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The Maine Medical Center Cancer Institute

Thoracic Oncology (Esophageal & Lung Cancers)
The Thoracic Oncology program at Maine Medical Center Cancer Institute meets the special needs of people with tumors in the thorax (within the chest cavity). The most common of these are esophageal cancer and lung cancer, and we provide a comprehensive range of diagnostic and treatment resources for them. The program is home to one of the most experienced teams of thoracic cancer specialists in northern New England, with an esophageal and lung cancer volume that qualifies MMC as a national center of excellence in this type of care. We are the only hospital in Maine with this level of surgical volume and the depth of experience it represents.

View Dr. Tracey L. Weigel's Profile

Types of Cancer Treated

Esophageal, including pre-malignant conditions

Lung, including:

  • Non-small-cell lung cancer (NSCLC) 
  • Small-cell lung cancer (SCLC)  
  • Carcinoid tumors (a slow-growing type of tumor usually found in the gastrointestinal system, and sometimes in the lungs or other sites) 
  • Mesothelioma (a tumor that may or may not be cancerous affecting the lining of the chest or abdomen)

Scroll through the content below or click on a topic to go directly to that content.

Esophageal Cancer Treatment  
Lung Cancer Treatment 
Thoracic Surgery Team 
Thoracic Oncology Clinical Navigator Program 
Why Choose Us for Esophageal and Lung Cancer Care 

Esophageal Cancer Treatment
Esophageal cancer often is diagnosed at a late stage of development when surgery is no longer an option. Early diagnosis and treatment, however, can significantly improve the patient’s outcome.

The Maine Digestive Health Center and the MMC Cancer Institute work together to provide patients a multidisciplinary approach to care. The center’s specialists diagnose and treat patients with disorders of the esophagus. Among the diagnostic procedures available are Barium Swallow (esophagram), high-definition endoscopy, endoscopic ultrasound, CT scan (computed tomography), and PET scan.

The center has a surveillance program for early changes (premalignant) in the esophagus called Barrett’s esophagus. Barrett’s can be caused by erosion from GERD (gastro esophageal reflux disease). Symptoms include difficulty swallowing, bleeding and weight loss. Our team will biopsy the lesion (remove a part of it) or when warranted, will remove it completely. We then periodically check for any new lesions that may form on the esophagus. Surgery or other new techniques may be used to remove lesions. Esophagitis is another condition commonly caused by GERD but also can be caused by medications, allergies and treatments for cancer. Esophagitis is the inflammation of the lining of the esophagus. Common forms of treatment include acid-blocking drugs and nutrition via an intravenous (IV) line, allowing the esophagus to rest. If left untreated, esophagitis can lead to Barrett’s esophagus.

A Multidisciplinary Approach
Depending on the stage and other characteristics of the esophageal tumor, the treatment plan may include endoscopy, open or laparoscopic surgery, chemotherapy, radiation, or a combination of these therapies. Maine Medical Center also offers patients treatment on clinical trials that are nationally recognized, ensuring that the latest advances in treatment for esophageal cancer are available in Maine.

When surgery is not an option, our team of specialists provides patients access to a variety of therapies. This multidisciplinary approach to each patient provides the best possible care. The team includes specialists in gastroenterology, radiology, surgery (see Thoracic Surgical Team below), pathology, medical oncology, radiation oncology, interventional radiology, and palliative care. Non-physician members of the team include an esophageal nurse navigator (see Thoracic Oncology Clinical Navigator Program below), research nurses, tobacco treatment specialist, oncology dietician, oncology social worker, and the American Cancer Society patient navigator.

Lung Cancer Treatment
The Thoracic Oncology program uses a multidisciplinary model to plan the care of patients with lung cancer. Our team of specialists meets weekly to review and discuss individual cases. This team includes specialists in pulmonary medicine (treating diseases of the lung), radiology, thoracic surgery (see Thoracic Surgical Team below), pathology, medical oncology, radiation oncology, interventional radiology, and palliative care. Non-physician members of the team include the thoracic oncology nurse navigator (see Thoracic Oncology Clinical Navigator Program below), research nurses, tobacco treatment specialist, oncology dietitian, oncology social worker, and the American Cancer Society Patient Navigator.

