Thoracic Oncology

American Standard of Healthcare

Thoracic Oncology

The Thoracic Oncology Program at the American Hospital Dubai is a multidisciplinary program for patients with lung, esophageal, mediastinal, chest wall tumors, and benign thoracic conditions. This comprehensive program provides a wide array of clinical services for lung cancer and other thoracic malignancies using a multidisciplinary team. The program consists of a highly distinguished and experienced nationally recognized cancer consultants highly trained in preoperative assessment and diagnosis of thoracic tumors.  Our medical oncology, radiation oncology, chest radiology, pathology, and pulmonary medicine is available to provide imperative treatments to cure patients. 


The most common malignant tumor worldwide, early detection and recognition of symptoms is key to achieving successful treatment. Implementing advanced screening at an early stage can prevent and cure patients.  A low dose of CT scanning or X-ray is making this now possible. 

What are the symptoms of lung cancer / how do you know you are at risk? 

Some population sectors at a much higher risk than most.  These are the smokers, passive smokers, people with exposure to carcinogenic (random gas, asbestos & talc dust, as well as family history, may put you at risk.   

Symptoms: 

  • Persistent cough, coughing blood, wheezing, shortness of breath and or discomfort during breathing.  
  • chest pains.  
  • Pneumonia symptoms such as a fever or mucus-producing cough as well as discomfort during swallowing.   
  • Weight loss and poor appetite. 

Treatment protocols: 

A team from the Thoracic Oncology Program at the American hospital Dubai consisting of qualified radiologists, Oncologists, as well as surgeons work together to best support your treatments needs according to your stage.   

  • When early detected surgery intervention may be  
  • If the tests show that the tumor has spread to the lymph glands inside the chest then other treatment protocol is considered.  Patient will receive chemotherapy in order to control and shrink the lymph glands and the tumor prior to surgery.
  • IF the tumor has spread to different body parts such as bone or liver only chemotherapy is recommended.

It is imperative that all patients receiving treatment to stop smoking specially those who have been recognized for surgery.  Prior to surgery patients will undergo blood work, an EKG and breathing tests to determine if surgery can be performed safely.  Patients who will continue to smoke are at a higher risk of developing pneumonia and other potentially serious complications. 

 

 

The Esophageal is the muscular tube that connects the mouth to the stomach in order to pass the food for digestion.   It is in front of the spine sitting behind the trachea, or windpipe. Therefore, portions of the esophagus are located in the neck, chest and abdomen.  

  • Esophageal cancer develops when the tissue that lines the esophagus becomes malignant due to these factors
  • Stomach acids which can lead to chronic acid reflux.
  • Smoking and heavy usage of alcohol.
  • Obesity
  • Conditions like gastroesophageal reflux disease (GERD),
  • Barrett's esophagus is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus
  • Achalasia (the lower esophageal sphincter) LES fails to open up during swallowing which results in backup of food in the esophagus.
  • A diet low in fruits, vegetables and certain vitamins and minerals

All esophagus changes are diagnosed by endoscopy which is a procedure used to examine the lining of the esophagus with a telescope.

What are the Symptoms of Esophageal Cancer?

  • This often silent and unnoticed as serious health issues. These are some of the indications
  • Persistent or intermittent difficulty swallowing.
  • A feeling that food is becoming stuck during swallowing.
  • Frequent choking, coughing, or gagging on food hoarseness.
  • Long and frequent hiccups attacks.
  • Chronic chest pains that occur while eating.

Diagnosis tools

First the physician will take the complete medical history for the patient. Secondly several diagnostic tools are applied in order to properly diagnose the patient

  1. Barium swallow: The patient swallow’s liquid that is visible on X-ray.  Several diagnostic x-rays are taken to check on blockage of the esophagus by any tumor.
  2. Endoscopy: A small flexible telescope is passed through the mouth into the esophagus in to check the lining of the esophagus and take a biopsy as needed. This procedure is done under sedation. The endoscopy is a versatile tool that can be used even during cancer to determine the spread of the cancer furthermore the presences of Barrett’s esophagus.
  3. Endoscopic Ultrasound: This procedure is very important to determine the appropriate stage of the tumor. The procedure is performed in conjunction of the endoscopy to take detailed ultrasound images of the tumor, surrounding tissues and lymph nodes.
  4. Computer tomography (CT Scan): This procedure is a tool used for additional information of the tumor size and the spread to other organs.
  5. Positron Emission Tomography (PET Scan): This scan is very sensitive detecting the small metastases. It determines accordingly treatment options.

Treatment protocols

The stage of the cancer is the most important factor to determine the type of treatment. This is according to the spread of the tumor. Surgery alone is the preferred treatment when cancer was detected in an early stage yet if spread to other organs such as the liver or bones more invasive treatments such as surgery, radiation, therapy, and chemotherapy are applied.  These options can be used parallel or as a combination for treatments.

Since the esophagus is in the neck, chest, and abdomen the tumors can develop in any of these areas. There are many operations accordingly where the tumor and a viable amount of the normal appearing esophagus are removed as it may contain cancerous cells that are only visible under microscope.

  • Surgery treatment
  • Radiation Therapy (high energy rays)
  • Chemotherapy

The purpose of the Surgery is both to remove the cancer and to allow patients to eat after the operation. During the operation, a small tube is placed in the intestines at the conclusion of the operation, which allows for some nutrition while patients recover from their operation. Usually, patients will be allowed to eat within a week after the operation. A modified diet that includes pureed foods and liquids is allowed and will progress to a regular diet within weeks after the operation. Most patients will need to eat smaller yet more frequent meals. It is not uncommon for patients to lose some weight after surgery. After several months, the lost weight is usually regained.

