Lung cancer survivor enjoying traveling, family after finding cancer early

Susan Fasola hadn’t smoked cigarettes for 10 years when a pain in her chest prompted her to seek a doctor’s opinion. She felt it every time she coughed, always in the same place in her upper right chest.

“It was not normal. I never felt anything like it,” she said. “This wasn't something that made me cough. This was when I coughed; it was like a hitch in a specific spot. And it was always the same spot.”

Fasola had started smoking as a teen in the 1960s – right at the peak of cigarette usage in the U.S., before reports on the dangers of smoking and public health measures really started to make an impact. She smoked two packs a day from the time she was 15 until she was about 30.

Then, with the help of hypnosis, she quit.

Three years later, she was tempted to start again.

“A friend was spending the night, and she smoked – oh, the days when we used to smoke indoors! I had one that night and then the next morning,” she recalled. This time, however, she didn’t let it go on too long. She returned to hypnosis and quit again.

“It became a habit. Twice a year, I would fall off the wagon. As soon as I fell off, I’d call the hypnotherapist and quit,” she said. “But the damage I did; it was pitiful to see me. I couldn’t smoke them fast enough – I moved my whole life out on the porch.”

It often takes multiple attempts to quit smoking before someone is successful, said MUSC Hollings Cancer Center researcher Benjamin Toll, Ph.D., who directs the MUSC Health Tobacco Treatment Program.

Although more than half of people who smoke try to quit each year, the nicotine in tobacco is so powerfully addictive that only about 8%, nationally, are successful, he said. Nonetheless, he and the counselors in the tobacco treatment program don’t look at those unsuccessful quit attempts as failures – instead, they’re practice steps to quit for good. And that is what happened for Fasola, who was finally able to quit successfully – for good.

Fasola explained her on-again, off-again history to MUSC Health pulmonologist Adam Fox, M.D., as they looked at a scan of her lungs last year. A spiky looking scratch showed on the scan, exactly where she felt the pain. It might be scarring, he told her, to which she wondered whether a bout of pneumonia might have caused it. “No, that seems unlikely,” he said. They discussed the possibilities and settled on repeating a scan for monitoring.

At that point, it wasn’t clear whether it was cancer, and Fasola had a big trip planned to Paris.

“It was with my grandson and his mother. So I was not missing that.”

Upon her return from the City of Lights, Fasola returned for another scan, which showed the spot had grown. That led to a biopsy, which confirmed it was malignant – lung adenocarcinoma, the most common form of lung cancer.

Adenocarcinoma wasn’t always the most common form of lung cancer caused by smoking. But when cigarette manufacturers introduced low-tar and “light” cigarettes – a marketing ploy designed to make the cigarettes appear less dangerous – they also redesigned them in such a way that led smokers to inhale the smoke more deeply into their lungs, leading to more cases of adenocarcinoma. A 2009 law now prohibits cigarettes from being labeled as “light.”

Fasola learned that her cancer was Stage 1A – a very early stage cancer. Because it was confined to that one spot and because she had enough lung capacity, she could have a lobectomy, a surgery to remove the lung lobe with the cancer, and not need any other type of treatment.

Fasola met with surgeon Barry Gibney, D.O., who specializes in lung and esophageal cancer and lung transplants.

“Upon meeting him, I just liked him a lot,” she said.

Surgery is the tried-and-true method for treating lung cancer, Gibney said. Techniques have changed over the years – for example, he was able to perform Fasola’s surgery using minimally invasive robotic surgery, leaving only four small marks – but the basis of the treatment remains the same. That does need to change, he noted.

“We do look at Stage 1 lung cancer as a whole, and when we group it as a whole, outcomes are worse than other solid organ malignancies, suggesting that we need to have other treatments. We just haven't found out what those treatments are, so it's an area of active investigation that will likely only be answered through clinical trials,” Gibney said.

Part of that answer is likely to come as precision oncology further develops. Researchers are realizing that lung cancers aren’t all the same – nor are they all caused by smoking. In fact, Gibney said, about 20% of lung cancer patients do not have a history of smoking. Immunotherapies and targeted therapies focus on specific mutations that can cause cancer.

“As we develop more and more precision-based medicines, we're going to find more and more targets that we hope we can go after to provide care for these patients,” Gibney explained.

Just as important is finding the cancer early, when there are more options for treatment. Fasola was fortunate to be diagnosed with an early-stage cancer. However, many people who have smoked don’t realize that there is a lung cancer screening test. An annual low-dose computed tomography (CT) scan is recommended for many who have smoked – yet only about 6% of people who are eligible for this screening get it. People are eligible for lung cancer screening if they:

• Are age 50 to 77 and;
  
  
• Currently smoke or quit within the last 15 years and;
  
  
• Have a 20-pack-year smoking history (one pack per day for 20 years, two packs per day for 10 years, etc.).

“This is still probably the most critical screening that a patient with risk factors for lung cancer can have because the earlier we detect their cancer, the better chance they have of surviving their cancer,” Gibney said.

Now, about nine months after her surgery, Fasola is finally starting to feel like herself. She’s finally lost the weird numb feeling in the surgical area and is starting to get back to some physical activity.

“My breathing is a little more labored. I don't get short of breath per se, but it's just more labored. I walk the dog, and I try to do a mile, but I feel it more than I did before,” she said.

Still, she’s enjoying her grandchildren – in addition to her teenage grandson, she has triplet “tween” granddaughters – and is planning a trip to Copenhagen. Her advice to others is to be proactive about their health.

“Any time you feel something that's not right anywhere, better to get it looked at and have it be ‘Oh, no big deal,’ then not have it looked at.”

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