DISEASES TREATED

I. Lung Cancer

II. Esophageal Cancer

III. Mediastinal Tumors

IV. Paravertebral (paraspinal) tumors

V. Lymphoma

VI. Lung Cancer Metastasis to the Spine

VII. Myasthenia Gravis

VIII. Benign Lung Diseases

IX. Benign Esophageal Diseases and Motility Disorders

Lung cancer is the leading cause of cancer death, but due to new technologies and improvements in diagnosing and treating lung cancer, the outlook is more hopeful than in years past. The Eliana Center for the Treatment and Healing of Thoracic Cancer, a nationally recognized center for outstanding outcomes in the treatment of lung cancer, is dedicated to staying on the cutting edge of these new developments.

Lung cancer comes in several forms and how a patient is treated depends on what form of lung cancer is diagnosed, and at what stage the cancer is found. There are two major types of lung cancer - non-small cell lung cancer and small cell lung cancer. There is also a non-small cell subtype of lung cancer called bronchoalveolar carcinoma, which is difficult to diagnose. Its treatment can be complex depending on the individual patient.

Most forms of lung cancer, especially small cell lung cancer, are caused by smoking or from being exposed to second-hand smoke. People who are exposed to asbestos or radon also increase their risk of developing lung cancer.

There are six types of non-small cell cancers. These types are determined by how the cancer cells look under a microscope. They are:

1. Squamous cell carcinoma, which occurs in the thin, flat squamous cells.

2. Adenocarcinoma, which occurs in cells that secrete.

3. Adenosquamous carcinoma, which occurs in cells that secrete and are flat.

4. Large cell carcinoma, which occurs in cells that are abnormally large.

5. Undifferentiated carcinoma, which occurs in cells that do not look like normal cells and multiply uncontrollably.

6. Bronchoalveolar carcinoma, which can resemble a lung infection.

There are three types of small cell lung cancer. These types are determined by how the cancer cells look under a microscope. They are:

1. Small cell carcinoma or oat cell cancer, which occurs in cells that are flat, small and oval, and resemble oat grains.

2. Mixed small cell/large cell carcinoma, which occurs in cells that are a mix of small and large cancer cells.

3. Combined small cell carcinoma, which is small cell lung cancer combined with squamous and/or secreting cells.

Depending upon the type and stage of the lung cancer, the experts at the Eliana Center treat patients with surgery, chemotherapy, radiation therapy, or combinations of the three. Specialists in thoracic surgery, pulmonary medicine, and medical and radiation oncology work together to develop an individualized treatment plan for each lung cancer patient. Surgical techniques can include such advanced approaches as video-assisted thoracoscopic surgery (VATS), robotic assisted surgery, and minimally invasive brachytherapy (radiation seed implants).

Role of Chemotherapy in Lung Cancer

Non small cell lung cancer is often difficult to cure with surgery alone, as cancer cells from lungs often spread to other parts of body and cannot be removed surgically. Studies have now shown that chemotherapy given after surgery referred to as adjuvant treatment, can significantly improve survival. Chemotherapy is a cancer treatment which uses “drugs” to stop the growth of cancer cells either by killing the cells or stopping them from dividing. When chemotherapy is given into a vein (injected) or taken thorough the mouth, the medication enters into the bloodstream, and can reach cancer cells throughout the body (systemic treatment). When the cancer cannot be removed by surgery, chemotherapy can be combined with radiation to better control the cancer.

The type of chemotherapy, number of cycles and frequency of treatment is based on the stage of the cancer and the patient’s clinical condition. Some commonly used chemotherapy medications are Cisplatin, Carboplatin, Taxotere, Taxol, Gemcitabine, Navelbine and Alimta. We now have a new class of medications “Molecular Targeted Therapy” which works by blocking the signals that make cancer cells grow and spread. This new generation of medications includes anti-angiogenic agents such as bevacizumab (Avastin) and oral inhibitors of the epidermal growth factor receptor (EGFR), such as gefitinib (Iressa) and erlotinib (Tarceva). Avastin is given in combination with chemotherapy and has improved survival in patients with advanced lung cancer. We are also investigating new treatment options in our ongoing clinical trials with either targeted agents alone or in combination with chemotherapy.

