Lung Cancer

When Expertise Really Matters

Joe is a lung cancer patientOn a gleaming day this past winter, Joe S. took his youngest child skiing at Wachusett Mountain — continuing a family tradition of shared outdoor sports that had given her older siblings the same chance to bond with their father. This outing carried more significance than usual, though. Several weeks before hitting the slopes, 54-year-old Joe S. had undergone a delicate operation at Milford Regional to remove a cancerous lung tumor — a surgery that in the wrong hands could mean carving out substantial tissue and robbing the organ of some exercise capacity.

Joe’s case rested with Dr. Ciaran McNamee, a highly respected thoracic surgeon from Brigham and Women’s Hospital who has overseen thoracic surgery at Milford Regional since 2003. Ultimately, the surgery would showcase Dr. McNamee’s expertise, the benefits of the hospitals’ collaborative approach and the ever-expanding thoracic services at Milford Regional, making medical trips to Boston for such care largely unnecessary. Still, until he was wheeled out of the operating room to begin his recovery, Joe’s case was anything but routine, given the size, location and possible origin of his growth. “It was more difficult than normal by a long shot,” says Dr. McNamee.

Joe doesn’t smoke, and Dr. McNamee suspected the unknown growth in Joe’s left lung had spread from previously treated kidney cancer. With the scan results, McNamee faced a dilemma. Because Joe’s earlier kidney cancer was slow growing, it was unlikely to have spread. However, if it did spread, the lungs would be a typical destination. In addition, the growth could turn out to be benign, or worse, an unrelated, faster-growing malignant lung tumor. To top it off, the pea-sized growth was too small and too close to crucial blood vessels deep within Joe’s lung for traditional needle biopsy through his chest, a procedure that normal provides a specific diagnosis and a clear path. This led to the central question: do they risk leaving the growth alone and watching it, or risk taking out a chunk or even possibly a whole lobe of Joe’s lung?

“I didn’t want to give him a big operation needlessly,” Dr. McNamee explains. “He was young, he was healthy, and I wanted to maintain that.”

So following standard practice at Milford Regional, Dr. McNamee convened several “tumor boards” to consult with colleagues from a range of specialties — a brain trust held in person at Dana-Farber/Brigham and Women’s Cancer Center at Milford Regional and then through a teleconference with specialists at both academic medical facilities in Boston. “It’s a good strategy,” Dr. McNamee says. “You access a lot of minds and a lot of opportunity to provide therapeutic input.”

The group’s consensus? Don’t wait, but skip chemo or radiation. Instead, perform a minimally invasive removal of the tumor at Milford Regional, using an advanced approach developed at the Cancer Center. Joe, who had been fully consulted at each step, agreed. “I felt I knew everything I needed to know going in,” he remembers. “I felt there was a good chance I’d never see this again by doing it now.” Joe says he was bolstered during this time by Dr. McNamee’s mantra, “He’s young, he’s healthy, he’s curable.”

The surgery took place in early March, 2013. A radiologist first made a small incision and then slowly guided a wire toward the tumor, pausing to put Joe in a CT scanner every now and again to gauge the progress. When he finished, staff wheeled Joe to the operating room. Dr. McNamee then put a recently developed technique into action: using images from the radiologist’s CT scans and the inserted wire, it pinpointed the tumor and determined where to place surgical staples to access it. Going too deep would mean potential damage to blood vessels and possible internal bleeding. Dr. McNamee avoided both dangers, removing a small wedge of lung that contained the tumor, which later tissue analysis showed had spread from the kidney as surmised. There was no evidence the cancer had spread further, with glands and lymph nodes clear. The lobe that held the tumor was largely spared. “I was quite pleased with the results,” Dr. McNamee says. “I’ll watch him from here on but I think we’ve given him every opportunity to live without cancer.”

A longtime visitor to Milford Regional and its doctors, Joe praises the facilities and the staff and says he is grateful. He had his tumor carefully removed, the bulk of his lung saved and his pain minimized, returning to work within days.

But it was also the little touches, he says… Dr. McNamee coming over to talk to him when he was waiting for an appointment with another doctor; the nurse who got him a cup of coffee before regular room service had opened for the morning. “If I called for a nurse, a nurse came,” he recalls. “If it was time for me to get something I needed, they were there. I may never have to see them again, but I’m pleased the resources are here in Milford if I need to address something in the future.”

For now, Joe is hitting the gym, riding his bike and, when the snow allows, taking his daughter to the slopes. Life is good. “We had a great day skiing,” he recalls with a smile.

Read more about Ciaran McNamee, MD or call his office at 508-488-3851 for an appointment.

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