Standing up to lung cancer

When most of us think of lung cancer, we think of smoking. But the truth is, approximately 20% of people who get lung cancer have never smoked. Read how one patient has waged war cancer against this lethal disease and is living 10 years beyond her initial diagnosis and still going strong. 

When cancer attacked Candi Troia, it didn't know what it was getting into. 

The energy-explosive 64-year-old recently celebrated her 10th anniversary of living after being diagnosed with stage 4 lung cancer in September 2010. 

When Troia received the sobering news, she knew she was headed for the fight of her life. But she was up to the challenge. "I'm too busy for cancer," says Troia, a busy real estate agent, part-time waitress and grandmother of eight grandchildren. 

What made the news especially surprising, says Troia, is that she has never smoked a cigarette in her life. "The only risk factor I have is that I have lungs, so it was shocking to say the least. I told my doctors to be very aggressive. Do whatever you need to do to save my life."

"Troia was diagnosed with a form of lung cancer that is more common among nonsmokers," says Troia's Nebraska Medicine medical oncologist Apar Kishor Ganti, MD. "The fact that she's still living today is a tribute to Candi's energy and positive attitude. She's a fighter and in her case, I think cancer is afraid of Candi." 

While smoking tobacco is responsible for 80% of lung cancer cases, there are still 20% of people who get lung cancer who have never smoked and have no known risk factors, says Dr. Ganti.  Lung cancer is the most common cause of cancer deaths in both men and women and the sixth most common cause of cancer in the world. 

When Troia was initially diagnosed, she was living in Kansas City, Kansas. She can still remember the symptoms that prompted her to seek medical advice. "I had pressure on my chest," she recalls. "But I had just had my physical, so I knew it wasn't a heart attack. It felt like a baby elephant was sitting on my chest." Then she noticed swelling in her sternum area. A visit to the emergency department and subsequent X-rays and a CAT scan found a spot on her lungs. 

Considering her age and the fact that she wasn't a smoker, her doctor treated her for a fungus, bronchitis and later pneumonia. But the spot remained and symptoms continued. A biopsy four months later revealed the worst – Troia had stage 4 lung cancer. She was given one year to live. 

For the first two years of her treatment, Troia jumped from doctor to doctor, trying to find one she trusted and a treatment regimen that worked for her. She eventually returned to Omaha to be closer to her grandchildren and began care at another Omaha hospital. But Troia still wasn't completely satisfied with her care. So when a friend insisted she see Dr. Ganti, Troia decided to get a second opinion. 

It only took that one visit for Troia to know Dr. Ganti would be her primary medical oncologist from there on out. "He cared about me," she says. "He went through hundreds of pages of my medical records. It was obvious that he was very intelligent and he knew his stuff. I believe that he is the one who has kept me alive."

Dr. Ganti changed her therapy to a newer targeted drug called tarceva, which has been effective in treating non-small cell lung cancer and has fewer side effects than the drug she had been taking. He also began scheduling CAT scans every three months and soon discovered fluid in Troia's brain area. Neurological surgeon Michele Aisenberg, MD, performed surgery and removed a small amount of cancer. 

But Troia didn't let this slow her down. She left the hospital three days after surgery, listed a house, and sold it in two days. Through all of this, Troia also achieved her best-selling year ever and performed ninth out of 750 agents with her real estate company. 

Troia has also become a strong and vocal voice for lung cancer research. She has been to Washington, D.C. twice to advocate before Congress as the Nebraska representative for the American Lung Association. At her most recent visit, she and others with the American Lung Association, were able to convince Congress to designate $40 billion to lung cancer research.

"Candi is doing extremely well," says Dr. Ganti. "She has greatly surpassed the life expectancy for people with this type of cancer. There's something about Candi that makes her unique. She's always stayed very active, she's upbeat and very functional. Study after study shows that people who have good functioning status, meaning they remain active, do better than others." 

The introduction of new targeted therapies and immunotherapies for lung cancer has also successfully increased the lifespan of certain types of lung cancer. Not only are they typically more successful than chemotherapy, but they also produce fewer side effects. 

Troia says she owes it all to Dr. Ganti. "Dr. Ganti has always been behind me 100%. He always does his research, explains everything in detail and is never intimidating. When I came to Nebraska Medical Center, I noticed a big difference in my care from everyone, no matter where I was at. It was like going from a Volkswagon to a Mercedes."

And Troia plans to keep riding that Mercedes for many years to come.