A small number of patients with lung cancer present with a significant involvement of their airways, such as a tumor within the cavity of the airways or airway compression around the airways that is secondary to tumors. In both cases, there is narrowing of the airway, which results in breathing difficulties, collapse of the lung and eventual pneumonia. Most of these patients have advanced lung cancer and are not candidates for tumor resection. The quality of life of such patients is often very poor.

The thoracic surgeons at the Eliana Center have developed one of the outstanding airway surgery programs in New York City. Using state-of-the-art endoscopic technology, they are able to place stents within the airways to open them up. Stenting technology is often combined with other advanced surgical techniques, including endoscopic excision of tumor, laser excision of airway tumors, and dilation of airway narrowing.

Through these advanced approaches, Eliana's patients have significant relief of their symptoms and are able to regain the ability to enjoy their lives. Because of its innovative successes, Eliana Center has developed one of the busiest and most successful airway programs in the city.

Esophageal cancer is a disease in which cancerous cells form in the tube that moves food and liquid from the throat to the stomach. The incidence of esophageal cancer is on the rise in the United States. We now see it in otherwise healthy younger patients who exhibit none of the usual risk factors. Previously associated with smoking and alcohol, esophageal cancer is now also linked to gastroesophageal reflux disease (GERD), which occurs when acidic stomach contents flow back into the esophagus. The Eliana Center for the Treatment and Healing of Thoracic Cancer is dedicated to finding ever better ways of diagnosing esophageal cancer at earlier, more treatable stages.

Esophageal cancer comes in two common forms:

1. Squamous cell carcinoma, which occurs in the thin, flat squamous cells. This cancer is often found in the upper and middle part of the esophagus.

2. Adenocarcinoma, which occurs in cells that secrete fluids such as mucous. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.

Improved diagnostic tools, such as sophisticated imaging procedures and endoscopy (a thin, lighted tube is inserted through the mouth and down the throat into the esophagus, where tissue samples may be taken for biopsy), as well as new surgical procedures -- including robotic and other minimally invasive techniques -- bring new hope to patients with esophageal cancer. The Eliana Center offers all these latest diagnostic and treatment technologies, including radiation and chemotherapy, as well as a multidisciplinary approach to care.

For appropriate patients, we offer a totally minimally invasive approach using laparoscopy and a combination of video-assisted thoracoscopic surgery (VATS) and robotic surgery. Our multidisciplinary approach for the treatment of this condition involves the use of esophageal stents, endoluminal treatment and innovative radiation therapies.

The mediastinum is the area in the middle of the chest. There are many organs and structures in the mediastinum, including the heart, esophagus, thymus gland (an organ that lies underneath the top of the breast bone and plays a role in the immune system) and trachea (the main airway that goes from the throat to the lungs).

When tumors or masses arise in the middle part of the chest, they are called mediastinal tumors or masses. There are many types of mediastinal tumors or masses, including thyroid goiters, neurogenic tumors (tumor of the nerve sheath near the back of the chest), and a proliferation of cells of the thymus such as in myasthenia gravis.

The experts at the Eliana Center for the Treatment and Healing of Thoracic Cancer, have extensive experience treating such mediastinal tumors.

The evaluation of mediastinal masses can be done through minimally invasive incisions and video assistance. While some tumors are benign and can be removed surgically, others need only a biopsy for diagnosis. Our less invasive diagnostic methods save the patient from larger, more painful incisions.

After complete evaluation and diagnosis, a number of treatment options may be available. Some types of tumors respond well to chemotherapy or radiation therapy. Others are better treated with surgery. In some situations, a combination of approaches is best.

