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Stephen Yang, MD
StephenYangMD (Physician - Surgery - Thoracic (Verified) )| Communities: Lung Cancer , Esophagus Cancer | Answers: 16 |
| Member Since: Aug. 2012 |
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Professional Statement
The Arthur B. and Patricia B. Modell Professor in Thoracic Surgery
Chief of Thoracic Surgery
Surgical Curriculum and Clerkship Director, The Johns Hopkins School of Medicine
Director, Thoracic Oncology Program
Stephen C. Yang, M.D. is Professor of Surgery and Oncology at The Johns Hopkins University School of Medicine and an attending surgeon at both The Johns Hopkins Hospital and The Johns Hopkins Bayview Medical Center. Dr. Yang graduated from Duke University with a B.A. in Chemistry and received his M.D. degree from the Medical College of Virginia. He completed his general surgery residency at the University of Texas Health Science Center at Houston, and finished his cardiothoracic surgery fellowship at the Medical College of Virginia. He also completed a 3 year thoracic surgical oncology research fellowship at the University of Texas M. D. Anderson Cancer Center.
Chief of Thoracic Surgery
Surgical Curriculum and Clerkship Director, The Johns Hopkins School of Medicine
Director, Thoracic Oncology Program
Stephen C. Yang, M.D. is Professor of Surgery and Oncology at The Johns Hopkins University School of Medicine and an attending surgeon at both The Johns Hopkins Hospital and The Johns Hopkins Bayview Medical Center. Dr. Yang graduated from Duke University with a B.A. in Chemistry and received his M.D. degree from the Medical College of Virginia. He completed his general surgery residency at the University of Texas Health Science Center at Houston, and finished his cardiothoracic surgery fellowship at the Medical College of Virginia. He also completed a 3 year thoracic surgical oncology research fellowship at the University of Texas M. D. Anderson Cancer Center.
Professional Info
Credential: MD
Primary specialty: Surgery - Thoracic
Medical school: Medical College of Virginia
Residency: Univ. Texas Health Science Center in Houston
Fellowship: Medical College of Virginia; M.D. Anderson Cancer Center
Areas of expertise:
Lung Cancer
Surgery
Early diagnosis and detection
Neoadjuvant therapy (preoperative chemo and radiation therapy)
Lung Diseases: fibrosis, emphysema
Esophageal Cancer
Surgery
Early diagnosis and detection
Neoadjuvant therapy (preoperative chemo and radiation therapy)
Mesothelioma
Diagnosis and surgical treatment
Neoadjuvant therapy and protocols
Mediastinal masses; diagnosis and surgical treatment
CT scanning for early diagnosis of tobacco related diseases
Lung transplantation - Adult and Pediatric programs
Video-Assisted Thoracic Surgery(VATS)/Thoracoscopy
Diagnosis and treatment of lung, mediastinal and pleural diseases
Lung volume reduction surgery for emphysema
Research interests:
Development of molecular markers for early diagnosis of lung cancer
Development of molecular markers for early diagnosis of recurrent lung cancer following surgical resection
Detection of teleomerase activity as a guide for the presence of lung cancer
Molecular biology of mesothelioma
Hospital affiliation: Johns Hopkins Medicine
Practice address:
Baltimore, MD
Practice phone number: (410) 614-3891
StephenYangMD Activities
There are several factors that determine whether a lobectomy is required over a segmental resection. These include: size of tumor, age of patient, pulmonary function, stage of disease, use of induction therapy, prior surgical resection, and body habitus. However, it is vitally important that anyone considering surgery should be evaluated by a board certified thoracic surgeon, and one who deals with lung cancer on a routine basis.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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6 months ago
It is unusual to give neoadjuvant (or preoperative or induction) therapy for stage 2 disease. Usually there are extenuating circumstances (such as delay in surgical therapy, bulky regional N1 nodes) that require neoadjuvant therapy. Adjuvant chemotherapy protocols are excellent these days, so that is why this is used postoperatively.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
Answer |
6 months ago
All those terms are the same. Minimally invasive is the general overall approach, and the techniques including VATS (which is thoracoscopy) and robotics are the different approaches.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
Answer |
6 months ago
In general, patients who have minimally invasive surgery (VATS) do recover faster, and return to work sooner. Limitations are less. Even though the pain is less initially with VATS, the degree of pain is about the same after 2 weeks.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
Answer |
6 months ago
Minimally invasive surgery depends upon the experience of the surgeon. In general, smaller tumors and earlier stage of cancer is usually amenable to video-assisted thoracic surgery (VATS). Robotic surgical techniques are being offered, however, this is still being studied. In general, if the surgeon is able to, VATS approaches are preferable to open surgery.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
Answer |
6 months ago
It is hard to determine how aggressive a lung cancer (like any other cancer) is. Staging is the most important factor to determine the best treatment of care. In general one looks at the cell type (if obtainable) and any clinical history. In general, small cell lung cancer and large cell lung cancer are more aggressive. If there is the luxury of having prior CT scans, this can help on grow rate.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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6 months ago
