medical Center all underwent advanced training in airway surgery, which is only performed a select centers in the country.

Surgery on the trachea involves removal (resection) of the diseased segment followed by reattachment of the ends of the airway (reconstruction). This is the preferred method of treating cancerous diseases, as well as benign diseases that have not responded to less-invasive techniques. Sometimes there is a need for a temporary or permanent tracheostomy, a surgically created opening in the neck for breathing.

Surgical resection and reconstruction is most often done through an incision in the neck, but occasionally requires extension of the incision into the chest through a sternotomy, or dividing the upper part of the breast bone. Diseases of the lower airway, or bronchi, can be approached through the side of the chest, dividing the muscle between the ribs (thoracotomy), and sometimes can be performed in a minimally invasive fashion (video-assisted thoracic surgery, VATS).


The Bonnie J. Addaio Lung Cancer Foundation - Lung Cancer Living Room. Read And Listen To Monthly Presentations By Lung Cancer Specialists, Physicians And Researchers. Read Here

Medical Services

Baylor Scott & White Center for Thoracic Surgery focuses exclusively on the treatment of non-cardiac chest disease.

  • Lung Cancer Screening
  • Lung Transplantation
  • Lung Volume Reduction Surgery (LVRS)
  • Mediastinal Surgery
  • Minimally Invasive Thoracic Surgery
  • Surgery for Achalasia
  • Surgery for Thoracic Outlet Syndrome
  • Sympathectomy for Hyperhidrosis
  • Thoracic Surgery for Anti-Reflux
  • Thoracic Surgery for Esophageal Cancer
  • Thoracic Surgery for Lung Cancer
  • Thoracic Surgery for Lung Carcinoids
  • Thoracic Surgery for Mesothelioma
  • Thoracic Surgery for Trachea
  • Thymectomy for Myasthenia Gravis

Lung Cancer Screening

If you are at high risk for lung cancer, you can be screened for the disease before symptoms develop through use of a low-dose computed tomography (CT) scan.

In the event a lung nodule or lesion is discovered, our renowned specialists provide crucial follow-up care and treatment guidance.

Lung Transplantation

Baylor Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Center, part of Baylor Scott & White Health is one of the largest, most comprehensive multi-specialty transplant centers in the United States. Our lung transplant program offers sophisticated diagnostic testing and innovative therapies for patients with advanced chronic lung disease. 

Lung Volume Reduction Surgery (LVRS)

Lung volume reduction surgery (LVRS) is a procedure performed to remove abnormal lung tissue in patients with significant shortness of breath due to chronic obstructive pulmonary disease (COPD). The diseased lung does not allow for normal air movement, resulting in air trapping and over-inflation of the lung. Removal of the diseased tissue allows for the more normal lung tissue to expand and improve air exchange.

For select patients, LVRS has been demonstrated to improve breathing ability, exercise capacity, and quality of life. Results depend on the location of the disease area within the lung as well as the patient’s exercise capability and ability to tolerate surgery.

Several tests are necessary to determine if a patient would benefit from this procedure, including:

  • Chest x-ray and computed tomography (CT) scan
  • Pulmonary function test (PFTs)
  • Arterial blood gas
  • Six-minute walk test
  • Electrocardiogram and echocardiogram

Pre-operative evaluation by a multidisciplinary team including a pulmonologist, respiratory therapist and thoracic surgeon is necessary to determine candidacy. The multidisciplinary team at Baylor University Medical Center has extensive experience evaluating patients for LVRS. Cessation of smoking is mandatory and all patients must complete an extensive pulmonary rehabilitation program prior to surgery.

LVRS must be performed by a thoracic surgeon with extensive experience performing this procedure in order to assure optimal outcomes. All surgeons in Baylor Scott & White Center for Thoracic Surgery ​have extensive experience performing this procedure.

