Your physician team may recommend an endobronchial treatment for you to manage a condition that impedes your airways and makes it difficult for you to breathe — bleeding, narrowing (stenosis) or a blockage in your lungs’ airways (bronchi).
These conditions may result from a number of factors, including lung tumors, blood clots, radiation treatment, connective tissue disease, or scarring from a tracheostomy or prolonged intubation. Endobronchial therapies can immediately open the airways and improve ability to breathe, come off a ventilator, and undergo additional cancer treatment. In some cases, endobronchial therapies can treat the tumor directly, offering an option for patients who cannot undergo surgery or radiation.
Reaching the lungs through the airways
Endobronchial therapies use a bronchoscope, a long, lighted tube passed through the mouth and trachea in order to reach the lungs, rather than an incision in the chest. You may have already undergone a bronchoscopy procedure to biopsy, diagnose or stage your lung cancer.
Physicians can perform a number of treatments, utilizing different types of tools passed through the bronchoscope. These include:
- Surgical procedures to cut away the tumor, scar tissue and other blockage. This may be accomplished in a number of ways, including:
- Cryosurgery. This uses a cryoprobe to freeze cancer cells, killing and removing them from the airway.
- Electrocautery. Using an electrified knife or snare (tiny loop), the tumor can be removed and a narrowing or stenosis can be opened.
- Argon plasma coagulation. A catheter threaded to the airways to release and electrify argon gas, changing its physical state to plasma, which can burn away tumor tissue and stop bleeding in the airway.
- Brachytherapy to deliver radiation therapy directly to the tumor. A catheter is threaded through the bronchoscope to the lungs where the radiation oncologist can place radioactive seeds in the tumor.
- Photodynamic therapy (PDT) to destroy a tumor blocking the airway. PDT is a technique that was developed at Roswell Park. First, a patient receives a photosensitizer drug which makes cancer cells extremely sensitive to a certain wavelength of light. Then, a laser fiber is passed into the airways to provide that type of light, causing a chemical reaction that kills the cancer cells.
- Stent placement to prop open an airway. Stents are small tubes that can be placed in a major airway to prevent its collapse from a pressing tumor. These stents are made of a variety of materials, including silicone and nitinol.