Lung cancer team works together from one unique patient to the next
We examine ourselves for breast cancer, wear sunscreen to prevent skin cancer and undergo colonoscopies to check for colorectal cancer, but are we taking any measures against the leading cancer killer in both men and women?
Lung cancer strikes in the young and the old, men and women, smokers and nonsmokers. It can appear in anyone, and it often goes undetected for years.
At just 35 years old, Francesca Albano was diagnosed with lung cancer after coming down with cold-like symptoms. Another patient dealing with shortness of breath, Patricia Hines, was diagnosed at age 59, more than a decade after she ended what had been a lifelong smoking habit.
Both women battled their cancer at UF Health Jacksonville, as have countless others.
Smoking is just one of many causes.
Unfortunately, lung cancer is typically silent until it progresses into its latest stages. But signs to look for include a persistent dry cough that doesn’t go away; chest pain; night sweats; and coughing up blood.
While lung cancer is most commonly caused by smoking, it’s just one of many causes.
“There are a high number of cases that aren’t associated with smoking. It can be caused by second-hand smoke, environmental causes, uranium exposure, radon, air pollution and probably additional causes that we don’t yet know,” said Harry D’Agostino, MD, University of Florida College of Medicine – Jacksonville associate professor of surgery and chief of the division of cardiothoracic surgery.
UF is playing a big role in trying to find lung cancer earlier. It is one of the only hospitals in the region offering lung cancer screenings to qualifying patients. Candidates must be between the ages of 55 and 74, and they must have a smoking history of at least 30 pack years (one pack a day for 30 years, two packs a day for 15 years, etc.).The screenings are already making a difference: trouble areas have been found in a number of participants, who were able to undergo early intervention procedures because of the screenings.
A team approach to treatment.
When lung cancer is found in a patient, an entire team of experts reviews the case.
Every week on Thursday morning, about 30 UF physicians crowd into a conference room in UF Health’s Clinical Center to talk about their cases. With decades and decades of experience among them, the physicians put their minds together to recommend the best treatment course for each patient as images of his or her lungs are displayed on a screen in the front of the room.
If a mass is dangerously close to the heart, the team decides whether the risk is too high to operate. If a patient is struggling with more than one type of cancer, the team decides which cancer should be treated first. This is where life-and-death decisions are made, and it is this group of physicians as a team that has saved many lives.
Hines remembers joking to D’Agostino that the team was “talking behind my back.” But she couldn’t have been happier about it.
Minimally invasive surgeries make the course easier for patients.
In Hines’s case, the team decided to remove part of her lower left lung, taking with it the 4 ½ centimeter tumor they found there. Amazingly, they were able to do it with a minimally invasive procedure, meaning they used a series of small, 1 ½ inch incisions rather than one large one.
Few hospitals offer minimally invasive surgery for lung cancer patients because it is a much more precise and labor-intensive procedure, requiring a higher level of skill from physicians, D’Agostino said.
At UF, these surgeries are offered using both the doctors’ hands and the aid of high-tech robotic equipment, depending on what’s required in each surgery.
Minimally invasive procedures are becoming increasingly popular because the recovery time is shorter, there’s less pain, less blood loss, less risk of infection and less scarring and damage to tissue afterward, D’Agostino said. In addition, since patients recover more quickly, it may allow the next step of treatment – chemotherapy – to be offered much earlier. D’Agostino said the UF team is currently participating in research in that area.
Hines, who had never been operated on in her life, was shocked how quickly she recovered.
“I had my surgery on a Wednesday, and I went home on Sunday. That’s not a long time for a procedure like that,” she said.
Once the mass was removed, Hines started chemotherapy treatments with medical oncologist Dat Pham, MD, a UF associate professor of medicine. Then radiation oncology assistant professor Bradford Hoppe, MD, MPH, built her a pod that she had to lay in while she received radiation treatments to eliminate residual cancerous cells.
Today, Hines continues to receive chemotherapy about once a month, and she always has a smile on her face. But it wasn’t always that way. She remembers crying for days when she was first diagnosed. She wants new lung cancer patients to know there’s hope.
“Keep a positive attitude, and that’s half the battle. Just because you hear the words ‘lung cancer’ doesn’t mean it’s a death sentence,” she said.
“The people at UF, I love them all. There is not a doctor, a nurse, an office person, a technician, anyone that hasn’t been fantastic. They’re all kind, they’re all helpful. Everyone just had a way of putting you at ease. They made a really stressful situation so much easier to go through.”
Lymph node detection important, too.
Francesca Albano thought she had a bad cold when she went to an urgent care center at age 35. A chest X-ray revealed a large mass on her lungs. She went to the UF Health emergency room and soon met with pulmonologist James Cury, MD, a UF associate professor of medicine. He began a series of pulmonary tests. Albano was shocked to find out the softball-sized tumor was advanced-stage lung cancer.
She and her partner Millie immediately decided to quit smoking; Millie threw all of their cigarettes in a dumpster that night. But Albano still had a very big fight ahead of her.
She remembers meeting D’Agostino to talk about her surgery on a Thursday. The very next day, on Friday morning, he removed the upper and middle lobes of her lung.
In Albano’s case, the excessively large tumor was too big for a minimally invasive procedure, D’Agostino said. While most tumors are small enough to extract between the ribs, Albano needed a larger incision. During her surgery, the team also tested her lymph nodes and found another tumor.
“A lot of surgeons don’t do a complete mediastinal lymph node removal,” D’Agostino said. But at UF Health Jacksonville it is routine. The mediastinal lymph nodes are found in the center of the chest and are one of the most common places for non-small cell lung cancer tumors to spread.
After her surgery, Albano also began undergoing chemo treatments with Pham. Within a year, however, cancer appeared again, this time in Albano’s brain. The tumor, which sat on her speech center, was inoperable. But there was still hope.
Albano went to see another member of the team: Randal H. Henderson, MD, MBA, a professor of radiation oncology and associate medical director of the UF Proton Therapy Institute.
“I went in for radio surgery, and they killed it. My tumor shrunk. I go back for X-rays and MRIs every few months to monitor it, but as far as I’m concerned, I’m in total remission,” Albano said. “The doctors here are absolutely incredible. I owe them my life.”
Patients save time and travel by seeing several physicians at one appointment.
A lung cancer patient often has to see a series of specialists for each step of treatment, and that can mean a lot of appointments, time and travel. But one of the assets of the Thoracic Oncology Program at UF Health Jacksonville is its multidisciplinary approach. Instead of having to make appointments with each different physician, patients are able to work with all of their physicians at once, and all of those physicians stay in contact with each other about their care.
D’Agostino came up with a program called “clinicals” that is unique to UF Health. On the day of clinicals, patients come in to see all of their doctors. The patients stay in their rooms while various specialists, such as a surgeon, pulmonologist, medical oncologist and others, come to them.
“Since we all see people in the same location, it’s easy to do. It saves the patients a lot of time and a number of trips,” D’Agostino said.
It’s all part of offering the best possible care to patients.
“We hold ourselves to the best care because there’s only one level of care, and that’s the best,” he said.
You can learn more about UF Health Jacksonville’s Thoracic Oncology Program at http://ufhealthjax.org/cancer/lung.