A less invasive biopsy option — and early lung cancer find

Cancer was not on Susan Rubesh’s mind when she checked into the emergency room at Sharp Memorial Hospital one day in late 2023. She had a bad cold and sinus infection and was worried about having pneumonia, remembering she had it several years before.

The emergency doctors treated her illness, which included having imaging done. They noticed a small spot on her right lung, known as an incidental lung nodule, meaning it was discovered unexpectedly through imaging while evaluating another condition.

Despite not suspecting cancer when she arrived, Susan had a bad feeling right away.

A crucial follow-up appointment

Susan was sent home after receiving treatment for the cold. But she knew she could not ignore the discovery of the nodule. She made a follow-up appointment to have it checked by Dr. Anuja Vyas, a pulmonologist with Sharp Rees-Stealy and affiliated with Sharp Memorial Hospital.

“At Sharp, we always try to have a team member reach out when someone has a spot discovered while in the emergency department,” says Dr. Vyas.

A recent study found that about 1.5 million incidental lung nodules are detected each year, but only half of patients follow up after the discovery to have them checked. Around 5% of incidental nodules turn out to be cancer, meaning an estimated 37,500 of these lung cancer cases go undiscovered annually.

“The earlier we find lung cancer, the more likely we can cure it,” Dr. Vyas stresses. “That’s why it’s so important to encourage people not to ignore a nodule when one is found.”

Advanced technology improves outcomes

Susan was quickly scheduled for a biopsy to assess the spot on her lung. Dr. Vyas used a procedure called robotic bronchoscopy. Unlike the invasive procedure of the past, which reached the nodule from outside the lung, robotic bronchoscopy uses a robotic arm to guide a tube through the mouth, following the lungs’ natural passageways.

This modern procedure allows access to nodules that couldn’t be reached previously. It’s also easier for patients, who are typically able to return home the same day. What’s more, the care team receives the results of the biopsy almost immediately.

Susan’s case turned out to be unusual because the biopsy tested negative for cancer. However, Dr. Vyas was still suspicious. “I’ve seen thousands of scans of nodules in my career and have learned to recognize the physical characteristics of ones that are cancerous,” she explains.

She suggested waiting a few months before performing another robotic bronchoscopy. This time, the testing revealed Stage 1 lung cancer.

“It’s like checking a piece of fruit to see if it’s rotten,” says Dr. Vyas. “You may cut out a piece that looks great, but that doesn’t mean a different part of the fruit hasn’t gone bad. I’m glad Susan followed our advice to test the nodule again.”

Treatment and recovery

Fortunately, because the cancer was caught early, Dr. Vyas told Susan the care team hoped to be able to remove it with surgery, without the need for chemotherapy or radiation.

“I was a little nervous, but Dr. Vyas was so warm, positive and clear with me that it gave me great confidence that everything would be okay,” Susan recalls.

Dr. Craig Larson, a cardiothoracic surgeon with Sharp Community Medical Group, used the da Vinci 5, the most advanced robotic-assistance system, to remove the bottom lobe of Susan’s lung. Her husband was able to visit her in her room that afternoon, and Susan returned home the following day.

“I would tell people, ‘Yes, it’s scary at first. But if you have the right doctor, they make you feel so at ease that you’re in the right state of mind to handle it,’” Susan says. “The surgery was easy, and the outcome for me was excellent.”

Susan’s care team showed her some breathing exercises to practice. Within a few weeks, she returned to her daily routine. “Every time I’ve faced a challenge and worried about my breath, I’ve been just fine,” she reports.

Susan recommends that everyone be proactive about their health and take their doctor’s advice when a follow-up is suggested.

“Had I waited or ignored the doctors, my cancer might not have been discovered until later, and the treatment would have been much harder,” she says. “So, make your appointments!”

Sharp HealthCare is proud to be the Presenting Sponsor of the American Lung Association’s LUNG FORCE Walk, on Saturday, May 31, 8 am, at the Carlsbad Flower Fields. Join a Sharp team or create your own.