Man with Lung Cancer Rides to Clear Recovery
For John Williams, it was another winter with another bout of pneumonia that wouldn’t clear up. "I had pneumonia that recurred for several years," he recalls. "Last year, my doctor saw a little something on a CT scan, but got negative results from a PET scan. When pneumonia sent me back to the hospital again this year, a second CT scan showed a small spot on my lung. That’s when my local pulmonologist referred me to an academic medical center for more specialized care."
A bronchoscope biopsy performed by University of Chicago Medicine pulmonologist D. Kyle Hogarth, MD--followed by tissue analysis by experienced pathologists here--confirmed a carcinoid tumor in Williams’ lung. Carcinoids are quite different than more common forms of lung cancer and are not related to smoking or smoke exposure. Williams was relieved to learn that carcinoid tumors grow slowly and are less likely to spread beyond the lungs. Unlike many cancers, carcinoids also are not visible on PET scans--which explains Williams’ negative scan.
"John had an early-stage carcinoid that partially blocked his windpipe," says Mark Ferguson, MD, a University of Chicago thoracic surgeon who specializes in surgery of the lung and esophagus, including minimally invasive surgery to treat lung cancer. "This type of lung cancer responds well to surgery. Chemotherapy and radiation therapy were not necessary."
Williams recalls, "Obviously I was frightened when I heard ‘lung cancer.’ But once I learned more about this type of cancer, I knew it was a matter of having it removed. I trusted Dr. Ferguson’s recommendation and didn’t feel the need to get a second opinion."
Choosing the Best Approach for Each Patient
Although the tumor was small, its removal was complicated by its location. "Lymph nodes were encasing blood vessels near John’s lungs, which made the surgery more difficult," says Dr. Ferguson.
Initially, the surgical team planned to perform a lobectomy (removing the diseased lobe of the lung) by using a minimally invasive technique called video-assisted thoracic surgery (VATS). VATS is a relatively new procedure not yet available at most hospitals. With VATS, the surgeon uses a scope equipped with a miniature video camera to view inside the lung during surgery.
"We begin with a surgical plan, but we are willing to adapt the plan once we see what the patient’s specific needs are," says Dr. Ferguson. In Williams’ case, the surgeons decided that open surgery with a direct view--instead of viewing by video camera--offered the best opportunity for full removal of the tumor with minimal damage to the lymph nodes, blood vessels and other healthy tissue by the lungs. The surgeons kept the incision as small as possible--large enough to allow for a clear view of the surgical area, but small enough to ease the recovery process. They approached the lung from the side through an incision under Williams’ arm.
Williams says, "Dr. Ferguson’s team removed about two-thirds of the upper-left lobe of my lung and some lymph nodes."
Even before surgery, the lung care team performs a series of tests to assess lung and heart functioning. "Preoperative tests are important to make sure a patient will have adequate lung capacity after surgery," says Dr. Ferguson. "We carefully assess each patient to determine whether they are eligible for surgery. If there is a concern about lung capacity, we may recommend a smaller operation or another treatment option instead of surgery, such as radiation therapy."
Making a Full Recovery
Williams recovered quickly and was back doing desk work a week after returning home. Months after the surgery, he had returned to his active lifestyle, including workouts with a trainer several times per week. In nice weather, you’ll find him bike-riding along Lake Michigan’s shoreline, anywhere between New Buffalo, Michigan and Chicago’s north side. "Even after having lung surgery, I can ride 15 miles without a problem," he says.