We believe our team approach benefits the patient in two important ways. First, the accurate diagnosis and staging of lung cancer often requires consultation with several different specialists. This can mean scheduling and attending multiple appointments over several days or weeks before treatment can begin. At the MMC Cancer Institute Thoracic Oncology program, we can often arrange all necessary consultations on the same day, in one location. Not only is this more convenient for our patients, but it can also expedite the process of diagnosis and staging so that treatment can begin sooner. In fact, our goal is to ensure that our patients move from presentation of a suspected lung cancer diagnosis to treatment within 30 days or less.

Another advantage of our multidisciplinary approach to lung cancer care is the weekly conference which is attended by the entire Thoracic Oncology team. Conference is used to present individual cases, review diagnostic procedures, discuss staging and treatment options, and collaborate on the best plan of care for each patient. The multidisciplinary group forms a consensus recommendation that is tailored to each individual. We then present the treatment plan to the patient at his or her clinic consultation. The weekly conference also serves as a forum to discuss clinical trials, advances in lung cancer care, and quality improvement measures which may impact future lung cancer care

Patient Screening and Diagnostic Resources
MMC Cancer Institute offers leading-edge diagnostic imaging methods, including combined anatomic and metabolic imaging, to aid in the detection of lung and other thoracic cancers and to monitor treatment effectiveness. Our capabilities include: 

  • Three magnetic resonance imaging scanners  
  • Four 64-slice computed tomography (CT) scanners   
  • PET/CT (integrated positron emission tomography and CT)   
  • Nuclear Medicine   
  • Ultrasound 
  • Vascular and Interventional Radiology

Our Thoracic Oncology program also offers state-of-the-art diagnostic resources and access to specialists trained in the latest techniques and technology for diagnosing and staging cancer, including: 

  • Endobronchial ultrasonography  
  • Electromagnetic navigational bronchoscopy (EMN)  
  • Mediastinoscopy   
  • CT-guided needle biopsy   
  • Video-assisted thoracoscopic biopsy 

Image-guided biopsies are supported by an on-site radiology nursing service that provides sedation, procedural support to the patient, and post-procedure recovery. Our extensive Picture Archiving and Communications System serves as a regional resource that enables rapid image sharing and interpretation, helping to speed diagnosis.

Treatment Options
MMC Cancer Institute’s Thoracic Oncology program offers the region's most comprehensive and advanced array of medical, surgical, radiation oncology and interventional radiology treatment options. Multidisciplinary conferences leading to appropriate consults and treatment recommendations take place on a weekly basis to meet the individualized needs of thoracic oncology patients. Our comprehensive array of state-of-the art treatment options includes the following:  

  • Thoracic Surgery   
    • Video-assisted thoracic surgery, a minimally invasive way to access the chest  
    • Wedge resection, removing a small section of one lung   
    • Segmentectomy, removing a segment, or part of a lobe, of one lung  
    • Lobectomy, the most common type of lung cancer surgery entailing removal of entire lobe of one lung 
    • Sleeve resection, removing a part of the airway with or without the adjoining lung and reattaching the remaining ends to preserve lung tissue and avoid a larger resection such as a pneumonectomy   
    • Pneumonectomy, removal of lung  
    • Robotic surgery, a technique in which a surgeon performs surgery using a computer that remotely controls very small instruments attached to a robot 
  • 3D Conformal External Beam Radiation Therapy  
  • Intensity Modulated Radiation Therapy (IMRT)   
  • Stereotactic Body Radiation Therapy (SBRT)  
  • High Dose Rate Brachytherapy   
  • Radiofrequency ablation   
  • Chemotherapy/targeted therapy   
  • Clinical trials providing access to novel cancer treatments   
  • Pulmonary rehabilitation   

Clinical Outcomes
As an indication of its commitment to evidence-based, high quality care, the MMC Cancer Institute Thoracic Oncology program published the first edition of its Lung Cancer Quality Report on Clinical Outcomes (.pdf) for physicians, as well as a companion booklet for patients. These editions provide a review of our current Lung Cancer Program and related services, and they highlight clinical outcomes data which can serve as a resource for physicians and their patients.

We believe our clinical outcomes in the management of thoracic malignancies speak for themselves, but our commitment to high quality, state-of-the-art care does not stop there. We continually strive to improve the quality of care for our patients through ongoing review of Thoracic Oncology program data compared to national benchmarks, quality improvement measures, educational programs, and comprehensive support services.

Thoracic Surgery Team
The Thoracic Oncology surgery team is led by Dr. Tracey Weigel, who also is the Division Director of Thoracic Surgery within the Department of Surgery, and Dr. Mayuka Fukanaga, a fellowship trained pulmonologist and a member of Chest Medicine Associates.

