When Fran Sargent’s doctor in Michigan said he’d need to remove her entire left lung to confirm she had cancer, her response was swift.
“I told him, ‘not so fast,’” she recalls. “I’m 78, I own a successful business, and I know my own mind. I won’t let anyone talk me into something I don’t want to do.”
A history of medical challenges
This lung cancer scare was the second time Fran had faced a life-altering disease.
In 2006, she was diagnosed with scleroderma, a chronic condition that occurs when the body makes too much collagen. As a result, the skin gets thick and tight, and scars may form on internal organs, including the kidneys, intestines, heart, and especially the lungs. Scarring can damage these organs and prevent them from functioning normally.
To monitor scleroderma’s impact on her body, Fran undergoes a battery of tests twice a year. When she failed a breathing test several years ago, her doctor feared scleroderma may have attacked her lungs. He ordered a CT scan, which revealed not scleroderma, but instead a suspicious spot on her left lung.
“It looks like a cancerous tumor,” the doctor told Fran. “It’s too deeply buried in the tissue to biopsy, so we’ll need to remove your entire left lung to arrive at a diagnosis.”
Fran could live normally with one lung if she limited her physical activity to nothing beyond a casual stroll, the doctor said. Anything more strenuous would likely require her to use an oxygen tank.
“My head was spinning,” Fran recalls. “It was a lot to take in, and I was overwhelmed.”
“Will I still be able to work?” she wondered. “Will I have enough energy to keep up with my grandchildren, and take vacations with my family?”
Mostly, she worried that surgery could cause her body’s immune system to flare up and send her scleroderma into overdrive. The disease had spared her lungs so far, but that could change.
A second, then a third opinion
Fran sought a second opinion from another doctor who echoed the previous verdict: the tumor was too deeply implanted to biopsy. The lung would need to be surgically removed.
By then, Fran was becoming resigned to undergoing surgery.
“I dreaded it, but I had doctors at two well-respected medical institutions telling me I needed it,” she says.
A friend who had recently been treated at MD Anderson convinced her to seek a third and final opinion.
“MD Anderson is the No. 1 ranked cancer center in the nation,” she thought. “What’s the harm in asking doctors there to weigh in, especially when so much is at stake?”
A team of specialists
Fran called askMDAnderson, MD Anderson’s team of health information specialists who answer questions and help new patients schedule appointments. Days later, she arrived in Houston, where she met with a team of MD Anderson specialists led by thoracic and cardiovascular surgeon Jack Roth, M.D.
“About a dozen doctors and health care professionals sat in on my first appointment,” Fran says. “My scleroderma made my case rather complicated.”
The health care team had already reviewed Fran’s medical records. They ordered more tests, including CT scans, PET scans and an endobronchial ultrasound, during which a flexible tube was passed through the Fran’s mouth and into her windpipe and lungs. A camera and ultrasound probe at the end of the tube created images of her lungs and nearby lymph nodes. This allowed doctors to more closely evaluate the suspicious mass seen on her previous scans.
MD Anderson experts find way to biopsy lung tumor
After reviewing the ultrasound images, Roth shared his recommendation: Take a tissue sample from the tumor and examine it under a microscope to determine whether it’s cancerous. Based on the biopsy’s findings, decide the next steps.
“Excuse me, what did you just say?” Fran remembers asking. “You can biopsy my tumor? Without removing my lung?”
Roth assured her it could be done, and two days later, interventional radiologist Joseph Steele, M.D., removed several tissue samples from different areas of Fran’s tumor while she lay on an operating table, awake and aware.
Using CT imaging and needle guidance software, Steele navigated between and around critical structures, deep into Fran’s lung to obtain the tumor tissue. Images flashed up on the display panel hanging over Fran, tracking the needle to the target.
“It was incredible,” Fran recalls. “Dr. Steele injected some lidocaine to numb my chest, then he guided the needle into my lung and collected the samples. I felt no pain whatsoever.”
During the procedure, the two chatted about best places to eat in Houston. Steele recommended his favorite restaurant, and that evening, Fran enjoyed a Cajun dinner.
“I still shake my head when I remember how two other doctors wanted to remove my lung,” Fran says in disbelief. “Thank goodness I called MD Anderson.”
Lung cancer diagnosis linked to KRAS genetic mutation
The laboratory results from Fran’s biopsy confirmed Fran had non-small cell lung cancer, the most common form of lung cancer. She wasn’t surprised.
“My father and his mother both died of lung cancer,” she says. “My father occasionally smoked cigars, but his mother never smoked. I always suspected my family was at increased risk.”
Fran was right. Genetic testing at MD Anderson confirmed she carried a mutation in a gene known as KRAS. Found in 15 to 25% of all lung cancer cases, KRAS mutations are believed to promote the growth and spread of cancer.
“The good news is my cancer was caught while it was still confined to my lungs,” she says. “It hadn’t yet spread to my lymph nodes or other areas of my body.”
Conventional radiation is typically delivered in relatively small doses each day over several weeks. But SBRT uses a narrower, more precisely focused beam to deliver higher radiation doses over a shorter period of time. This reduces damage to healthy nearby lung tissue.
“Avoiding damage to normal tissue is extremely important since radiation can cause scarring,” explains Melenda Jeter, M.D., Fran’s radiation oncologist. “SBRT is an excellent option for patients who have early-stage lung cancers for which surgery is not possible. The outcomes are excellent.”
It worked for Fran. Four years later, she continues to show no signs of cancer. She returns to MD Anderson every six months for follow-up scans that check for signs of recurrence.
“I always look forward to seeing Dr. Jeter,” Fran says, “and I’m so appreciative of the excellent care she continues to provide. Visiting her is not only like seeing a doctor, but also a friend.”
Collaboration kept her safe from COVID-19
When the COVID-19 pandemic struck, Jeter consulted with Fran’s local doctors in Michigan so Fran could get her scans done closer to home.
“We want to protect our patients by limiting long-distance travel during the pandemic,” Jeter says. “Tests can be done in a patient’s hometown, then sent to MD Anderson for review. I can discuss the results virtually with the patient and the patient’s local physician.”
No signs of cancer
Fran’s hometown doctor was stunned to learn that her tumor was treated without surgery at MD Anderson, and that her lung was still intact.
“How did they do it?” he asked.
“I told him ‘MD Anderson works miracles,’” Fran replied. “I’ve met so many people who were told to go home and get their affairs in order. Then they came to MD Anderson, and years later they show no signs of cancer.”