Lung cancer
"When I coughed, a small speck of blood came out. That had never happened before, so I had it checked right away," says Caulk, a wildlife officer. He scheduled an appointment with the FirstHealth Family Care Center-Seven Lakes, where a chest X-ray revealed a suspicious mass in his right lung. Caulk's primary care provider immediately referred him to Andy C. Kiser, M.D., a board certified cardiothoracic surgeon and Medical Director of the Chest Center of the Carolinas, a new outpatient program at FirstHealth Moore Regional Hospital. There, a CT scan and biopsy confirmed that Caulk had non-small cell lung cancer that had spread to lymph nodes in his chest. "Even though I was as sick as I was, I was walking six miles a day and didn't have any breathing problems," Caulk says. "I never suspected I had cancer. If you have just one symptom, get it checked." "Mr. Caulk did the right thing by seeking medical care right away," Dr. Kiser says. "The sooner cancer is diagnosed, the better a patient's chances of cure." Signs of trouble As with other types of cancer, lung cancer grows silently in the body, often absent of symptoms until the disease has spread beyond the affected lung. "In the earliest stages of lung cancer, you won't feel anything or know you have it," Dr. Kiser says. "But as the disease progresses, symptoms begin to emerge. You may experience a persistent cough or cough up blood. Other symptoms, which vary by individual, include pain in the chest cavity or ribs, weight loss, decreased appetite, repeat bouts of pneumonia or bronchitis, shortness of breath, wheezing, or hoarseness." To find the cause of symptoms, a personal assessment and sophisticated medical testing are required. At the Chest Center of the Carolinas, physicians evaluate an individual's personal and family medical history, tobacco use, and exposure to environmental and occupational dangers. A physical examination is also performed, and specially trained physicians and technical staff use some of the latest advances in technology to provide an expert diagnosis. In addition to chest X-rays and CT scans, bronchoscopy and surgical biopsies are the most widely used methods to diagnose lung cancer. Bronchcosocpy is performed under local anesthetic. During the short outpatient procedure, a pulmonologist inserts a flexible tube through the patient's nose or mouth into the lungs. A tiny camera at the end of the tube allows doctors to "see" into the lungs and collect a tissue sample. Surgical lung biopsy is performed under general anesthesia at FirstHealth hospitals. A tissue sample is collected through a small incision in the chest and then sent to a pathologist for further study. "Once a diagnosis is confirmed, we conduct additional tests to stage the cancer, or determine if the cancer has spread and how far," Dr. Kiser says. "In addition to multi-slice CT scanning, we use whole-body positron emission tomography (PET) scanning, a noninvasive outpatient procedure, to accomplish this."
During a PET scan, a small amount of radioactive glucose is injected into the bloodstream. A highly sensitive electronic scanner then traces the path of the glucose inside the body, helping physicians detect the location and activity of even the smallest tumors. Individualized treatment "Treatment is based on the type, stage and size of the lung tumor," Dr. Kiser says. "Our goal is to preserve healthy tissue while destroying the tumor at its point of origin, in addition to any cancer cells that have spread throughout the body." A widely used surgical procedure called lobectomy is often recommended for patients with early-stage lung cancer. In this procedure, which is performed under general anesthesia, a cardiothoracic surgeon removes all or part of the affected lung. If cancer is present in the nearby lymph nodes, they are removed as well. Treatment for patients with middle-stage lung cancer may involve surgery, chemotherapy and radiation—either individually or in combination. "We treat patients with chemotherapy to shrink the tumor before surgery," Dr. Kiser says. "After the tumor is removed, some patients may also receive radiation to eliminate the last traces of disease." Although surgery is not recommended for patients with late-stage lung cancer, notes Dr. Kiser, chemotherapy and radiation are frequently used. The goal is to enhance quality of life and minimize pain and discomfort. When doctors discovered cancer in Gary Caulk's right lung, his treatment team at the Chest Center of the Carolinas developed a comprehensive, three-part plan of attack. "First, I received a couple of rounds of chemotherapy to shrink the tumor away from my heart," Caulk says. "Then Dr. Kiser performed surgery to remove the tumor. Now I'm receiving six weeks of radiation. When that's complete, I'll receive more chemotherapy to clean up any cancer cells that could possibly be left over and stop any problems down the road." Caulk is receiving outpatient respiratory therapy five days a week to help his body adjust to the use of just one lung.
A coordinated team approach "The Chest Center of the Carolinas is the region's first and only private-practice multidisciplinary clinic in a community-hospital setting," he says. "Our treatment team includes board certified physicians with special skills and training in a variety of medical and surgical specialties—medical oncology, radiation oncology, cardiothoracic surgery, pulmonology, radiology and pathology." What makes this approach unique is that patients receive the latest advances in cancer diagnosis, treatment and rehabilitation from some of the region's most accomplished specialists—all in the comfort of their own community. "Our treatment team collaboratively cares for all the complex needs of patients with lung and esophageal cancer," says Cindy Mooney, R.N., Chest Center Coordinator. "Patients don't have to drive all over town to undergo testing, see a physician or receiv treatment. We offer all the specialists and services they need right under one roof." Mooney serves as a central point of contact for patients and referring physicians. The Chest Center's medical team meets regularly to review individual cases and develop appropriate treatment plans for each patient. "We carefully consider the type and stage of the cancer, the patient's age and overall health, the risks and benefits of various treatment options, and the patient's personal preferences," says Dr. Kiser. Gary Caulk is very satisfied with the personalized care he has received. "You can't get this kind of service anywhere," he says. "Normally, you get one doctor to work on you. At Moore Regional Hospital, I had several doctors, and they all were familiar with my case. They explained everything clearly, helping me and my wife understand what to expect during and after treatment. They answered all our questions. You know what you are receiving and why, and how it will affect your body." Caulk was back on the walking trail just two months after his lobectomy. "I'm up to three miles a day now, and still walking," he says. |
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A simple home-improvement project may have saved Gary Caulk's life. While building a stone garden wall in his yard one June afternoon, the 51-year-old Moore County resident began coughing from the dust and debris.