If surgery is warranted, a number of minimally invasive approaches have been developed over the last decade. Video-assisted thoracoscopic surgery (VATS) is a procedure that uses a small camera and pencil-sized incisions to look into the chest cavity and to biopsy and/or surgically remove mediastinal tumors. ?More recently, robotic surgery has been used to treat many mediastinal diseases. In fact, Eliana Center surgeons were among the first groups to develop, use and publish their results with robotic surgery for all forms of thoracic and cardiac surgery, including thymectomy (removal of the thymus gland) for myasthenia gravis, mediastinal evaluation of tumors, and complex posterior mediastinal tumors.

One special type of mediastinal tumor is the neurogenic tumor or nerve sheath tumor. This tumor is usually made up of nervous system components and appears in the back of the chest next to the vertebral column. Although such paravertebral (also called paraspinal) tumors are usually benign, they should be treated. If left untreated, these tumors tend to grow into or put pressure on nearby structures, and can cause disability or death. Of particular concern is the so-called "dumbbell tumor," which has both a thoracic component and an intraspinal component. The intraspinal portion can cause significant injury to the spinal cord, leading to neurological problems.

The Eliana Center for the Treatment and Healing of Thoracic Cancer has a close working relationship with the Hyman-Newman Institute for Neurology and Neurosurgery. This working partnership between our thoracic surgeons and their neurosurgeons offers many advantages to patients who have benign or malignant disorders affecting the vertebral bodies, nerve roots and adjacent structures in the chest.

Meticulous preoperative diagnostic testing and planning is absolutely critical in treating paravertebral tumors. While some of these disorders require complex open surgeries, some of them can be corrected with Eliana Center's expertise in advanced minimally invasive techniques or video-assisted thoracoscopic techniques.

Lymphoma is a type of cancer that develops in the body's immune system or lymphatic system. The lymph system is made up of thin tubes that branch into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes, found in clusters in the underarm, pelvis, neck and abdomen. The lymph nodes make and store infection-fighting cells. Several organs are also involved in the body's defense against infection, including the spleen (an organ in the upper abdomen), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat).

Since lymph tissue is found throughout the body, lymphoma can begin almost anywhere and can spread to almost any other part of the body. The multidisciplinary approach of the Eliana Center for the Treatment and Healing of Thoracic Cancer is, therefore, especially well suited to the treatment of lymphoma.

Lymphoma comes in two common forms:

1. Hodgkin's Disease, which most commonly affects young adults and sometimes people older than 55 years of age, and makes up about 15% of all lymphomas. The disease typically occurs in the lymph nodes above the collarbone, and in younger adults is more likely to appear on the chest cavity between the lungs.

2. Non-Hodgkin's Lymphoma, which occurs mostly in older adults with an average age of about 67. It makes up about 85% of all lymphomas. While this form of the disease occurs most often in the lymph nodes above the collarbone, it can also appear in the nodes in the abdomen. The non-Hodgkin's lymphomas are less predictable and more apt to spread.

The chance of recovery and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread throughout the body), the size of the swollen areas, the results of blood tests, the type of symptoms, and the patient's age, sex and overall condition. Typical treatment options available at the Eliana Center include chemotherapy and radiation therapy.

Sometimes, a lung cancer tumor will grow into the spine or other vertebral structures, such as the nerve roots. This growth is a difficult complication that can result in pain, weakness or paralysis, depending on the location of the tumor and whether it has invaded or compressed nerve roots or the spinal cord.

Click here to read about how the Eliana Center treats lung cancer that has metastasized to the spine

The Eliana Center for the Treatment and Healing of Thoracic Cancer has extensive experience in the surgical removal of mediastinal tumors and cysts, particularly using innovative minimally invasive procedure. This capability has been applied to other disorders, including the treatment of myasthenia gravis.

Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of muscular weakness. Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles because of an abnormal antibody released by the body's own immune system.

Thymectomy, the surgical removal of the thymus gland (which often is abnormal in myasthenia gravis patients), improves symptoms in certain patients and may cure some individuals, possibly by re-balancing the immune system.

