Heart Test Finds Lung Mass

Coronary calcium screening offered at no charge by UH can yield important findings

When Wendy DiDomenico’s sister had a heart attack at 55, she decided it was time for a coronary calcium score to assess her own risk.

An avowed believer in preventive medicine, the Medina Country resident isn’t afraid of screenings such as mammograms for breast cancer and colonoscopies to check for colorectal cancer. The coronary calcium score is a simple, low-dose CT scan of the heart, offered at no charge by University Hospitals.

Wendy’s test did not show cardiovascular disease that required any medication or treatment. But a spot on Wendy’s lung needed another look.

“Lit up like a Christmas tree”

At her follow-up scan, Wendy said that the spot on her lung “lit up like a Christmas tree.” She saw the providers at UH Parma’s Lung Nodule Clinic, who were able to diagnose it as a carcinoid tumor. This type of slow-growing tumor responds well to surgery, according to thoracic surgeon Christopher Towe, MD, who offered her surgical resection.

The Lung Nodule clinic monitors and treats these kinds of masses, which are often found incidentally on radiology tests. Many nodules may not require surgery, Dr. Towe notes, but following their growth over time reassures patients that they are not in danger. According to the American Cancer Society, lung carcinoid tumors account for 1 to 2 percent of all lung cancers and are typically slow-growing, although some can metastasize to other areas of the body.

A smoker since her teen years, particularly during her years working as a nurse, Wendy also would have been eligible for a lung CT screening, which the American Lung Association recommends for anyone 50 to 77 years old who has a 20-pack-year history (defined as one pack of cigarettes a day for 20 years or two packs a day for 10 years), or who has quit smoking in the past 15 years. These low-dose CT scans of the lungs can catch cancer before it starts manifesting symptoms in patients.

“Lung cancer screening is an invaluable tool to identify early lung cancers in patients with significant tobacco exposure history,” says Dr. Towe, who also offers CT screening to individuals beyond the screening guidelines with significant tobacco exposure history, since cancer risk increases with age. As this screening modality is endorsed by the US Preventive Health Task Force, it is typically covered by insurance.

“University Hospitals has been embracing this screening modality given its substantial health benefits,” Dr. Towe says. “My experience with patients is that they see incredible value in the test, as it feels like a great way to inform them of what is happening ‘on the inside.’ Many of my patients feel a sense of guilt or regret from long-term tobacco use, and use lung cancer screening to help motivate them for positive lifestyle modifications such as tobacco cessation.”

Innovation in lung surgeries

UH is not only innovative in tracking and treating these tumors. Wendy received a minimally invasive surgery to remove the tumor from her lung. She was discharged the day after her operation. Specialists like Dr. Towe have published studies on this approach to expedited post-operative care.

In articles such as “Early Discharge After Lung Resection Is Safe: 10-Year Experience” published in the Journal of Thoracic Disease, and others in The Annals of Thoracic Surgery and The Journal of Thoracic and Cardiovascular Surgery published over the past five years, UH surgeons have shared their success in discharging patients the day after minimally invasive lung surgery. Dr. Towe reports that UH’s rate of post-op day 1 discharge more than triples the national averages.

Lung cancer surgeries were once only performed with a large incision between the ribs called a thoracotomy to reach the lungs. Patients often spent several days in the hospital recovering. Dr. Towe says UH thoracic surgeons transitioned to video-assisted procedures and then to using a surgical robot, which have led to decreased incision size, reduced pain and shorter hospital stays.

“In the past, it was common that patients would be in the hospital three to five days, and now many patients are leaving the hospital the first day or two after surgery,” Dr. Towe says. “Our research group at UH has published on the safety and benefits of day 1 discharge, and are leading the way in these super short hospital stays. We believe this innovative approach is associated with fewer complications and a faster return to normal activities.

“Many in the thoracic surgery world are reluctant to break with traditional dogmatic approaches of longer stays, but UH has been embracing these innovative strategies to improve patient outcomes.”

Make time for testing

Wendy, only in her late 50s, looks forward to many more years of antiquing, baking, time with her husband and four dogs, and trips to Amish country with friends. Over the next decade, she will make time for an annual CT scan of her lungs.

“I’m doing well,” she said. “You’ve got to get your testing done.”