Early detection combined with advanced technology helps Scottsdale mom stave off two bouts of lung cancer.
Sara Bennett is optimistic despite two recent battles with lung cancer.
"I'm very fortunate," said the retired homemaker, who raised five children with her husband, Buck. Her optimism has been bolstered by successful treatments she has received at Mayo Clinic in Arizona.
Her story illustrates the benefits of periodic monitoring and early detection of cancer. And her treatment also points out the growing arsenal of cancer-fighting alternatives, such as stereotactic radiation.
A full life
When Sara celebrated her 80th birthday in February, she could look back on a fulfilling life. A native of West Virginia, she met her husband, H.B. "Buck" Bennett, when they were students at West Virginia University in Morgantown, W.Va. They married and moved to Iowa where he worked in the explosives business, until retirement in 1996 to Arizona. Also a sportsman, Buck was playing tennis three times a week right before his death from an aortic aneurism in 2008.
Sara had been a patient at Mayo Clinic previously, when she was treated for a benign cyst on her thyroid. Mayo doctors began to monitor Sara's lungs in 2002, when a scan revealed what was initially suspected to be valley fever.
She had smoked cigarettes in her youth but had quit while still young, so it was a surprise to her when, after periodic scans, she received a lung cancer diagnosis in 2005.
"I had no symptoms whatsoever, no shortness of breath, no pain, no anything," she said.
That's not unusual, and it's generally a good sign. If caught early, lung cancer frequently doesn't present any symptoms, said Dr. Steven E. Schild, chair of the radiation oncology department at Mayo Clinic in Arizona.
When patients have symptoms, it generally means the cancer is much less curable, he said. Lung cancer is the number one cancer killer worldwide, estimated to have caused 159,000 deaths in the United States alone in 2009. Of the 219,000 patients diagnosed with lung cancer in 2009, 116,000 were men, and 103,000 were women.
"Lung cancer is most common in the elderly," Dr. Schild said. "The majority of patients are smokers or former smokers."
The disease is most common in patients over 65 years of age, with a median age of 71 (half younger, half older). Sara's medical oncologist, Dr. Helen J. Ross, said, the disease "is particularly problematic in the very old as they may tolerate treatments less well; however available data show that they have the same chance of responding to treatment as their younger counterparts."
Sara underwent surgery in 2005 for two simultaneous cancers, one in her right lower lung and another in the right upper lung. The procedure involved a lobectomy plus a wedge resection.
"I didn't have to have chemo or radiation because they felt it was all out," Sara said. Relieved that the cancer was caught early, she resumed her active lifestyle.
However, because of the risk of recurrence, Sara was followed closely with scans. In the fall of 2008, a new, two-centimeter mass was found in her remaining right lung. The nodule was gradually increasing in size. Her medical team thought it was a recurrence or a new primary non-small cell lung cancer.
Dr. Ross said, "Sara benefited by having input from thoracic surgery, radiation oncology and medical oncology, all of whom had access to the same patient information, and decisions about treatment were reached collaboratively."
Because of her age and reduced lung capacity due to previous surgery, Sara was not considered a good candidate for either surgery or conventional radiation. Instead, she was referred to Dr. Schild for stereotactic body radiation therapy (SBRT).
In contrast to conventional radiation therapy, stereotactic techniques include "fixation, ultra-precise treatment planning, RT directed to known disease alone, and high doses per fraction," according to a 2006 article by Dr. Schild and Dr. Jeffrey A. Bogart in The Journal of Thoracic Oncology. Pioneered in Europe and Japan approximately a decade ago, SBRT offers local disease control with few side effects.
SBRT is generally recommended for patients who are not good candidates for a resection (operation) because of a health problem such as poor pulmonary function or other diseases. And some patients opt for SBRT because they don't want surgery.
"We know we can get local control in somewhere between 80 to 90 percent of people, and most of the time the cancer doesn't grow back where you radiate it," Dr. Schild said. "Complications, which are rare, can include chest pain or respiratory symptoms. Most people tolerate (SBRT) like nothing happened. They get off the table and don't feel anything."
Prior to her treatment, Sara underwent extensive preparation to pinpoint the exact location of the tumor. A regular CT scan was followed by a four-dimensional CT scan, the latter adding the dimension of time so that doctors could map tumor movement when Sara breathed.
A mold was made to hold Sara in position. She received four treatments in a two-week period, instead of the conventional 30-35 radiation treatments over 6-7 weeks. CT scanning was performed on the treatment machine to locate the tumor exactly prior to each treatment.
Today, Sara says she feels great. She celebrated her birthday with her family on a Cancun vacation, playing tennis, going deep sea fishing and sightseeing. At home, she stays busy playing tennis and volunteering with Mayo Clinic ALS patients just as her late husband did.
The only trace of her treatment is a scar where the tumor used to be. She continues to have CT scans every four to six months. "I think she'll be fine," Dr. Schild said.
Her optimism shining through, Sara agrees.
"I always felt so fortunate that we were on top of things and were able to get it early," she said. "That's why I have so much confidence in Mayo."
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