The camera is inserted through one incision and a specialized stapler is inserted through another incision to remove the diseased lung. The procedure is then repeated on the opposite lung. One or two drainage tubes are left in each side of the chest to remove fluid and air which typically accumulate after lung surgery; once drainage of fluid and air has ceased, the tubes are removed and the patient is discharged home, which is typically 7-10 days after surgery.

Complications of LVRS include bleeding, infection including pneumonia, persistent leakage of air from the lung tissue, and death. For appropriately selected patients, these risks are low and outcomes are excellent, with improved exercise capacity and increased long-term survival. Alternatives to LVRS include no surgery, continued medical management and pulmonary rehabilitation.

New in 2019, surgeons at Baylor Scott & White Center for Thoracic Surgery now offer endoscopic lung volume reduction surgery. In appropriately selected patients, small valves can be placed in the airway without incisions to reduce the size of the emphysematous lung. This technique is known as endoscopic lung volume reduction surgery.

Mediastinal Surgery

Mediastinal surgery represents any procedure performed within the central portion of the chest. The mediastinum is surrounded by the breastbone in front, the spine in back, and the lungs on each side. The types of surgery range from small procedures performed to diagnose disease processes as well as more significant operations necessary to remove larger tumors that grow in this region.

Some tumors of the mediastinum require complete removal. Techniques to remove them include:

  • Sternotomy: Division of the breastbone, identical to what is performed in open-heart surgery . A sternotomy allows access to the entire chest cavity including the heart, great vessels and lungs, and may be necessary to remove larger tumors and masses.
  • Thoracotomy: An incision between the ribs. Similar to a sternotomy, this procedure allows wide access to the right or left chest and removal of large tumors that are localized to one side or the other

Some tumors of the mediastinum are amenable to less invasive approaches, such as video-assisted thoracic surgery (VATS) or robotic surgery. This depends on the type, size and location of the tumor.

Minimally Invasive Thoracic Surgery

Baylor Scott & White Center for Thoracic Surgery at Baylor University Medical Center leads the field in minimally invasive thoracic surgery. Using small incisions and less traumatic techniques, patient recovery is greatly improved.

Some of the benefits of minimally invasive thoracic surgery include:

  • Faster recovery and return to normal activities
  • Shorter hospital stay
  • Lessened pain and decreased need for pain medications
  • Improved cosmesis
  • Diminished blood loss

Our surgeons at BSW​ Center for Thoracic Surgery at Baylor University Medical Center use video-assisted thoracic surgery (VATS) and robot-assisted technology to approach most tumors in the chest and abdomen.

For lung cancer surgery, technology and surgical technique has evolved that allow equivalent operations to be performed through small incisions and without rib spreading. 

Surgical procedures for lung cancer are grouped into the following categories:

  • Wedge resection: Removal of the tumor along with a rim of normal tissue surrounding the cancer. Most appropriate for very small tumors that are located peripherally (toward the surface of the lung).
  • Lobectomy: Removal of the entire lobe of the lung that contains the cancer. There are three lobes that compose the right lung and two that compose the left lung. The artery, vein and airway (bronchus) of the lobe are dissected out and divided and drainage basins of the lung (lymph nodes) removed. This is the standard operation for most lung cancers and in most circumstances, lobectomy provides the best likelihood that the tumor will not return (recur).
  • Segmentectomy: Removal of the anatomic portion of a lung called a segment. Each lobe is composed of smaller segments. This also involves a systematic approach to the artery, vein and airway supplying the segment of lung harboring the cancer with the removal of lymph nodes. A segmentectomy is appropriate for smaller tumors.
  • Pneumonectomy: Removal of the entire lung. Performed only when other lung sparing techniques are not possible.

Your surgeon will discuss which option is best for you dependent on the location and size of your tumor, what other medical conditions you have and how good your lung function is.

Surgery for Achalasia

Treatment options for patients with achalasia are variable. These range from medical to surgical, depending on a patient’s age and medical condition. Your surgeon and gastroenterologist will choose the best treatment for you.

