New option for lung cancer removal

As a longtime smoker, Debbie Enciso was diligent about annual lung cancer screenings since the age of 50. In February 2019, her primary care doctor spotted a hazy area on her CT scan. He said that while it didn’t mean she had cancer, cancer could eventually develop in that spot so it would be important to monitor the area.

One year later, Debbie’s lung scan revealed that the suspicious spot — referred to as a “ground glass” haziness because of its appearance — had grown from 6 millimeters to 10 millimeters. However, it still wasn’t solid so no one could be certain it was cancer. A radiologist suggested waiting another year to check her next lung scan.

“I’m a huge self-advocate for health care and that didn’t sit well with me,” says Debbie. “I didn’t want to wait another year and let what could be cancer continue to grow. So, I asked what else we could do now.”

She was referred to a pulmonologist who recommended a PET scan, another type of imaging that can provide different types of information than a CT scan. While the PET scan came back negative, Debbie was told that the spot could still be cancer and that she had the option of undergoing a partial lung resection to remove that portion.

To perform a lung resection, her doctor said it would be necessary to insert a double cannula, or long tube, into her throat to inflate her lung. Unfortunately, Debbie endured extensive damage to her vocal cords during a surgery to remove part of her thyroid in 2011, resulting in five additional surgeries and a tube in her throat for 10 months. Inserting the double cannula would cause further damage and render her unable to speak.

To avoid damage to the vocal cords, her doctor suggested a tracheostomy — an incision in the front of the neck to insert a breathing tube into the windpipe. Anxiety related to her post-traumatic stress disorder (PTSD) from having a tube in her throat for 10 months led Debbie to look for other options.

Finding help at Sharp HealthCare
After a friend mentioned a story she saw on the news about Sharp Grossmont Hospital's new lung cancer detection device called the Monarch™, Debbie immediately began researching online. She found a Sharp Health News article about awake video-assisted thoracic surgery, or AVATS, which explained how Dr. Ara Klijian can perform minimally invasive lung surgery using local, instead of general, anesthesia. That meant he could do the lung resection without inserting a tube in her neck.

“That got me excited,” remembers Debra. “I couldn’t imagine losing my voice and I was relieved that there might be a better option for me, so I called Dr. Klijian.”

Dr. Klijian referred her to see pulmonologist Dr. Kaveh Bagheri to determine if she was a good candidate for surgery. He believed Debra was a good candidate, although she would not undergo a traditional AVATS procedure.

“Since Debbie did not have a nodule, it would have not been possible to see or feel anything abnormal with a scope,” explains Dr. Klijian. “We decided that the best course of action would be to perform a hybrid procedure. Before I operated, a radiologist inserted a needle and wire into the area of haziness and injected dye to create a visual marker on exactly the location I wanted to target.”

Making a series of small incisions and using a camera attached to a scope, Dr. Klijian removed the suspicious area of Debra’s lung. Using a technique called “intermittent apnea” — a controlled pausing of a patient’s breathing — he was able to perform the operation without deflating the lung.

“Traditionally, a breathing tube would need to be inserted and we’d have to collapse the lung to do a surgery like this,” says Dr. Klijian. “With this hybrid approach, I was able to remove Debbie’s cancer using light sedation and without having to perform a tracheostomy. As a result, she was in the hospital less than 24 hours, and had less recovery time and fewer complications than with other methods.”

Once the lung segment was removed, Dr. Klijian sent a sample to pathology for testing. The results confirmed that the spot was adenocarcinoma in situ, or early-stage cancer. Now that the area has been removed, Debbie is cancer-free.

Debbie is relieved that her cancer was removed before it had a chance to grow into a full-fledged tumor or spread to other areas, which would make it much more difficult to treat. She admits it’s scary to imagine how different things could have been if she had waited another year for her next scan, or if she hadn’t researched and learned about the advanced surgery options available at Sharp HealthCare.

“Dr. Klijian and Dr. Bagheri were absolutely terrific. I don’t think I’d be where I am today without them,” says Debbie. “I could have been sitting around for a year while my lung cancer had time to grow. I’m so thankful to have been able to get this surgery and be cured without losing my ability to speak.”

It has been a slow recovery, but Debbie says she continues to get stronger and looks forward to being the active person she was before her surgery. A retired property manager, she is now a mosaic artist and lives with her 25-year-old son, who has been a tremendous help and support throughout her journey.

“I’ll happily work through a tough recovery knowing I’m cancer-free and will live through this. I’m very grateful.”