Friday, November 22, 2013 - Beating Back Lung Cancer

A nonsmoker with no family history of lung cancer, survivor Jeanne Montague, center, doesn’t dwell on why she got sick. Now energetic and working full-time, she credits daughters Erin, left, and Kellie for keeping her spirits up during treatment.

“I thought I was going through menopause,” said Jeanne Montague, an operating room scheduler at Greenwich Hospital. “I’d wake up sweating in the middle of the night.” So, at age 52, she made an appointment with her gynecologist.

She also had a cough. Bronchitis? Her primary care physician listened to her chest, thinking she might have pneumonia or some other type of infection. He ordered blood tests and put her on an antibiotic for 10 days, but nothing changed.

Knowing that both of her sisters had asthma, Montague thought she might now have it, too. A CT scan showed otherwise. It detected a troublesome spot on her lung that was later identified as adenocarcinoma. A common type of cancer in women, often nonsmokers, this type of tumor can be present for a long time before symptoms occur.

Leading the team effort to put Jeanne Montague on the road to recovery were, at left, Dr. Paul Waters, head of Thoracic Surgery and Surgical Oncology, and Dr. M. Sung Lee, her oncologist.

When a Colleague Becomes a Caregiver
Montague was then scheduled to see Dr. Paul Waters, section head of Thoracic Surgery and medical director of Surgical Oncology.

She knew him well from her role at the hospital, but now she was in unfamiliar territory. Dr. Waters performed a mediastinoscopy, a procedure that allowed him to view and biopsy the area behind Montague’s breastbone to see if the cancer had spread to nearby lymph nodes.

The results showed one of the nodes was affected. “The majority of patients diagnosed with lung cancer have locally advanced tumors,” said Dr. Waters. This means the cancer has spread to at least one lymph node near the original tumor, but not to other areas of the body.

Montague’s cancer was Stage 3a, based on tumor size and lymph node involvement. Many patients with lung cancer are diagnosed at a later stage than this, generally because there are no early symptoms.

Determining the stage of cancer is important because it helps set the best course for treatment. Dr. Waters discussed Montague’s case with Greenwich Hospital’s tumor board, a group of cancer specialists that includes an oncologist, surgeon, radiologist, pathologist and other members of the team.

Pulling Out All the Stops
To shrink the size of the tumor and try to destroy the cancer in any lymph nodes, Montague received a combination of daily radiation and weekly chemotherapy for about a month prior to surgery.

While the radiation targeted the area of the tumor, the chemotherapy drugs circulated throughout her entire body. A pathologist determined which drugs would be most effective by testing them on a sample of Montague’s cancer cells in the lab.

The month of presurgery treatment wasn’t easy. The radiation irritated Montague’s esophagus, making it uncomfortable to eat. She lost a lot of weight, but not her sense of humor. “It did what diets weren’t able to do for me,” she said with a smile.

Her daughters, then 24 and 22, kept her spirits up when the chemo left her feeling drained. The power of family was an ongoing strength for this single parent household, and they celebrated when the cancer disappeared from her lymph node and the tumor itself had shrunk.

October 6, 2010: The day of surgery had arrived. Dr. Waters removed the tumor, along with several lymph nodes near Montague’s lungs and esophagus.

Although only one lymph node had previously tested positive for cancer, excising more was a preventive measure to eradicate any potentially affected areas.

After four days in the hospital, Montague went home to heal before starting another round of chemotherapy, this time once a week for three months. “We were concerned that some cells were left, so the chemotherapy was given to reduce the chance of the cancer remaining in her body,” explained Montague’s oncologist Dr. M. Sung Lee.

The regimen wasn’t pleasant, but Montague knew it was necessary to jump the hurdle back to the healthy side of life.

Elusive Answers…
Montague wasn’t a smoker and had no family history of lung cancer. Yet she doesn’t dwell on why she got sick.

“Lung cancer can happen to anyone,” she said. “There’s nothing I know of that could have caused it, and I’m not going to go crazy trying to figure it out.”

Agreeing, Dr. Waters noted that tumors sometimes appear for unknown reasons. Environmental factors, such as ongoing exposure to secondhand smoke, asbestos and radon can play a role in the development of lung cancer, he added.

The “People” Factor
Although she comes to the main hospital daily, Montague never had occasion to walk across the street to the Bendheim Cancer Center until she became a patient herself. “That’s a whole world I never knew existed,” Montague recalled. “The doctors were so straightforward and competent that I felt confident the entire time.

For a horrible thing to have happen to you, it was still a great experience.” Now 55, Montague is back to her regular routine, heading to the beach whenever she has free time and, this past year, helping to plan a wedding for her oldest daughter. She has follow-up visits with Dr. Lee every six months and remains cancer-free.

These days when she schedules patients for cancer surgery, she talks about her experience and how it turned out. “It helps put patients at ease. Being knowledgeable about the process makes it not as scary,” said Montague. “When you understand the medicine behind the treatment, it makes it much easier to go through it.”

Technology Brings New Hope
New, minimally invasive techniques for cancer care are being introduced, thanks to rapidly evolving innovations in the medical field.

Advances in radiation are extremely helpful for patients who are not eligible for surgery because of other medical conditions they may have. For example, a treatment called stereotactic body radiation therapy (SBRT) can destroy a tumor in just a few sessions.

“The challenge in the past has been that the lung is constantly moving, so the risk of damaging healthy tissue is higher,” explained Dr. Ashwatha Narayana, head of Radiation Oncology.

“Now, SBRT allows us to track the motion of the lung and turn on the radiation only when the diseased tissue comes into focus.”

For patients with Stage 1 or Stage 2 lung cancer, this is a very good option, according to Dr. Narayana. “Many times it can replace surgery entirely when cancer is detected early.”

Endobronchial ultrasound is a minimally invasive technique to find lung cancers in their earliest stage. Another noninvasive test is electromagnetic navigation bronchoscopy, more commonly called iLogic. Described as “GPS for the lungs,” it provides a real-time view through a video monitor while the physician guides a flexible catheter through very delicate vessels in the bronchial tree. There, the catheter can reach small lung lesions for biopsy and, in some cases, treatment.

High Risk? Get Screened!
Heavy smokers over the age of 50 are considered to be at high risk for lung cancer, and are encouraged to get a low-dose CT scan screening through the International Early Lung Cancer Action Program at Greenwich Hospital.

For current or former smokers who have smoked at least a pack a day for 30 years or the equivalent, a federal government health panel now recommends making annual low-dose CT scan screening the standard of care.

Clinical trials have shown these screenings to be more effective than chest X-rays in detecting early stage lung cancer, when it is most treatable.

This endorsement helps pave the way for Medicare and other private insurers to begin coverage for this type of screening, possibly as early as next year.

For more information on lung cancer treatment and services at Smilow Cancer Hospital's Greenwich Hospital Campus, see Services > Cancer (Oncology) > Lung Cancer.