Surgical Innovations in Lung Cancer Treatments
Lung cancer is the second most common cancer and is the leading cause of cancer death in men and women. Ankit Bharat, MD, chief of Thoracic Surgery and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, discusses the latest advances in lung cancer treatment, and when it is important to refer to the specialists at Northwestern Medicine. He discusses how Northwestern Medicine team is using innovative research to prevent, treat, and manage lung cancer.
Featured Speaker:
Ankit Bharat, MD
Ankit Bharat, MBBS, is the chief of Thoracic Surgery in the Department of Surgery, Harold L. and Margaret N. Method Research Professor of Surgery and associate professor of Surgery (Thoracic Surgery) and Medicine (Pulmonary and Critical Care). Dr. Bharat specializes in malignant and benign chest and esophageal diseases. His research focuses on lung preservation, transplant immunology and airway biology, achieved through collaboration with the Kovler Comprehensive Transplant Center and the Division of Pulmonary and Critical Care Medicine. Transcription:
Surgical Innovations in Lung Cancer Treatments
Melanie Cole (Host): Lung cancer is the second most common cancer and is the leading cause of cancer death in men and women. Joining me today is Dr. Ankit Bharat. He’s the Chief of Thoracic Surgery at Northwestern Medicine, and he’s with me to share how Northwestern Medicine team is using innovative research to prevent, treat, and manage lung cancer. Dr. Bharat, it’s such a pleasure to have you with us. Tell us a little bit about yourself before we get into the segment today and your specialty at Northwestern Medicine.
Ankit Bharat MD (Guest): Well, thank you for the opportunity. My name is Ankit Bharat as you mentioned. I’m the Chief of Thoracic surgery at Northwestern, and just like my peers, I also am a clinically active thoracic surgeon and our specialty includes taking care of patients with all types of cancers in the chest which include lung, esophageal, tracheal cancers and mediastinal tumors, for example. We also take care of patients who have problems that may not include cancers, for example, lung failure and offer treatment such as lung transplant and mechanical life support, et cetera.
Host: So, the Lurie Cancer Center’s focus is that engaging multidisciplinary teams to best treat a patient. What does this look like for lung cancer team? Tell us a little bit about why a multidisciplinary team is so important for this particular type of cancer?
Dr. Bharat: So, Melanie, since we’re talking about lung cancer, I’ll keep it focused to lung cancer. See, what has happened in the field of lung cancer is the tremendous development in all subspecialties that are necessary to treat a patient with lung cancer, which includes not just medical oncology, not just radiation oncology, but to treat—but then also lots of other support specialties like the social workers and psychologists and so forth. So, the advancements that are taking place in all of these specialties to better serve the patient has made the field much more complex. So, it’s important that all these teams get together and talk about every patient on an individual basis to best formulate the care path and previously, you know, when there was more of a cookie-cutter approach, you could just have a patient come in, you know, perform surgery and there were not many variations of surgery and then give them the same cocktail of chemotherapy. It was perhaps okay to have one or two people drive that, but because there is that innovation and because there are so many people who could potentially make an impact into the favorable outcome of the patient, it’s necessary to have that level of engagement from all of the different specialists. So, at the Lurie Cancer Center, when we take care of patients with lung cancer, all of these people are involved, and we discuss every single patient and come up with an individualized care plan which we think would give the patient the best possible outcome.
Host: And what a great point, Dr. Bharat, that it is such a comprehensive, multidisciplinary approach now and so many people as you say are so important for better outcomes. So, tell us about some of the exciting latest advances in lung cancer treatment and what other oncologists should know that could be practice changing.
