Diagnosed with a rare form of lung cancer, patient finds path to healing at Hoag

In the summer of 2024, Janice Munemitsu, an Orange County native, found herself among a growing number of Asian women with a rare form of lung cancer. 

“As someone who doesn’t smoke and has been healthy all my life, it was a shock,” she said. 

What began as a sudden onset of a rare eye disease eventually led to a CT scan of Janice’s lungs. The resulting images were initially thought to be a bacterial infection as they didn’t look like a typical lung tumor. 

Searching for answers, Janice went to Hoag, where she met with Javier A. Longoria, MD, a triple-board certified interventional pulmonologist at the Hoag Family Cancer Institute, for a biopsy. 

To achieve the fastest and most accurate biopsy of the area in question, Dr. Longoria utilized a combination of the Intuitive Ion robotic bronchoscope and Siemens Cios spin Mobile 3-D cone beam CT. 

Funded by Hoag Innovators, a group of philanthropists, entrepreneurs and community leaders dedicated to catalyzing innovation at Hoag through philanthropic investments, the tools enhance biopsy accuracy beyond 90 percent, improving early detection of lung cancer. 

Though swift and accurate, the results were difficult for Janice to hear. The 2 ½-inch mass was indeed cancer. 

“It wasn’t the news I was hoping for, but I was grateful Dr. Longoria and his team caught it when they did,” Janice said.

Advanced genetic sequencing of her tumor revealed Janice is a carrier of a specific gene mutation referred to as RET (Rearranged during Transfection). Prevalent among women of East Asian heritage, research has shown the mutation can lead to tumor growth.

“Dr. Longoria shared with me that this type of cancer isn’t typically caused by lifestyle or environmental factors like smoking,” she said. “It was just a bunch of cells from this gene that decided to mutate.”

The biopsy had also revealed an atypical lymph node that would require evaluation by the Hoag Tumor Board, a group of clinical experts that examine complex cases, before further steps could be determined. 

“The question was, ‘Is this atypical node cancerous?’” said Janice. “If so, I probably would have had to complete chemotherapy or radiation before any surgery could be performed.”

The Board confirmed that the node was indeed atypical, but not cancerous, and Janice was cleared for surgery. 

“It's hard to put into words how team-oriented the Hoag patient experience is,” said Janice. “The coordinated effort of the physicians, and the nurse practitioners and the schedulers, it all felt very holistic for me. All my appointments and tests were quickly scheduled for me, thanks to Hoag’s proactive team. That gave me tremendous peace.” 

Matthew D. Stanley, MD, a fellowship-trained thoracic surgeon at Hoag Family Cancer Institute, determined Janice would need to undergo a bilobectomy—a resection of two lobes of the right lung—to ensure complete removal of the cancer. 

Though a bilobectomy was once considered a highly invasive and painful procedure, Hoag’s adoption of modern robotic technology has improved recovery times while optimizing outcomes for patients undergoing the procedure. 

“Hoag has a fleet of Intuitive da Vinci robots that allows us to perform precise, minimally invasive surgeries, benefits of which include shorter hospital stays and a lot less pain for the patient,” Dr. Stanley said. 

“We make five small incisions that are about 2 centimeters in size. Through those incisions, we place a camera as well as some robotic instruments that we control from a console. Using those instruments and the camera, I’m able to identify the lobe of the lung with the cancer and remove it from the body.”

Within 30 days of her biopsy and diagnosis, Janice’s tumor and two affected lung lobes were successfully removed. As a precaution, she completed four rounds of chemotherapy under the care of Hoag Oncologist Alain C. Mita, MD. She is currently undergoing immunotherapy treatments. 

A writer, Janice is getting back to the activities she enjoys most, including speaking engagements, volunteering, hiking at Crystal Cove and travel.

“I’ve told my friends about this journey, and they’re amazed,” she said. “At Hoag, you don’t wait weeks for answers. You’re surrounded by a team ready to care for you right away.”