Joan Hinckley
An Incidental Finding

Joan Hinckley had always been active. The PAMF patient is an avid hiker and tennis player, and she had kept herself healthy for most of her 70 years. Then, she started getting the flu more often, which turned into repeated bouts of pneumonia. Her doctor Henry Thai, M.D., became concerned and ordered a CT scan—a computer-assisted X-ray that shows detailed pictures of body tissues and structures. The CT scan showed a mass in her lung.

“They thought it might be lung cancer,” Joan says. “Obviously, I was very upset.”

Dr. Thai immediately referred her to PAMF pulmonologist Richard Chalker, M.D., for treatment. Dr. Chalker ordered a PET scan of her lungs. A PET scan delivers a three-dimensional image of the body’s biologic function. While a CT scan shows detailed images, the PET scan shows how the body organs and tissues are functioning. Combined PET/CT scans pinpoint abnormal metabolic activity, such as cancer growth.

Dr. Chalker found that Joan didn’t have a mass in her lungs but rather a series of nodes. Unfortunately, he couldn’t tell if the nodes were cancerous or not. To find out, they would need to biopsy the nodes. Through the scans, the doctors also found out that Joan had a tumor in her right breast, which was cancerous. The tumor was small and in the early stages.

“It was an incidental finding,” Joan says.

Her doctors knew they needed to treat her breast cancer, but before they could do that, they needed to find out if the nodes in her lungs were cancerous. A retired nurse, Joan braced herself for thoracic surgery. At that point, Dr. Chalker mentioned that interventional pulmonologist Ganesh Krishna, M.D., might be able to do the biopsies by endobronchial ultrasound (EBUS), a procedure that allows doctors to biopsy several areas using special bronchoscope with an ultrasound attachment at the tip. EBUS is used to biopsy lymph nodes in the middle of the chest .

Dr. Krishna was able to perform biopsies of all the nodes via bronchoscopy, and he determined that all the nodes were benign. This meant that Joan was able to start chemotherapy for breast cancer.

“I was extremely grateful that I was able to find Dr. Krishna,” she says. “There are only a few doctors around that do this type of procedure, and Dr. Krishna is one of them.”

Because the breast cancer was caught at such an early stage, she has a 95 percent chance of recovery. Joan feels fortunate that through this series of events, the doctors were able to catch her breast cancer at an early stage before any lymph nodes were involved.

“It was a fluke that they were able to find my cancer,” she says. “I wasn’t having symptoms.”

As to the nodes in her lungs, Dr. Chalker says Joan most likely has sarcoidosis, a disease in which abnormal collections of inflammatory cells form as nodules. This can happen in any number of organs of the body, and in Joan’s case, the nodules formed in the lungs. To control any shortness of breath, Joan uses an inhaler and Advair, an asthma medication as needed to control symptoms. Other than that, she’s concentrating on finishing her chemotherapy.

“My son is a doctor, and he told me I was very lucky they caught my breast cancer at an early stage,” Joan says. “I feel fortunate. My prognosis is very good.”