For those requiring surgical treatment, we offer several options:

Surgical myotomy

Surgical myotomy with an antireflux procedure is performed minimally invasively at the Center for Thoracic Surgery using a robotic technique. The operation is called a Heller myotomy with Dor fundoplication, named after the physicians who described the procedure. Five, one inch incisions are created in the abdomen and robotic arms used to perform the myotomy and antireflux procedure. Patients are typically discharged the day after surgery after a night of observation in the hospital. Recovery and return to work is rapid.

Peroral esophageal myotomy (POEMS)

Peroral esophageal myotomy (POEM) is an endoscopic technique used to divide the circular muscle fibers of the lower esophageal sphincter. Overall, the success rate is high and may hold promise as an alternative to the minimally invasive transabdominal approach. However, results are preliminary with limited data for its use in the United States.

Esophagectomy

In some patients in whom all therapies at treating achalasia have failed, symptoms are severe and in whom quality of life is intolerable, complete removal of the diseased esophagus (esophagectomy) is necessary. Fortunately, this occurs extremely infrequently. If esophagectomy is required, replacement of the esophagus is performed using the patient’s stomach and return to eating and swallowing with good quality of life is still achievable

Surgery for Thoracic Outlet Syndrome

The surgery involves removing the first rib and the muscles that are attached to it.  The procedure requires a small incision (4-5 cm) above the collarbone allowing visualization of not only the nerves in charge of moving the arm and hand but also the vein and artery that supply and drain blood from the arm.  With this approach, we are able to perform a complete decompression of all the structures involved in the thoracic outlet syndrome.  Patients usually stay in the hospital for 2-3 days.​

Sympathectomy for Hyperhidrosis

Surgery is an option to treat severe hyperhidrosis (excessive sweating) in patients who have failed topical therapies.

The surgical treatment involves dividing the sympathetic chain which is the nerve that conducts the abnormal stimulation to the sweat glands. The sympathetic chain runs vertically along the ribs and is located about an inch away from the bony spine and is easily identified by the surgeon. Sympathectomy is the operative division of that nerve. The sympathetic chain is typically cut and divided or, in addition, a short portion of the chain is removed.​​ 

Surgery for hyperhidrosis is routinely performed by minimally invasive techniques. Endoscopic thoracic sympathectomy(ETS), also known as thoracoscopic sympathectomy or sympathicotomy, is the most frequently used method. 

Thoracic Surgery for Anti-Reflux

If the hiatal hernia causes the stomach to become obstructed (blocked) or strangulated (blood supply cut off), surgery is needed to untwist the stomach and return it to its normal location. During surgery the stomach is brought back to its normal anatomical position below the diaphragm and the hiatus closed to a normal size.

Hiatal hernia surgery can usually be performed using minimally invasive surgery. The most common form of hiatal hernia repair is the Nissen Fundoplication where the hiatus is closed, the stomach returned to its appropriate position and a portion of the stomach used to form a valve and prevent the backwash of stomach contents into the esophagus. Your surgeon will choose the best hiatal hernia approach and repair for you.

With careful patient selection and meticulous surgical technique, outcomes for hiatal hernia surgery and GERD are excellent. The risk of surgery is relatively low and improvement in quality of life excellent. Recurrence (return) of a hiatal hernia despite repair can occur but is generally uncommon. Surgeons in the Baylor Scott & White Center for Thoracic Surgery are experienced in all forms of hiatal hernia repair and surgery for GERD.

Thoracic Surgery for Esophageal Cancer

Surgery for esophageal cancer presents the best chance for cure in treating localized esophageal cancer and is considered the “gold standard” against which all other treatments are compared. Surgery for esophageal cancer requires the removal of most of the esophagus. The extent of the surgery is determined by the size and location of the tumor. In order for the patient to be able to eat, the stomach is freed up in the abdomen and connected to the upper portion of the esophagus, above where the tumor has been removed. With time, a patient will be able to resume eating most foods normally and return to good quality of life.

