Cancer and the thoracic surgeon

The practice of thoracic surgery is a model of using a multidisciplinary approach to the care of patients, particularly in the area of cancer. These diseases include primary malignancies of the lung, esophagus, pleura, chest wall, airway and mediastinum; less commonly, metastatic deposits to the lung, pleura, chest wall and mediastinum require the thoracic surgeon’s attention for diagnosis, for potential curative resection, or for palliative intervention. The optimal and efficient approach to diagnosing, staging, and managing patients with thoracic malignancies is constantly evolving, with the choices available to the patient becoming ever more complex. Yet, the care is moving toward personalization, based on certain factors such as demographics, staging characteristics, and biologic markers. Thus, the traditional roles of the individual disciplines managing these patients are constantly being challenged and are becomes less frequent. As a result of advanced imaging technologies and patient demand for ‘minimally invasive’ procedures, several disciplines are now providing overlapping services. The input from a wide range of these specialists demonstrates the importance of a multidisciplinary approach to optimize treatments and to streamline care. Weekly conferences are held to discuss these complex patients, and a list of those whose services are often required is listed in Table 1. This chapter will focus on the common diagnostic, staging, and therapeutic modalities that are available to the clinician taking care of the patients with non-small cell lung cancer (NSCLC). In particular the aspects of management that fall ‘in-between’ disciplines will be the focus of this discussion.