Dr. Bharat: You know, unlike a lot of cancers, surgery still remains the mainstay of treatment for lung cancer, and I would like to spend a few minutes just talking about the advancements because as I interact with patients and physicians in the community, I feel like not everybody is quite up to speed with what has happened in terms of surgical innovation. So, when we talk to a community, people still have the perception that if they need to get surgery for lung cancer, they need to get their chest cracked open, some ribs taken out, ribs spread and you know, their chest wall muscles cut and so forth. So, you know, with the advancement of minimally invasive surgeries and the two big approaches, they include robotic surgery as well as what we call thoracoscopic surgery that is done using cameras. We are able to perform the same operations with none of that. In fact, most of these procedures are done using three or four incisions, which each of those are as big as the size of our fingertips, So, patients don’t have to go through all of that. So, that’s number one. The second thing is with the advancements in surgical treatment, we don’t have to remove the entire lung of the patient or the entire, what we call, lobe, of the patient, but now, we perform what we call lung conservation surgery, where instead of taking the whole lobe out, we can take just one small segment and still get the patient the same cancer outcome, but we can preserve [the] majority of their lung function.
A simple way to explain that is to probably compare that with breast cancer surgery. You may have heard of patients, and they’re going entire mastectomy, or their entire breast taken off previously for small cancers, but now, you can just take a small portion out and preserve the patient’s breast. So, it’s the same concept that wasn’t as well-developed previously. When it comes to medical oncology, there has been tremendous innovation as well, and specifically, now, we have identified the mutations and genetic makeup of each cancer, and that allows us to target those mutations and genetic changes to better beat that cancer. Previously it was just a standard chemotherapy, but now that has changed, and that complemented the discovery of agents that fall into what we call immunotherapy. In fact, the scientist that identified this won the Nobel Prize last year, but these are quite effective and because of this, the patients are able to live much longer and get better cure rates, even when they have a metastatic disease, and then, finally, when it comes to radiation therapy, we have way better tools to use in patients who may not be surgical candidates for a variety of reasons. So, that has again, extended our ability to take care of patients and treat these cancers without causing a lot of harm to, you know, our patients with lung cancer.
Host: Wow. What an exciting time, Dr. Bharat and thank you for that explanation. You’re currently the principal investigator on several NIH funded grants focusing on examining airway biology, lung preservation, and transplant tumor immunology. Tell us a little bit more about this work briefly, if you would, and how you feel these findings translate into clinical care discoveries.
Dr. Bharat: So, Melanie, the fundamental focus of our research program is to understand how the immune system in the patient, you know, gets altered in a manner to allow lung cancer to develop and then finally how it presents the metastasis of lung cancer and then finally how to modulate that immune system to better achieve control of lung cancer. So, we have several basic science projects ongoing. We also have an interest in what we call the microbiome and how it impacts the development of lung cancer, and what microbiome essentially means—each of us has a unique set of those microscopic bacteria that forms a microbiome, kind of like a tropical forest in all of us in every single organ. Now, this microbiome, as it turns out, you know, it can lead to the development of cancers, but then also it can modulate the immune system and train it to fight cancers better. So, we are trying to understand that, and we’re trying to figure out how that can be modulated to improve patient-specific outcomes—so, a number of things going on. A lot of cutting-edge research and we hope that in the upcoming time, we’ll be able to take a lot of these observations that are coming from our research program and then apply it to our patients to get them the best possible outcome.
Host: What an amazing time for the treatment of lung cancers, Dr. Bharat. As we wrap up, you were recently named the Chief of Thoracic Surgery. Tell us a little bit about your vision for the Northwestern Medicine Thoracic Surgery team and what you would like other providers to know about screening and treatment for lung cancer.
Dr. Bharat: So, yeah, it’s been a privilege to be the chief of such a prestigious program. Our vision is really to be of service to our community in the region, in the nation, and overseas, and we strive always to provide the best possible outcomes for our patients. I’ve had family members who’ve had cancer. I’ve gone to hospitals, and I understand the tremendous emotional burden that a diagnosis of cancer comes. So, we want to be there for our patients and really to provide the best possible outcome, but that’s not just it, you know. It needs to be done in a manner that the patient feels that they’re part of a family, and so we treat every patient as if he or she was our own, and that’s evident by the compassionate care that every member of our team provides to our patients, and then finally, I would say, you know, if any—if you’re unclear about what the next steps are, we are always available to provide advice, so don’t hesitate to call us if we can be of help and offer any advice in the treatment of patients.