Most surgery for esophageal cancer can now be performed at Baylor University Medical Center using minimally invasive approaches such as VATS (video assisted thoracic surgery) or laparoscopically. Surgery for esophageal cancer should be performed by surgeons with specific training and focus on cancers of the esophagus.

Your surgeon will evaluate your fitness for surgery, whether your tumor is resectable (removable) and discuss the surgical approach (minimally invasive vs larger incisions).

Thoracic Surgery for Lung Cancer

In most cases, the treatment of lung cancer is determined by its stage. Localized cancers are treated by surgery. Regional cancers are treated by a combination of therapies including chemotherapy, radiation and surgery. Distant disease is treated by chemotherapy.

Surgery for lung cancer presents the best chance for cure in treating localized lung cancer and is considered the "gold standard" against which all other treatments are compared. Surgery for lung cancer requires the removal of the tumor as well as a surrounding rim of normal lung tissue. The extent of the surgery is determined by the size and location of the tumor. Most surgery for lung cancer can now be performed at Baylor University Medical Center using minimally invasive approaches such as VATS (video assisted thoracic surgery) or robotically (using small incisions and robotically controlled operative arms).

Surgery for lung cancer should be performed by surgeons with specific training and focus on cancers of the chest. All our thoracic surgeons at BUMC focus specifically on chest malignancies. 

Your surgeon will determine whether your tumor is resectable (removable), the extent of the surgery (how much lung needs to be removed with the tumor) as well as the surgical approach (minimally invasive vs traditional larger incisions). Your surgeon works closely with pulmonologists (lung doctors) to determine fitness for surgery and optimize lung function before and after surgery.

Thoracic Surgery for Lung Carcinoids

The method of treatment depends on the size of the tumor, its location, and a patient’s overall health. Surgery is the mainstay of treatment. Your surgeon will guide you in this decision making.

The main types of surgical treatment are

  •  Sleeve resection - An operation that involves cutting a section of the airway (breathing tube) above and below the tumor and removing this section along with the tumor itself. The sections of the airway are then reconnected. Lung tissue may or may not have to be removed. This is a complex procedure that should be performed by a thoracic surgeon with experience in this type of airway reconstruction. All thoracic surgeons in the Center for Thoracic Surgery have experience with sleeve resection.
  •  Wedge resection - In cases where the tumor is very small, a procedure may be performed to remove a small, wedge-shaped portion of the lung using minimally invasive surgery.
  •  Lobectomy - This is the primary type of surgery performed for carcinoid tumor. This type of surgical procedure involves the removal of a portion of the lung called a lobe. This can typically be performed using minimally invasive techniques such as VATS (video assisted thoracic surgery) or robotically.
  •  Pneumonectomy - This procedure involves removal of the entire lung. It is rarely required for a carcinoid tumor.
  •  Lymph node dissection - The lymph nodes (drainage basins) of the lungs and the tumor are always removed during surgery for carcinoid tumors to reduce the risk of the tumor spreading to other parts of the body.

Thoracic Surgery for Mesothelioma

Surgery is most commonly performed when disease is in its earlier stages (localized to the chest). The purpose of surgery is to remove all cancer from the chest. Types of surgery include.

  • Pleurectomy: Complete removal of the covering of the lungs and the lining of the chest
  • Extrapleural pneumonectomy: Removal of one lung along with the lining of the chest, the diaphragm (muscle of breathing) and pericardium (outside covering of the heart).

Radiation or chemotherapy may be used as follow-up to surgery to kill any invisible cancer cells. This form of treatment is known as adjuvant therapy (given after surgery). Your chest surgery should be performed by a specialized thoracic (chest surgeon) with expertise treating pleural mesothelioma. All thoracic surgeons in the Department of Thoracic Surgery at Baylor University Medical Center have extensive experience in surgery for mesothelioma.

Your thoracic surgeon will determine whether you are a candidate for surgery and whether tumor is removable. Some tumors cannot be removed due to their location or if the cancer has spread. If you are not a candidate for surgery, chemotherapy may be recommended or you may be offered a clinical trail through the Chest Cancer Research and Treatment Center.

