The Thoracic Oncology Program at UC Davis Comprehensive Cancer Center, directed by Dr. David R. Gandara, is a national and international center of excellence for lung cancer treatment. 

It is the largest and most comprehensive program in Northern California, providing a wide array of clinical and research services, ranging from prevention strategies to new diagnostic and therapeutic approaches.

In addition to lung cancer, expertise in the diagnosis and treatment of other thoracic malignancies, such as mesothelioma, esophageal cancer and thymoma, is available.

Composed of a multi-disciplinary team of experts in medical oncology, pulmonary medicine, thoracic surgery, radiation oncology, pathology and radiology, our program includes nationally prominent clinicians and researchers who meet weekly at the Thoracic Oncology Tumor Board to coordinate evaluation and treatment strategies for each new patient, in effect providing "one-stop shopping" by combining the opinions of approximately 20 different team members.

Our Thoracic Oncology specialists rank among the country's leading lung cancer researchers, designing and conducting clinical trials of promising investigational therapies that often become the recognized standards nationally and internationally. Clinical trials sponsored by the National Cancer Institute are available for almost every situation and stage of lung cancer.

Each patient's clinical history and medical record, including PET scans, CT scans and other imaging studies, are reviewed by this multidisciplinary team before a an opinion is rendered and recommendations made. The treatment team is rounded out by nurses with advanced training in thoracic oncology, along with dietitians, social workers and clinical research associates for clinical trial entry.  The team's goal is an individualized treatment plan tailored to each patient.

cellStudies now support screening high-risk groups — such as heavy current or former smokers of a certain age —  which may help detect lung cancer early enough to increase the chance of cure. In addition, patients with small simple isolated spots on their lungs, called pulmonary nodules, may need to be further evaluated. Computed tomography (CT) scanning of the chest may be an appropriate screening modality in a select group of “at risk” patients. For more information, contact your primary care provider, or set up an appointment with a member of our lung cancer team.

Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the same time.  The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, including smoking, and past jobs, illnesses, and treatments will also be taken. 

Laboratory tests: Medical procedures that test samples of tissuebloodurine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time. 

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. 

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. 

PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Sputum cytology: A procedure in which a pathologist views a sample of sputum (mucus coughed up from the lungs) under a microscope, to check for cancer cells. 

Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.

Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened. 

Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells. 

Light and electron microscopy:  A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells. 

Immunohistochemistry study:laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

  • A cough that doesn’t go away
  • Trouble breathing
  • Chest discomfort
  • Wheezing
  • Streaks of blood in sputum (mucus coughed up from the lungs)
  • Hoarseness
  • Loss of appetite
  • Weight loss for no known reason
  • Feeling very tired

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Smoking cigarettes, pipes, or cigars is the most common cause of lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk. If a person has stopped smoking, the risk becomes lower as the years pass.

Anything that increases a person's chance of developing a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for lung cancer include the following:

  • Smoking cigarettes, pipes, or cigars, now or in the past
  • Being exposed to second-hand smoke
  • Being treated with radiation therapy to the breast or chest
  • Being exposed to asbestosradon, chromium, nickel, arsenic, soot, or tar
  • Living where there is air pollution

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Different types of treatments are available for patients with non-small cell lung cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer.  When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial.  Some clinical trials are open only to patients who have not started treatment.

Treatment may include FDA-approved and/or investigational approaches, such as:

  • Chemotherapy — generally given by infusion at the Cancer Center.
  • Molecular targeted therapy — this new generation of medications includes oral inhibitors of the epidermal growth factor receptor (EGFR) for lung cancer, such as gefitinib (Iressa) and erlotinib (Tarceva) and anti-angiogenic agents such as bevacizumab (Avastin) for protocol treatment of mesothelioma.
  • Radiation therapy — state-of-the-art radiation therapy is offered in the Radiation Oncology Clinic on the ground floor of the Cancer Center.  Our Thoracic Oncology Program specializes in combined modality therapy integrating systemic agents such as chemotherapy together with chest radiation with or without surgery, and our approaches are acknowledged throughout the country as state-of-the art.
  • Surgery — surgeries are scheduled at both the UC Davis Medical Center's main hospital and the outpatient University Surgery Center.  Thoracic surgeons play an active role in the diagnostic and therapeutic approach to each patient, as appropriate based on the stage of cancer and other individual patient characteristics.

More about surgical interventions for lung cancer

Clinical Trials

UC Davis Comprehensive Cancer Center has a large clinical trials network, offering patients access to the newest drugs and treatments before they become widely available.  The Cancer Center participates in two National Cancer Institute-sponsored adult clinical trials groups: the Southwest Oncology Group (SWOG), made up of 283 leading cancer treatment and research institutions throughout North America, and the NRG , comprising 250 centers.

