At age 60, Terri Ann DiJulio is an avid cyclist who views aging as a privilege. "I fiercely protect my joy and live every moment to the fullest," she says. A shocking diagnosis more than a decade ago helped shape that perspective.
Emergency room doctors first noticed something was amiss in 2003. At 42, Terri Ann was healthy and active — so when imaging tests revealed a nodule on her lung, no one thought it was cancer.
Two lung surgeries later, Terri Ann was cancer free, but not out of the woods. "I've had three separate early-stage lung cancer treatments; I've seen advancements over the years," she says. "Back then, they had to go in through your back and spread your ribs open. I was in the hospital seven straight days with chest tubes. It was a very painful process."
A Second Lung Cancer Diagnosis at Penn Medicine
For a decade, doctors closely watched Terri Ann's lungs for any new signs of cancer using low-dose CT scans. During that time, four other members of her family went on to develop lung cancer, including two uncles who were being treated at Penn Medicine. So when her original pulmonologist left clinical medicine, she decided to call her uncle's pulmonologist, Anthony R. Lanfranco, MD. It was Dr. Lanfranco who broke the news to Terri Ann.
"I had lung cancer again, 11 years after my first diagnosis," she remembers. "I burst into tears; he was so kind and compassionate. He just sat there with me and let me cry and promised that he would be there every step of the way."
Radiation and a 20-Mile Bike Ride
Dr. Lanfranco had Terri Ann meet with the Chief of Penn Thoracic Surgery Sunil Singhal, MD. Due to the tumor's location, removing it would involve taking out the rest of her right lung, too. Terri Ann couldn't imagine going through another surgery, so he gave her another option instead: stereotactic body radiation therapy (SBRT). SBRT (also known as stereotactic radiosurgery) precisely destroys tumors using large doses of radiation.
"On the third day of radiation, I went on a 20-mile bike ride," says Terri Ann. "About 10 days after I finished treatment, I was in bed for two days with fatigue, but that was it. I'll take that over not being able to walk up a flight of stairs any day."
Lung Cancer Surveillance Finds Another Nodule
Terri Ann re-entered Penn's Lung Nodule Surveillance Program for watchful waiting. Dr. Lanfranco and Penn's Director of Thoracic Oncology, Corey Langer, MD, monitored her scans. Things looked good until the end of 2020, when her scan revealed a suspicious nodule — this time on her left lung.
Six months later, the nodule had changed enough for her to need treatment. "Dr. Lanfranco is like my team captain and coach. He's not fully invested in any particular treatment. Instead, he's invested in my lungs."
Together, they weighed the pros and cons of her treatment options. While Dr. Lanfranco took her concerns about surgery seriously, he tactfully urged her not to close the door on it. "Dr. Singhal said it would be an easy surgery, because I hadn't had surgery on my left lung before," she says. "It was really hard for me to set aside my emotions and look at the science and the facts. I'm glad I was able to, because surgery was clearly the best option."
TumorGlow ®: A Groundbreaking Surgical Technique
Sixteen years had passed since Terri Ann's first lung cancer surgery. And a lot had changed. Now, Dr. Singhal could access her lungs via a surgical robot — with only two small incisions required. Terri Ann also could enroll in a groundbreaking clinical trial testing a new imaging technique called TumorGlow ®.
TumorGlow® is a specially designed dye we inject into patients. It goes to tumor cells, which become activated and start glowing," explains Dr. Singhal.
In lung cancer, TumorGlow® allows surgeons to:
- See the edges of the cancer to ensure they completely remove it and leave a border of normal lung tissue
- Find extra cancers in the area that they may not know about
- Locate hard-to-find tumors, such as ground glass opacities (fuzzy gray areas on CT scans or X-rays)
Terri Ann had ground glass opacities. TumorGlow® was able to show a difficult-to-find small tumor," adds Dr. Singhal. "More importantly, it found a second cancer which was not present on the CT scan!"
Dr. Singhal was able to take out both tumors in the same wedge resection surgery. "It didn't impact my quality of life," notes Terri Ann. "His treatment saved me from further treatment a year or two down the road."
After her operation, Terri Ann was in the hospital for just two days. A month later, she went for a 30-mile bike ride.
Making a Difference: Lung Cancer Advocacy
Since Terri Ann's initial diagnosis, her mother, aunt and two uncles have died from lung cancer. "It's an insidious disease. If you have lungs, you can get lung cancer; the stigma [of tobacco use] has gotten in the way of research funding and treatment," she says. "I found my calling through my lung cancer diagnosis. I use my story and my family's story to get out there in the world and educate people."
Her passion for lung cancer advocacy is already making a difference. She now speaks publicly to help others going through lung cancer and increase federal funding for the disease. In honor of 60 years of life, she also set a goal to raise $60,000 for the GO2 Foundation for Lung Cancer. The GO2 Foundation is dedicated to improving the lives of those vulnerable, at risk and diagnosed with lung cancer. She raised $80,000 — even as the COVID-19 pandemic turned the world upside down.
I am so lucky to have Penn Medicine in my backyard. Because when you're dealing with a significant disease, you want the best of the best," says Terri Ann. "Every doctor is so compassionate. They don't see you as a statistic. They see you as a person…they're invested in keeping me healthy, and they're invested in my quality of life."