Specialized techniques are available to control and limit the amount of pain patients experience after surgery. Often, an epidural catheter is used which provides excellent pain relief for the first few days. Once the catheter is removed, pain pills are prescribed to limit the discomfort for the next few weeks.

According to the stage of the cancer Radiation therapy is used to destroy cancer cells, shrink tumors, and stop the progression of the cancer. This can be prior to surgery to shrink the tumor or following surgery to wipe out any remaining cancer cells. Radiation therapy helps in the relieve of the pain and to ease swallowing. Radiation therapy can be applied externally or radioactive by implanting it in the tumor.

Chemotherapy is a combination of drugs to kill cancer cells throughout the body. It can be administered before or after surgery to shrink the tumor or destroy remaining cells or rigorously when surgery is not possible.

 

 

These chest wall tumors are almost always formed from bone, cartilage, and/or soft tissue of the chest wall. Some are benign such as infections or growth such while others are malignant lesions such as sarcomas or metastatic cancers which occurs when cancer cells breakaway from where they first formed travelling through the blood and lymph system to form new tumors in other parts of the body. 

What are the Symptoms

  • Pain or soreness in the chest area.
  • Impaired movement.
  • A lump or bump protruding from the chest

Diagnosis

Although the diagnosis of these lesions may be difficult, like other cancers diagnosis starts with a through medical history followed by

  • Complete physical including chest and CT scan.
  • A biopsy may be needed if there is suspicion of malignancy.

Treatment protocols: 

Multimodality therapy may be applied

Surgery treatment including reconstructive surgery When surgical resections is required. Reconstruction surgery is performed in conjunction with our plastic surgeons who have enabled us to repair nearly any chest wall defect.

  • Radiation Therapy (high energy rays)
  • Chemotherapy

A chronic digestive disease where the stomach acids refluxes into the esophagus.  Patients suffering from this condition have a weakened sphincter.  This can cause an inflammation of the esophageal lining and  continuous feeling of heartburn chest pain and even sour taste in the mouth. 

Symptoms

The most common symptom is heartburn also known as acid indigestion.  Other symptoms include:

  • Chest pain
  • Difficulty in swallowing (dysphagia)
  • Persistent dry cough
  • Hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Sensation of a lump in your throat

  If GERD is left untreated it can lead to ulcer formation , bleeding and scarring

 Treatment:

Treatment of GERD is decided by the physician according to the age and severity of the case.  A life style change is required for the success of the treatment.

  • Medication to neutralizing stomach acids, thereby providing quick relief.
  • Surgery Nissen fundoplication : The upper part of the stomach is wrapped around the lower esophageal sphincter. This prevents the refluxes back in the esophagus.

Nutrition: Certain foods must be avoided such as high fat, acidic, spicy food mint and caffein

Primary palmar hyperhidrosis is a pathological condition characterized by excessive over respiration that is not necessarily associated with the body’s temperature, nervousness, or physical activity.

Symptoms:

Heavy sweating usually occurs on the palms of the hands, the soles of the feet, in the armpits (axillary), in the groin area, and/or under the breasts

Treatment:

The cause of the sweating is believed to over stimulation of sympathetic nerve which supplies the offending sweat glands.  A minimally invasive thoracoscopic approach allows for division o the nerves and relives from this condition.

This is a chronic autoimmune disease that affects neuromuscular transmission resulting in debilitating weakness. The thymus gland plays a big role in this disease through the production of antibodies that attack these receptors, preventing communication signals between nerves and muscles.

Symptoms:

  • General fatigue
  • Weakness in arms and legs.
  • Drooping of mouth and eyelids.
  • difficulty in speech.
  • Difficulty in swallowing.

Treatment:

This debilitating disorder is treated with

  • Anticholinesterase drug therapy
  • Drug therapy
  • Steroids immunosuppressive agent
  • Plasmapheresis
  • Surgery options are available according to the severity of the case. A Thymectomy  is an option  which is highly recommended for most patients, where the thymus is surgically removed.    A less invasive surgery is by using minimal access approach that allows for equivalent resection of the thymus )

A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain.

What is a hiatal hernia?

A defect in the diaphragm that causes part or sometimes all of the stomach to migrate above the diaphragm to the chest cavity and causes heart burn, indigestion , acid reflux and bloating.

Can Surgery Help Fix a Hiatal Hernia?

Sometimes a hiatal hernia requires surgery. Surgery is generally used for people who aren't helped by medications to relieve heartburn and acid reflux, or have complications such as severe inflammation or narrowing of the esophagus.

Surgery to repair a hiatal hernia may involve returning your stomach down into your abdomen ( in is natural place) and making the defect opening in your diaphragm smaller, reconstructing an esophageal sphincter or removing the hernia sac so no acid return from the stomach to the esophagus.

Or your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery). With our minimally inavsive approach patients have a smooth and fast recovery and return back to their daily routine in the shortest possible time compared to open surgery.

 

 

American Hospital Professional Physicians

American Hospital Panel of Doctors

Our Physicians are all American Board Certified or of equivalent, supported by western trained Perfusionist, Nurses and support staff.

Ali Al Dameh

Consultant
Surgical Oncology, Thoracic Surgery, General Surgery, Weight Loss Surgery,

Arabic, English

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