In this episode, Ziad Hanhan, MD, hosted a discussion about lung cancer diagnosis, surgical management, and evolving treatment paradigms. Dr Hanhan is a thoracic surgeon at Hackensack Meridian Health, chairman of Surgery at Bayshore Medical Center in Holmdel, New Jersey, and chief of Thoracic Surgery at Riverview Medical Center in Red Bank, New Jersey. He was joined by:
Thomas Bauer, MD, the chair of surgery at Jersey Shore University Medical Center in Neptune Township, New Jersey, and Hackensack Meridian Health School of MedicineRachel NeMoyer, MD, a thoracic surgeon at Hackensack Meridian HealthDrs Hanhan, Bauer, and NeMoyer discussed current standards and future directions in thoracic oncology, emphasizing multidisciplinary collaboration and technological innovation. The conversation opened with an overview of lung cancer epidemiology, and the experts noted that this disease remains the leading cause of cancer-related mortality in both men and women. They explained that approximately 90% of lung cancer cases are attributable to tobacco use, making cessation a key preventive measure. They also emphasized that early detection through low-dose CT screening improves outcomes when the disease is identified at an early stage. However, despite these advances, they stated that most lung cancer cases in the United States continue to be diagnosed at stage III or IV, underscoring the need for improved screening adherence.
They expanded on current lung cancer screening guidelines and noted that lung cancer often presents with nonspecific symptoms, such as chronic cough or hemoptysis, and that many cases are discovered incidentally on imaging. The surgeons also discussed diagnostic strategies for pulmonary nodules and emphasized a patient-tailored approach that balances diagnostic yield with procedural risk. They also acknowledged that emerging modalities, such as liquid biopsy and breath-based DNA detection, are promising but still investigational.
They underscored that frailty assessment remains integral to surgical candidacy determination, with both clinical evaluation and pulmonary function testing guiding decision-making. The team also highlighted the role of multidisciplinary tumor boards in integrating surgical, medical, and radiation oncology perspectives. For early-stage disease, surgery remains the standard, whereas patients with stage III disease typically receive neoadjuvant therapy incorporating immuno-oncology agents. The group also discussed expanding surgical indications in select stage IV cases, reflecting improved survival associated with immunotherapy.
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