Usually a regular lung spirometry that obtains FEV1, FVC, lung volumes, DLCO and ABGs. These tests allow the surgeon to determine whether the patient can tolerate surgery, have a portion of the lung removed, and how much to remove. Rarely does a pulmonary stress test is needed (to obtain MVO2 max) when there is a borderline situation; this is usually the final test to determine whether a patient can have a portion of the lung removed.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
Answer |
6 months ago
First radiologic studies such as a CT scan or a PET scan is done. If lung cancer is highly suspected, and appears early stage, then surgical resection is suggested if the patient is healthy enough and has good pulmonary reserve. If the disease is suspected to be advanced, then tissue diagnosis is needed. This can be obtained either through transthoracic needle biopsy, transbronchial biopsy, or endoscopic bronchial ultrasound. If the case is unusual, difficult, or more advanced disease, the patient should be evaluated at a center which deals with lung cancer routinely.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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6 months ago
Often, patients with intermediate to advanced esophageal cancer have dysphagia and are unable to tolerate anything orally. They are encouraged, however, to swallow more so to maintain some quality of life as opposed to “train” to swallow before surgery. It is felt that the longer patients do not do the physical act of swallowing that they do “forget” how to after surgery.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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8 months ago
Generally during the neoadjuvant therapy phase, the usual laboratory values, toxicities and side effects (e.g. pancytopenia) are followed. Formal radiologic assessments (CT, PET/CT, endoscopy) are not usually made until just prior to surgery.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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8 months ago
For chemotherapy, usually two-drug regimens are preferred; three drugs are offered for patients who have good performance status, are physically fit, and can be frequently monitored for drug toxicities. There are several drug combinations, but paclitaxel/carboplatin and cisplatin/5FU being the two most common regimens. Between 40-50.4 Gy of radiation is used for induction regimens. However the doses and schedules can vary according to personal preferences and patient toxicities; there are published guidelines such as those by the National Comprehensive Cancer Network (NCCN). In general the histology does not influence the regimen, but the location and treatment intent can vary the schedules.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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8 months ago
It depends which lymph nodes are involved. In patients with localized or mediastinal lymph nodes and no other distant metastases, they would still be considered for neoadjuvant therapy followed by surgery. With more distant lymph node involvement (supraclavicular, paraortic), response to therapy may be less likely to result in a situation where surgery is offered.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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8 months ago
Before surgery, lymph node involvement can be determined by activity on the PET/CT scan, endoscopic esophageal ultrasound (EUS) if locally involved near the primary tumor, or other means of biopsy by endoscopic bronchial ultrasound (EBUS) or mediastinoscopy/VATS. Usually PET scan sufficies, and there are certain criteria to suggest lymph node involvement using EUS.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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8 months ago
Unfortunately most esophageal cancers when diagnosed are at an advanced stage. If no tests have been set up, then the surgeon should talk about confirming histologically that they do have cancer, explain what other tests are required to stage the cancer (EUS, PET/CT), and provide a brief introduction to the multidisciplinary care of cancer, involving medical and radiation oncology. Though it is not uncommon that patients and their families will do web-based research prior to a surgeon’s visit, a firm plan is individualized for each patient at the time of the initial surgical visit, and surgical approaches will be discussed. Controversies do exist regarding the most optimal surgical approach, however, the surgeon will review the options and what is the most preferred based on outcomes and personal experience.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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8 months ago
The only way currently to detect esophageal cancer is having a high suspicious when one has symptoms. These include dysphagia (difficulty swallowing), regurgitation of undigested food, severe chest pain after eating, bad reflux not improved with medication, and weight loss associated with these symptoms. It is highly encouraged that when one has one or more of these symptoms that tests be ordered, such as an upper GI study, or upper endoscopy/esophagoscopy. Occasionally, early stage esophageal cancer can be found incidentally during a routine upper endoscopy.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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8 months ago
The usual risk factors include a history of gastroesophageal reflux, smoking and alcohol use. Unfortunately we don’t have any biomarkers or xrays to help us determine who is high risk. There are certain diseases which can increase the risk, such as Barrett’s esophagus, achalasia, or a history of a caustic injection that damages the esophagus; these patients should be monitored long-term for developing esophageal cancer. Patient with high grade Barrett’s disease may already have invasive cancer present.
New answer by StephenYangMD (Physician - Surgery - Thoracic (Verified))
1
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8 months ago
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