UH Parma's Lung Nodule Clinic Discovers, Treats Man's Suspicious Mass

The confident care of a skilled surgeon using a robot to remove a mysterious mass in his chest was enough to intrigue Star Wars fan Tom Farmer. A physically fit executive who walks up to five miles most mornings, Farmer had just begun experiencing occasional but inexplicable episodes of light headedness after he turned 60. His primary care physician ordered a coronary artery calcium scoring scan, a noninvasive diagnostic test offered free at University Hospitals that can detect calcification of the coronary arteries and determine heart attack risk.

As often occurs, the CT scan of his chest yielded information about his heart – and beyond. The scan showed a 4.5-centimeter mass on his thymus, an immune system gland, in the center of his chest. Farmer was surprised, as he had not felt any pain, pressure or discomfort – not a single symptom that a foreign, potentially cancerous mass was forming. Up to half of all adults who get a chest X-ray or CT scan have lung nodules, according to the American Thoracic Society. They typically appear as a white spot or shadow on a radiographic image and are too small to cause pain or breathing problems. They may result from an irritant, scar tissue or a healed infection.

Farmer was referred to the Lung Nodule Clinic at University Hospitals Parma Medical Center. Even before his appointment took place, he received a call from coordinator Kellie Selig, RN, explaining what he could expect. This call comforted him, immediately putting him at ease. “Kellie was very calming,” said Farmer, a father of four and grandfather of nine. “This was the most serious health situation I had ever faced. I was scared in that moment – and here is this wonderful person who is going to guide me through.”

Nurse practitioner Lynda Boldt, CNP, of the Community Care Clinic, where the program is based, evaluates each patient for referral to the appropriate specialist, such as a pulmonologist for bronchoscopy, interventional radiology for biopsy or additional scanning, or a thoracic surgeon, Christopher Towe, MD, for removal. Farmer was referred immediately to Dr. Towe, who prides himself on expediting referrals from the clinic. “I literally walked out of that meeting with Kellie, Lynda and Dr. Towe thinking I couldn’t have a better team,” Farmer said. “These guys, they know their stuff.”

The Lung Nodule Clinic has put minds at ease and caught cancer early for hundreds of patients since it opened three years ago. “Concerning conditions are seen almost immediately,” says Dr. Towe. “We never refuse an emergency evaluation. In fact, most patients go from a worrisome CT scan to a definitive care plan within 10 days.”

Across the country, an estimated 70 percent of lung nodule cases fail to be tracked. UH Parma’s lung nodule clinic include a registry that logs patients so these often slow-growing masses are tracked over time. “We want zero patients lost to follow up,” Dr. Towe said. “We want to miss no one.”

Farmer talked with Dr. Towe about the tumor found on his thymus. He learned he had two options: a biopsy, where a sample of the mass is sent to pathology to determine whether the tumor was dangerous, or a complete resection of the mass. Farmer was drawn to the latter, especially when Dr. Towe explained that he could use a robot – “like R2D2” – in the modern new operating theatres at UH Parma Medical Center. Dr. Towe is increasingly using the Da Vinci Xi, a high-tech robotic platform, for removal of masses like this one. Of particular note: many patients go home from UH Parma within 24 hours of their operation due to a novel fast-track recovery program. This is far quicker than the national average of four days, says the surgeon.

Fewer than 5 percent of all nodules turn out to be cancer, and even in these cases, the cancer is often in its earliest stages. Tom’s cancer had not spread to other organs, but some aggressive features necessitated a series of daily radiation treatments for six weeks. “Within 48 hours of being told I had this mass in my chest, I was meeting with my thoracic surgeon,” Farmer said. “I’m a Star Wars fan, and when he mentioned a robot like R2-D2, I knew I liked this guy. His confidence makes you feel great.”