Thoracic Surgery for Trachea

Diseases of the trachea are complex and require a multidisciplinary approach. The Department of Thoracic Surgery at Baylor University Medical Center coordinates care between our thoracic surgeons, interventional pulmonologists, head and neck surgeons, radiologists, anesthesiologists, and pathologists to determine the optimal strategy for each individual patient.

We treat a variety of disease affecting the trachea, including benign conditions like tracheal stenosis and tracheal inflammation as well as malignant conditions like tumors and cancer.

Treatments range from the administration of medication (such as chemotherapy) or radiation, to endoscopic interventions, to open surgery. Our physicians are constantly trialing new products and techniques to stay on the cutting edge of tracheal medicine, and often will provide therapy to patients deemed untreatable at other centers.

Endoscopic Interventions

Endoscopic interventions, which use no incisions and have minimal side effects, can be performed for treatment or symptom relief. These interventions include:

  • Tumor resection
  • Dilation
  • Stents

Surgical Options

Open tracheal surgery is complex, and requires a specialized center and a highly trained team. The surgeons in the Department of Thoracic at Baylor University Medical Center all underwent advanced training in airway surgery, which is only performed a select centers in the country.

Surgery on the trachea involves removal (resection) of the diseased segment followed by reattachment of the ends of the airway (reconstruction). This is the preferred method of treating cancerous diseases, as well as benign diseases that have not responded to less-invasive techniques. Sometimes there is a need for a temporary or permanent tracheostomy, a surgically created opening in the neck for breathing.

Surgical resection and reconstruction is most often done through an incision in the neck, but occasionally requires extension of the incision into the chest through a sternotomy, or dividing the upper part of the breast bone. Diseases of the lower airway, or bronchi, can be approached through the side of the chest, dividing the muscle between the ribs (thoracotomy), and sometimes can be performed in a minimally invasive fashion (video-assisted thoracic surgery, VATS).

Thymectomy for Myasthenia Gravis

The surgical treatment of MG is thymectomy (complete removal of the thymus gland). Thymectomy should be performed by a thoracic surgeon with specific expertise in removal of the thymus gland for MG. Theoretically, this removes the source of abnormal antibody production.

Individual response to thymectomy varies depending on a patient’s age, response to prior medical therapy, severity of disease and duration of symptoms. In general, 70 percent of patients have complete remission or significant reduction in medication needs within a year of the procedure. The other 30 percent of patients who have thymectomy experience no improvement in their symptoms. Data suggests that patients who have thymectomy are two times as likely to experience remission compared to medical treatment alone.

Thymectomy can be performed by several different surgical techniques, including:

  • Transsternal thymectomy
  • Robotic thymectomy
  • Video-assisted thorascopic thymectomy (VATS)

Your surgeon will choose the best approach for you.

Media

Introduction


Respiratory Failure


Esophageal Perforation


Airway


Gastric Volvulus


Emergent Lung Transplant


Chest Trauma


Pericardial Tamponade


Hemoptysis


Aortic Dissection


Pneumothorax


Coronary Syndromes


Lung Surgeon Talks Of Vaping Dangers


¿Cómo prevenir el cáncer de esófago? Un experto le explica (How to prevent esophageal cancer - an expert explains)


Lung Cancer Prevention, Detection, And Treatment


See Legendary Basketball Couch, Jim Valvano Famous 1993 ESPY Speech Here.


When A Lung Patient Climbs Mountains! Read The Inspirational Story


The New York Times - Patient Voices: Lung Cancer. Read And Listen To Their Stories


The New York Times - E-Cigarettes’ Risks And Benefits: Highlights From The Report To The FDA


The New York Times - Vaping Can Be Addictive And May Lure Teenagers To Smoking, Science Panel Concludes


The Bonnie J. Addaio Lung Cancer Foundation - Lung Cancer Living Room. Read And Listen To Monthly Presentations By Lung Cancer Specialists, Physicians And Researchers


The Compass, Fall 2019 issue

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