Dr. Weigel specializes in surgical treatment of thoracic malignancies (esophageal, lung, thymoma and mesothelioma), including advanced thoracoscopic lung surgeries such as VATS lobectemies and laproscopic/VATS esophagectomies.  She has been an investigator in several NIH-funded research studies conducted through the American College of Surgeons Oncology Group (ACSOG) and Eastern Cooperative Oncology Group (ECOG).  Dr. Weigel’s research interest focuses on the benefits of minimally invasive surgeries for lung and esophageal cancer and preoperative onco-geriatric assessment of elderly patients in need of lung and esophageal cancer surgeries.  In addition, her practice focuses on advanced laparascopic, thoracoscopic and robotic surgeries for complex, benign esophageal diseases/disorders, such as achalasia, paraesophageal hernias and leiomyomas.

Dr. Weigel was recently named among the top 1% of physicians in her specialty by US News and World Report. Prior to joining Maine Medical Center in 2012, she served as Chief of Thoracic Surgery at the University of Wisconsin. Dr. Weigel completed a research fellowship in Tumor Immunology/B Cell Biology at Roger Williams Cancer Center at Brown University, and both surgical oncology and thoracic oncology fellowships at Memorial Sloan-Kettering Cancer Center. She received her medical degree from the University of Rochester School of Medicine and completed her general surgery residency at Brown University and her cardiothoracic surgery residency at the University of Wisconsin.

Dr. Fukanaga’s major clinical interests are in the diagnosis and treatment of lung cancer. She brings specialized expertise in endobronchial ultrasonography, electromagnetic navigational bronchoscopy and ultrasound-guided lymph node biopsy.

Dr. Fukanaga completed Medical School at the Keoi University School of Medicine in Japan and her internship, residency (Internal Medicine) and fellowship (pulmonary and critical care) at Beth Israel Medical Center/Albert Einstein in New York City, where she served as both Chief Resident and Chief Fellow. 

Thoracic Oncology Clinical Navigator Program
The Thoracic Oncology Clinical Patient Navigators, one nurse dedicated to esophageal cancer patients and the other to lung cancer patients, serve as key members of the team. A patient typically meets the Navigator when he or she is newly diagnosed with cancer. This diagnosis can be devastating and often leaves patients and families feeling overwhelmed, hopeless and confused. Initial contact with the Navigator assures these patients and families that they have an advocate and an easily accessible source of information and support. The Navigator helps to ensure that patients obtain an accurate diagnosis and appropriate treatment in a timely and efficient manner. The Navigator also educates patients regarding the diagnosis of their cancer and its treatment. Well-educated patients usually have a greater sense of control and are able to make fully informed decisions about their care.

Perhaps most importantly, the Navigator ensures that patients know they are not alone and remains available to them throughout their cancer journey. All navigator services are provided free of charge. Patients may call or visit the Clinical Patient Navigator as often as needed for support, information and assistance throughout the course of their treatment and into their survivorship.

Why Choose Us for Esophageal and Lung Cancer Care   

  • Exceptionally coordinated care, ensuring that we carefully guide patients through diagnosis and staging procedures from the moment they are referred to MMC with a suspicious finding  
  • A truly multidisciplinary team approach that brings together the expertise of all the appropriate specialists who collaborate on each patient's plan of care  
  • A full range of advanced diagnostic and treatment resources in one close-to-home location  
  • The expertise of highly trained surgeons who perform the most thoracic cancer procedures in Maine, a depth of experience that qualifies MMC as a national center of excellence in this type of care 
  • The option for minimally invasive surgery, when appropriate, which means faster healing, less pain, shorter hospital stays and improved ability to tolerate subsequent chemotherapy  
  • A demonstrated track record of excellent outcomes when compared to national benchmarks  
  • A wide array of support and educational resources that address the emotional and psychosocial needs of patients 
  • Outstanding inpatient and outpatient care from a large complement of oncology-certified nurses at the first acute-care hospital in Maine to earn Magnet designation, the highest honor an organization can receive for nursing care
 

  

MMCCI-Lung-Cancer   

Lung Cancer Care - Quality Outcomes for Patients
View the Lung Cancer Quality Report for Patients (.pdf)
 

22 Bramhall Street | Portland, Maine 04102-3175 | 1-(877)-831-2129