Host: Thank you so much, Dr. Bharat. What amazing information and such an exciting time. Thank you so much for joining us. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. For more information on the latest advances in medicine, please visit nm.org to get connected with one of our providers. If you found this podcast informative and so interesting, please share on your social media. Share with other providers, share with your patients and be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.
Surgical Innovations in Lung Cancer Treatments
Melanie Cole (Host): Lung cancer is the second most common cancer and is the leading cause of cancer death in men and women. Joining me today is Dr. Ankit Bharat. He’s the Chief of Thoracic Surgery at Northwestern Medicine, and he’s with me to share how Northwestern Medicine team is using innovative research to prevent, treat, and manage lung cancer. Dr. Bharat, it’s such a pleasure to have you with us. Tell us a little bit about yourself before we get into the segment today and your specialty at Northwestern Medicine.
Ankit Bharat MD (Guest): Well, thank you for the opportunity. My name is Ankit Bharat as you mentioned. I’m the Chief of Thoracic surgery at Northwestern, and just like my peers, I also am a clinically active thoracic surgeon and our specialty includes taking care of patients with all types of cancers in the chest which include lung, esophageal, tracheal cancers and mediastinal tumors, for example. We also take care of patients who have problems that may not include cancers, for example, lung failure and offer treatment such as lung transplant and mechanical life support, et cetera.
Host: So, the Lurie Cancer Center’s focus is that engaging multidisciplinary teams to best treat a patient. What does this look like for lung cancer team? Tell us a little bit about why a multidisciplinary team is so important for this particular type of cancer?
Dr. Bharat: So, Melanie, since we’re talking about lung cancer, I’ll keep it focused to lung cancer. See, what has happened in the field of lung cancer is the tremendous development in all subspecialties that are necessary to treat a patient with lung cancer, which includes not just medical oncology, not just radiation oncology, but to treat—but then also lots of other support specialties like the social workers and psychologists and so forth. So, the advancements that are taking place in all of these specialties to better serve the patient has made the field much more complex. So, it’s important that all these teams get together and talk about every patient on an individual basis to best formulate the care path and previously, you know, when there was more of a cookie-cutter approach, you could just have a patient come in, you know, perform surgery and there were not many variations of surgery and then give them the same cocktail of chemotherapy. It was perhaps okay to have one or two people drive that, but because there is that innovation and because there are so many people who could potentially make an impact into the favorable outcome of the patient, it’s necessary to have that level of engagement from all of the different specialists. So, at the Lurie Cancer Center, when we take care of patients with lung cancer, all of these people are involved, and we discuss every single patient and come up with an individualized care plan which we think would give the patient the best possible outcome.
Host: And what a great point, Dr. Bharat, that it is such a comprehensive, multidisciplinary approach now and so many people as you say are so important for better outcomes. So, tell us about some of the exciting latest advances in lung cancer treatment and what other oncologists should know that could be practice changing.
Dr. Bharat: You know, unlike a lot of cancers, surgery still remains the mainstay of treatment for lung cancer, and I would like to spend a few minutes just talking about the advancements because as I interact with patients and physicians in the community, I feel like not everybody is quite up to speed with what has happened in terms of surgical innovation. So, when we talk to a community, people still have the perception that if they need to get surgery for lung cancer, they need to get their chest cracked open, some ribs taken out, ribs spread and you know, their chest wall muscles cut and so forth. So, you know, with the advancement of minimally invasive surgeries and the two big approaches, they include robotic surgery as well as what we call thoracoscopic surgery that is done using cameras. We are able to perform the same operations with none of that. In fact, most of these procedures are done using three or four incisions, which each of those are as big as the size of our fingertips, So, patients don’t have to go through all of that. So, that’s number one. The second thing is with the advancements in surgical treatment, we don’t have to remove the entire lung of the patient or the entire, what we call, lobe, of the patient, but now, we perform what we call lung conservation surgery, where instead of taking the whole lobe out, we can take just one small segment and still get the patient the same cancer outcome, but we can preserve [the] majority of their lung function.
