It starts quietly and moves quickly. By the time lung cancer causes symptoms, it’s often gotten a strong foothold in the body. Physicians like surgeon Kemp Kernstine, M.D., Ph.D., director of City of Hope’s Lung Cancer and Thoracic Oncology Program, refuse to give in to the disease and are constantly looking for better ways to fight it.

In the second of a two-part interview about lung cancer (click here for part one), Kernstine discusses today’s and tomorrow’s treatments.

Kemp Kernstine, M.D., Ph.D.: Lung cancer treatment does vary by stage. For the earliest stages, where the disease appears fairly contained, surgery is the primary treatment. It has the greatest chance for cure of all treatments for lung cancer. Chemotherapy and radiation are typically reserved for more advanced disease. Please understand, however, that these treatments are not static; they are constantly improving. There are new drugs with greater effectiveness and less toxicity. Also, there are new radiation therapy techniques, including TomoTherapy, which we use here at City of Hope.

With greater information about each tumor and its specific characteristics, as well as details about the patient, we will soon be able to design very specific therapies for each patient. Our ongoing research is helping us learn how.

EH: How important is robotic surgical technology to lung cancer treatment?

KK: We are at the very earliest stages of the use of robotic technology in the treatment of lung cancer. Currently, the standard is open or large-incision surgery, which is provided to selected patients with early disease. The smaller incisions with robotic surgery appear to reduce pain and speed recovery from the surgery.

Advancements in the technology should open more opportunities for patients. Some improvements we’re looking for include better vision and imaging of the surgical field, so we can better see the cancer and determine the amount of lung we need to remove. Also, different methods to cut and sew tissues could make us more efficient and effective, and we’re researching new methods to deliver treatment and prevention drugs.

In a futuristic vein, researchers are already testing miniature robots, injecting them into vessels to perform very simple tasks. This nanotechnology could open new doors for treatment.

Ultimately, the role of robotics in the treatment of lung cancer is yet to be determined, as the technology continues to mature.

EH: What's it going to take to finally improve survival rates for lung cancer patients?

KK: As with any cancer treatment, prevention is likely to be the most effective. Smoking should be discontinued. Screening may also be effective. We have developed a blood test that appears to identify lung cancer before it shows up on a computed tomography, or CT, scan. Currently we are making refinements that will hopefully be available to patients within the next five or so years. Finally, as I noted, we are learning more about the biology of lung cancer and the patients that develop it. Potentially, if we are not able to cure it, we may be able to convert it to a chronic disease less likely to result in death or debility.