A pulmonologist is a medical doctor specializing in diseases of the respiratory system, including the lungs, airways, and chest wall. When a patient receives a lung cancer diagnosis, the pulmonologist is a member of the multidisciplinary team guiding care. While fundamentally involved in overall management, they typically do not serve as the primary specialist leading anti-cancer treatments like chemotherapy or radiation. Their primary involvement centers on establishing the initial diagnosis, accurately staging the disease, and managing the patient’s lung health during and after treatment.
The Pulmonologist’s Role in Diagnosis and Staging
Pulmonologists are usually the first specialists to confirm lung cancer following abnormal findings on a chest X-ray or CT scan. Their expertise lies in performing minimally invasive procedures to obtain the tissue sample, or biopsy, necessary for a definitive diagnosis. Obtaining the biopsy is necessary because the specific cell type and genetic markers found determine the subsequent treatment plan.
A common procedure is bronchoscopy, where a flexible tube is passed into the airways to visually inspect the lungs and take tissue samples. This can be coupled with an Endobronchial Ultrasound (EBUS), which uses an ultrasound probe to visualize and sample lymph nodes in the chest. Sampling these lymph nodes is important for accurately staging the cancer, determining if the disease has spread beyond the primary tumor.
If the suspicious area is located in the outer regions of the lung, the pulmonologist may perform a transthoracic needle biopsy, often guided by a CT scan. The precise tissue and cell samples gathered through these techniques allow pathologists to identify the cancer type and oncologists to determine the disease’s extent.
Primary Cancer Treatment: The Role of the Oncologist
Once the pulmonologist provides the diagnosis and staging information, the medical oncologist assumes the role of the primary physician guiding the cancer treatment. The medical oncologist specializes in using systemic therapies—treatments that travel through the bloodstream to attack cancer cells throughout the body. These therapies include chemotherapy, targeted drug therapy, and immunotherapy.
The treatment plan is coordinated with other specialists, such as the radiation oncologist, who uses high-energy beams to destroy tumors, and the thoracic surgeon, who may surgically remove the tumor. The medical oncologist oversees the entire course of systemic treatment, adjusting dosages and managing side effects. Their expertise centers on the biological and genetic characteristics of the cancer cells, using molecular diagnostics to select the most effective drug regimen.
Supportive Care and Long-Term Pulmonary Management
The pulmonologist’s involvement continues long after the initial diagnosis, shifting to the management of respiratory symptoms and overall lung health. They treat complications arising from the tumor or as side effects of cancer therapy. For instance, the pulmonologist may perform thoracentesis to drain a pleural effusion, a fluid buildup around the lung that causes shortness of breath.
They also manage chronic lung conditions, such as Chronic Obstructive Pulmonary Disease (COPD) or emphysema, which frequently exist alongside lung cancer. Optimizing the function of non-cancerous lung tissue is necessary to ensure the patient can tolerate the physical stress of treatments like surgery or radiation. This concurrent management of co-morbidities helps maintain the patient’s quality of life.
The pulmonologist is a provider of supportive care, which addresses symptoms to improve comfort and overall well-being. This can involve prescribing medications for a persistent cough or shortness of breath (dyspnea), or managing airway blockages using endoscopic techniques like stent placement. The pulmonologist remains a consultant on all matters related to the patient’s ability to breathe throughout treatment and into long-term survivorship.