One doesn’t typically connect lung cancer with good fortune, but when a low-dose CT scan finds early, stage 1 cancer that is removed during minimally invasive surgery, one could feel lucky.
That is how Gun Giuliana (pictured at right) felt last spring after she received the diagnosis, quit smoking and recovered from video-assisted thoracic surgery (VATS). The small tumor, found thanks to low-dose CT scan screening, was removed along with the upper lobe in her right lung.
“I was thrilled that I didn’t need radiation or chemotherapy,” says Mrs. Giuliana, 69, a retired bank teller who lives in Westford. “I had no symptoms — no coughing, no pain. I would never have known.”
She considered quitting smoking many times. “Every time I made an appointment with Dr. Azam, I wanted to quit before I saw her.”
Seema Azam, MD, her primary care physician at Westford Internal Medicine for more than ten years, wanted the same thing. “I counseled Gun at every visit,” she recalls. “Quitting smoking is the most powerful strategy to reduce the risk of lung cancer.”
In March 2017, Mrs. Giuliana told Dr. Azam that she was planning a trip to Sweden to see her mother and wanted to make sure her health was fine. “I asked Dr. Azam about having a chest x-ray, and she told me about the CT scanning for lung cancer,” says Mrs. Giuliana.
They reviewed the criteria for the screening:
- Between age 55 and 77
- Smoked a pack of cigarettes or the equivalent for 30 years
- Either still smoke or quit less than 15 years ago.
She met the criteria and had a low-dose screening CT scan at
Emerson’s Westford Health Center. Things then moved quickly.
Off cigarettes and into the operating room
The CT scan identified a suspicious lesion, which led Dr. Azam to refer Mrs. Giuliana to
Meena Mehta, MD, an Emerson pulmonologist. “Dr. Mehta told me the safest thing was to have a PET/CT scan performed,” says Mrs. Giuliana. The test, which was interpreted by Lisa Intriere, MD, an Emerson radiologist, combines a 3-D image of the anatomy (CT scan) with positron emission tomography (PET), which shows hyperactive functioning of cancer cells. It can help predict if a lung nodule is cancerous and detect evidence that cancer has spread. Since many lung nodules are benign and never become cancer, a
PET/CT scan can avoid unnecessary tests and treatment.
Based on the PET/CT results, Dr. Mehta referred Mrs. Giuliana to
Ashok Muniappan, MD, a thoracic surgeon on staff at Massachusetts General Hospital and Emerson. “Dr. Muniappan showed me the PET/CT scan and recommended surgery as soon as possible. If a biopsy showed it was cancer, he’d perform VATS to remove the right upper lobe and a lymph node. Right away, I trusted him.”
“Although Mrs. Giuliana was planning a trip, I told her that having surgery was the most prudent thing to do,” Dr. Muniappan explains. He also told her that she would need to be off cigarettes for two weeks in order to have surgery. She cancelled her trip and quit smoking immediately.
Dr. Muniappan performed her surgery in 2017 at Mass General, and it was easier than she anticipated. “Once I got home, I rested for about a week, but I functioned fine and didn’t have much pain,” says Mrs. Giuliana. “Tylenol took care of it.”
The surgical removal of a lobe can have a small impact on a patient’s breathing — mainly in the form of mild breathlessness. “Dr. Mehta prescribed a rescue inhaler, but I haven’t had to use it,” she says.
“Most people will bounce back quickly after VATS,” says Dr. Muniappan, who notes that, despite small incisions, patients should expect some pain. “The ribs, which are nearby, are sensitive. We don’t take shortcuts. If we need to perform traditional, open surgery — for larger or more advanced cancers — we do, and patients typically recover without a problem.”
Emerson has a strong group of specialists
The fact that Mrs. Giuliana’s stage 1 lung cancer was found early and treated is a testament to the effectiveness of screening with low-dose CT scans. A National Cancer Institute study that involved 58,000 current and former smokers was halted in 2011 when it was shown that use of the screening cuts lung cancer deaths by 20 percent.
“We are definitely finding lung cancer at an earlier stage, when treatment is most effective,” says
Elizabeth Peters, MD, the Emerson radiologist who interpreted Mrs. Giuliana’s CT scan. “Historically, more than two-thirds of patients were diagnosed with lung cancer at stage 3 or 4, when cure is harder or impossible to achieve.”
The challenge, says Dr. Muniappan, is to avoid operating on benign lung nodules that may never progress to cancer. “I often tell patients ‘don’t worry if you have a lung nodule,’ because we monitor them as necessary,” he notes. “We continue to improve our diagnostic ability — that is, when should we intervene?”
Having a strong multidisciplinary group of specialists is key. “You need an experienced thoracic surgeon, radiologists, pulmonologists and oncologists,” he says. “We have that at Emerson. It is the only way a lung cancer program functions well.” Dr. Muniappan is at Emerson weekly to see patients, perform small surgical procedures and attend the lung tumor conference.
Six months after Mrs. Giuliana’s surgery, a CT scan of her chest was negative, indicating that the cancer was gone. She also had a follow-up appointment with Dr. Muniappan, something that will continue for two years. “I see him in Concord, which is convenient,” she says. “I can’t say enough about Dr. Muniappan.”
“Gun is a textbook case of how lung cancer screening should work,” notes Dr. Azam. “Her cancer was identified at an early stage, and she received treatment immediately. She told me that she feels lucky.”
Emerson’s low-dose CT lung screening program is available at the hospital and the Westford Health Center. Please ask your physician if this test may benefit you. To schedule the test, call 978-287-3003.