A simple way to explain that is to probably compare that with breast cancer surgery. You may have heard of patients, and they’re going entire mastectomy, or their entire breast taken off previously for small cancers, but now, you can just take a small portion out and preserve the patient’s breast. So, it’s the same concept that wasn’t as well-developed previously. When it comes to medical oncology, there has been tremendous innovation as well, and specifically, now, we have identified the mutations and genetic makeup of each cancer, and that allows us to target those mutations and genetic changes to better beat that cancer. Previously it was just a standard chemotherapy, but now that has changed, and that complemented the discovery of agents that fall into what we call immunotherapy. In fact, the scientist that identified this won the Nobel Prize last year, but these are quite effective and because of this, the patients are able to live much longer and get better cure rates, even when they have a metastatic disease, and then, finally, when it comes to radiation therapy, we have way better tools to use in patients who may not be surgical candidates for a variety of reasons. So, that has again, extended our ability to take care of patients and treat these cancers without causing a lot of harm to, you know, our patients with lung cancer.
Host: Wow. What an exciting time, Dr. Bharat and thank you for that explanation. You’re currently the principal investigator on several NIH funded grants focusing on examining airway biology, lung preservation, and transplant tumor immunology. Tell us a little bit more about this work briefly, if you would, and how you feel these findings translate into clinical care discoveries.
Dr. Bharat: So, Melanie, the fundamental focus of our research program is to understand how the immune system in the patient, you know, gets altered in a manner to allow lung cancer to develop and then finally how it presents the metastasis of lung cancer and then finally how to modulate that immune system to better achieve control of lung cancer. So, we have several basic science projects ongoing. We also have an interest in what we call the microbiome and how it impacts the development of lung cancer, and what microbiome essentially means—each of us has a unique set of those microscopic bacteria that forms a microbiome, kind of like a tropical forest in all of us in every single organ. Now, this microbiome, as it turns out, you know, it can lead to the development of cancers, but then also it can modulate the immune system and train it to fight cancers better. So, we are trying to understand that, and we’re trying to figure out how that can be modulated to improve patient-specific outcomes—so, a number of things going on. A lot of cutting-edge research and we hope that in the upcoming time, we’ll be able to take a lot of these observations that are coming from our research program and then apply it to our patients to get them the best possible outcome.
Host: What an amazing time for the treatment of lung cancers, Dr. Bharat. As we wrap up, you were recently named the Chief of Thoracic Surgery. Tell us a little bit about your vision for the Northwestern Medicine Thoracic Surgery team and what you would like other providers to know about screening and treatment for lung cancer.
Dr. Bharat: So, yeah, it’s been a privilege to be the chief of such a prestigious program. Our vision is really to be of service to our community in the region, in the nation, and overseas, and we strive always to provide the best possible outcomes for our patients. I’ve had family members who’ve had cancer. I’ve gone to hospitals, and I understand the tremendous emotional burden that a diagnosis of cancer comes. So, we want to be there for our patients and really to provide the best possible outcome, but that’s not just it, you know. It needs to be done in a manner that the patient feels that they’re part of a family, and so we treat every patient as if he or she was our own, and that’s evident by the compassionate care that every member of our team provides to our patients, and then finally, I would say, you know, if any—if you’re unclear about what the next steps are, we are always available to provide advice, so don’t hesitate to call us if we can be of help and offer any advice in the treatment of patients.
Host: Thank you so much, Dr. Bharat. What amazing information and such an exciting time. Thank you so much for joining us. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. For more information on the latest advances in medicine, please visit nm.org to get connected with one of our providers. If you found this podcast informative and so interesting, please share on your social media. Share with other providers, share with your patients and be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.