Dr. Winawer discusses Pope Leo's health

New this morning, thousands of worshipers packed St. Peter's Square as Pope Leo held his traditional Sunday blessing from a window at the Apostolic Palace. This comes a day, just a day, after being released from the hospital after undergoing surgery for lung cancer. And this diagnosis surprised so many, particularly because he has no known history of smoking. But lung cancer can, in fact, develop in those who have never smoked. And advances in early detection like this and treatment are offering patients some new hope, for sure. So what should we know about his diagnosis? Here to discuss it, Emory, Dr. Neal Wittenworth. So good to see you. Good to see you too, KP. And we were so surprised about this. How was this lung cancer discovered? Serendipitously, because he's a non-smoker. We don't screen patients who are non-smokers. And patients who are smokers, who've smoked for what we call 20 pack years, either a pack a day for 20 years, two packs a day for 10, or something similar like that. We screen with CAT scans every year from the age of 50 to 80. That's what the American Cancer Society and U.S. Preventative Service Task Force recommend. He's 71 with no smoking history. So how did they find this? I think from my reading, most likely what happened, it was found incidentally, probably they did a CAT scan of his abdomen because you can see the lower lobes of the lung through a CAT scan of the abdomen. And they found this nodule in the right lower lobe and subsequent biopsy and further evaluation revealed adenocarcinoma, which is the most common form of lung cancer in non-smokers. So I think it was this serendipitously found. Wow. Just so lucky. And when you say nodule, just before we move on, what does that mean? it's a small growth okay uh and nodules come in all different sizes and based on the shape of the nodule and how it looks and the size you determine the workup some nodules are merely just followed with a repeat CAT scan in six months but in this case there was enough of a concern not to wait Sure, so this brings me to the next question: how common is lung cancer in people who have never smoked and what causes it? Yeah, lung cancers can occur in about 20% of non-smokers of lung cancer, 10 to 20%. And what caused it, it's hard to know. It could be secondary smoke exposure, environmental exposure, radon gas, asbestos, or just genetic factors or a combination of all those. And many times we don't really know what the underlying cause of this was, but it can certainly occur lung cancer is not solely a disease of smokers and so why was surgery recommended you said sometimes it's kind of a sit back and wait and monitor why was surgery recommended because they thought they could cure this okay uh that that's why you have three lobes on the right lung and you have two lobes on the left this occurred in the right lower lobe most people can survive a lobectomy which was this this was you do test prior to make sure you have enough reserve And most people who are not chronic smokers, who have obstructive lung disease, they can tolerate this type of surgery. So they knew that the Pope would be able to tolerate this surgery. And the goal is to remove the tumor, look at the margins, make sure you've resected it fully, assess the regional lymph nodes, make sure that the lymph nodes are not involved. Didn't spread that way. Exactly, exactly. but there was no evidence. I'm sure they did a PET scan first to make sure there was no evidence of disease elsewhere outside the lung, because you don't want to put, subject the patient to surgery if it's not going to be curative. So they felt they had a really good opportunity for cure and remove the whole right lower lobe. So as far as the Pope's prognosis is concerned, what does that look like, Dr. Winnemer? I think it's excellent. And we've also seen an explosion in the last 10 years of specific targeted therapy for mutations they'll take this tumor and they'll analyze it and there may be certain mutations like for example something called EGFR or ALK and if you have those types of mutations you can give targeted treatment specifically after surgery or you could do immunotherapy or chemotherapy it's too early to know we don't know the staging we that hasn't been released we don't know about the lymph nodes and what the it may just be this is all he needs yeah um but we'll have to stay tuned for that but the prognosis for him because it was detected early is excellent and once again it was just serendipitous sometimes you get very fortunate when you find something that you weren't looking for and that actually can a lot of times we chase things that don't mean anything but in this case they found something and good for him I mean, we need to keep him healthy, you know, so this is really a great finding, and look how good he looked. I mean, a day later after being released from the hospital, that's incredible. Now, Dr. W., you mentioned targeted therapy and the advances. How has that changed lung cancer care? Oh, it's significantly improved survival, and when you compare a lung cancer diagnosis from the 90s to now over the last 20 or 30 years and specifically over the last decade it's significantly improved survival so they'll test the tumor once they remove the lobe which they did they'll analyze it for the specific mutations and if those mutations are present they'll do targeted treatment in addition to the surgery which will give a benefit because he still has even if they didn't do that you have a good chance of survival if they got the whole tumor but uh this increases it even that much more which would be obviously really beneficial for sure and just one final question is this a situation where he's going to maybe end up on oxygen or have a tank available readily available yeah i don't think he'll need oxygen you recover pretty well from a lobectomy and the really key thing also is the fact that he was a non-smoker although it's interesting that this developed in somebody like himself. The benefit is he doesn't have any underlying emphysema. He doesn't have any prior lung disease. He's in good health generally. So he might take a little bit of rehab to get your wind back, per se, but there's no reason why he shouldn't make a full recovery from this and do well. And hopefully this is curative. All right, some great perspective on this headline. thanks so much dr. W good to see you as usual it's always great to see you still ahead this morning a lot more ahead sometimes you can