Previously, good candidates for thymectomy required complex, invasive surgeries to remove the thymus gland. Minimally invasive incisions and robotic technology now allow Eliana Center's surgeons to routinely remove the thymus gland for tumors or treat myasthenia gravis through smaller incisions and in a less invasive manner.

Our surgeons performed the world's first complete endoscopic robotic thymectomy for myasthenia gravis. Using the da Vinci Surgical System, a camera and two small pencil-sized instruments are placed inside the chest cavity. While this technique is similar to thoracoscopic or video-assisted thoracoscopic surgery (VATS), the robotic system allows improved visualization and improved dissection and suturing capabilities compared to VATS. These abilities may even be improvements over open surgery because of the increased magnification and precise dissection techniques.

There are many non-cancerous conditions in the lungs that can benefit from the expertise of the surgeons of the Eliana Center for the Treatment and Healing of Thoracic Cancer. Such conditions include:

Spontaneous pneumothorax, which occurs when air leaks through weak spots into the space between the lung and chest wall. This leakage causes the lung to partially collapse and makes breathing more difficult. Treatment frequently includes surgically inserting a chest tube to relieve pressure on the lung and enable it to re-inflate. We can also surgically repair suspected weak spots or chemically treat the lung surface to prevent future collapse.

Emphysema, which is one of a group of lung disorders known as chronic obstructive pulmonary disease (COPD). Emphysema's predominant symptoms include shortness of breath and sensations of breathlessness. Over time, the effort to draw a breath becomes more labored. Emphysema sufferers may find relief from lung reduction surgery, which often eliminates the need for oxygen therapy and significantly enhances breathing. Many patients with cancerous diseases also have emphysema. Our knowledge of techniques to remove or repair areas of emphysema can significantly reduce the risk of surgery in these patients and improve their quality of life.

Interstitial lung disease, which is the general term for a diverse group of chronic disorders. When a surgical biopsy is necessary to identify the specific type of interstitial disease, our surgeons routinely use minimally invasive techniques to reduce risk and trauma, especially among extremely ill patients.

While not associated with the immediate presence of cancer in most cases, many benign esophageal diseases are risk factors for the development of esophageal cancer. Physicians at the Eliana Center for Healing and Treatment of Thoracic Cancer have extensive expertise with these diseases and their proper treatment. Such conditions include:

Gastroesophageal reflux disease (GERD), which occurs when acidic stomach contents flow back into the esophagus. Common symptoms include heartburn, regurgitation, reflux-induced cough or asthma, and difficulty swallowing due to esophageal scarring and narrowing.

Esophageal motility disorders, which are characterized by uncoordinated muscle contractions along the esophagus that prohibit efficient swallowing. One such disorder, achalasia, occurs when the muscle at the lower end of the esophagus prevents food from entering the stomach. Also, the muscle along the lower half of the esophagus may not contract properly to propel food down the esophagus. These abnormalities cause food to remain in the esophagus, which can lead to lung infections or breathing disorders.

Esophageal diverticulum, which resembles a small hernia or pouch protruding through the wall of the esophagus. This protrusion traps food and can cause swallowing difficulties, bad breath, regurgitation, breathing disorders or infections.

Benign esophageal cysts and tumors, which can cause chest pain and difficulty swallowing and breathing.

There are many ways that the surgeons of the Eliana Center for the Treatment and Healing of Thoracic Cancer can help patients with benign esophageal diseases and conditions. Some examples include:

• Patients who do not respond to medical therapy, and younger patients who want to avoid a life-long GERD medication program, may be candidates for surgical correction of the esophageal anti-reflux mechanism. Our surgeons typically perform this minimally invasive procedure through small incisions in the abdomen. For some patients with very advanced disease, however, more extensive procedures may be required. Our surgeons have the experience to employ these methods when necessary.



• Our surgeons treat achalasia and esophageal diverticulum with minimally invasive and robotic techniques designed to remedy the disorder and alleviate the underlying causes.



• Benign esophageal cysts and tumors can be surgically removed by using minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS) and robotic surgery.