Dr. Kelly, as chairman of the SWOG Lung Committee, directs a multi-institution group of thoracic cancer specialists located in all 50 states in NCI-sponsored clinical trials evaluating new treatments.  In addition, our physicians conduct novel clinical trials through the California Oncology Consortium, a research collaboration that also includes the City of Hope National Medical Center in Duarte, Calif., and the University of Southern California in Los Angeles.  Knowledge and advances generated and shared through these cooperative groups benefit all of our patients with thoracic malignancies.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center 

Surgical Oncology / Thoracic Surgery

Lisa Brown, M.D., MASLisa M. Brown, M.D., M.A.S.
Assistant Professor of Thoracic Surgery

David Cooke, M.D., F.A.C.S.David Tom Cooke, M.D., F.A.C.S.
Associate Professor and Section Chief, General Thoracic Surgery
Associate Program Director, Cardiothoracic Surgery Residency

Hematology and Oncology

David Gandara, M.D.David R. Gandara, M.D.
Professor Emeritus of Internal Medicine, Hematology and Oncology
Associate Director for Clinical Research, UC Davis Cancer Center
Director, Thoracic Oncology Program

Karen Kelly, M.D.Karen Kelly, M.D.
Professor of Internal Medicine, Hematology and Oncology
Associate Director for Clinical Research
Phase I Clinical Director

Primo Lara, Jr., M.D.Primo N. Lara, Jr., M.D.
Professor of Internal Medicine, Hematology and Oncology
Director, UC Davis Comprehensive Cancer Center

Tianhong Li, M.D., Ph.D.Tianhong Li, M.D., Ph.D.
Professor of Internal Medicine, Hematology and Oncology

Jonathan Riess, M.D., M.S.Jonathan Riess, M.D., M.S.
Associate Professor of Internal Medicine, Hematology and Oncology

Pulmonary Medicine

Nicholas Stollenwerk, M.D.Nicholas Stollenwerk, M.D.
Assistant Professor of Internal Medicine, Pulmonary and Critical Care

Ken Yoneda, M.D.Ken Y. Yoneda, M.D.
Professor of Internal Medicine, Pulmonary and Critical Care

Diagnostic Radiology

Ramsey Badawi, Ph.D.Ramsey Badawi, Ph.D.
Professor of Radiology 
Director of Nuclear Medicine Research

Elizabeth H. Moore, M.D.Elizabeth H. Moore, M.D.
Professor of Radiology

Radiation Oncology

Megan Daly, M.D.Megan Daly, M.D.
Assistant Professor

Ruben Fragoso, M.D., Ph.D.Ruben Fragoso, M.D., Ph.D.
Assistant Professor

Shyam Rao, M.D., Ph.D.Shyam Rao, M.D., Ph.D.
Assistant Professor


Danielle BahamDanielle Baham, M.S., R.D.

Kathleen NewmanKathleen Newman, R.D., C.S.O.

Genetic Counselors

Kellie BrownKellie Brown, M.Sc., L.G.C.

Nicole Mans, M.S., L.C.G.C.Nicole Mans, M.S., L.C.G.C.

Daniela Martiniuc, M.S.Daniela Martiniuc, M.S.

Jeanna Welborn, M.D.Jeanna Welborn, M.D.

Social Work

Sara Chavez, LCSW, OSW-C, ACHP-SWSara Chavez, L.C.S.W., O.S.W.-C., A.C.H.P.-S.W.

UC Davis Comprehensive Lung Cancer Screening Program

UC Davis offers a multidisciplinary program for comprehensive lung cancer screening. The program provides low-dose chest computed tomography (LDCT) technology to detect lung cancer early in its most treatable form in individuals at the highest risk for lung cancer. The groundbreaking National Lung Screening Trial clearly shows that LDCT screening reduces the risk of dying from lung cancer in heavy smokers by 20 percent compared to screening with simple chest X-rays.

The UC Davis Comprehensive Lung Cancer Screening Program addresses recommendations released in July 2013 by the United States Preventive Services Task Force for annual LDCT scans to screen individuals at high risk for lung cancer.  We use a multidisciplinary team of radiologists, thoracic surgeons, pulmonologists, pathologists, medical oncologists and radiation oncologists to develop a best-practice, patient-centered plan.

Who do we screen?

UC Davis CLSP serves a specific high-risk population for lung cancer. This population is defined by the results of the multi-institution National Lung Screening Trial, Preventive Services Task Force recommendations and the Centers for Medicare and Medicaid Services. It includes the following:

High-Risk Patients:
• Current or former smokers 55-77 (or 80 depending on insurance) years of age
• Smoked the equivalent of one pack of cigarettes a day for at least 30 years
• If a former smoker, he/she should have quit within the previous 15 years

How do I schedule an exam?

We would be happy to assist you with lung cancer screening or answer additional questions. To schedule an appointment with the Department of Radiology call 916-734-0655. A referral from your primary care provider is required and can be faxed to 916-703-2254. The results will be reported back to your primary care provider. Should an abnormality be found that requires further evaluation; our UC Davis lung cancer screening practitioners, including pulmonologists and/or thoracic surgeons, will assist you.

If you are still a smoker, we also can offer you advice and help on strategies to stop.