An Illinois Former Boxer Who Never Smoked Says Her Lung Cancer Diagnosis Was a ‘Big Awakening…It Could Happen to Me’

“This was a big awakening,” Stoll told CBS News.

Stoll, who served as a mixed-martial arts self-defense instructor, has been practicing the sport for nearly 20 years.

“I was definitely feeling as though the test must be wrong, because I was too healthy for lung cancer,” she added during an interview with WIFR News.

“I tried to reassure him that it was nothing, and it was probably something that was damaged from my pulmonary embolism, and he didn’t think I was very good at diagnosing myself,” Stoll told CBS News. “He was like, ‘Well, it probably is nothing, but let’s schedule a PET scan, just to check,'” Stoll said.

The Illinois native adds that she never smoked cigarettes, a leading risk factor for lung cancer, which made her diagnosis more unexpected. However, non-smokers can also be diagnosed with the disease.

According to the Centers for Disease Control and Prevention (CDC), in the United States, about 10% to 20% of lung cancers happen in people who never smoked or smoked fewer than 100 cigarettes in their lifetime.

Dr. Ronald Natale, a medical oncologist at Cedars-Sinai Medical Center, says targeted treatments are being developed that will be able to address the genetic drivers of lung cancer in nonsmokers.

“Among patients who are nonsmokers, or former very light smokers, we identify a mutation that we can target with pills in about 60% to 70% of them. That leaves 30% or so, 40%, in whom we either have a target for which we do not have a successful treatment,” Dr. Natale tells SurvivorNet.

“Among patients who are smokers, who have more complex cancers that have hundreds, sometimes thousands of mutations, don’t have a driver mutation that we can give a pill for, which is only a tiny percentage of lifelong smokers. Chemotherapy is the primary treatment in most patients,” Dr. Natale explains further.

Scientists have spent years trying to understand how people who’ve never smoked develop the disease. Although second-hand smoke is one known contributor, many questions still remain — and researchers are working to uncover what other hidden risks might be involved.

Now, we’re a step closer to getting answers thanks to a team of scientists led by researchers from the National Institutes of Health (NIH) and the University of California, San Diego, who studied lung cancer in people who had never smoked.

The research published in Nature looked closely at the genetic makeup of lung tumors from 871 never-smokers to better understand how the disease develops.

WATCH: Smoking and Cancer Risk

They found that people exposed to high levels of air pollution — especially the fine particles emitted by cars and factories — were much more likely to have damage to a specific gene called TP53, which normally helps prevent cancer.

The study also showed that exposure to pollution was associated with shortened telomeres —the protective ends of chromosomes in our DNA that wear down with age and stress. Shortened telomeres are linked to higher risks of cancer and other serious health problems.

Researchers also highlighted some of the genetic changes caused by pollution that looked similar to the damage typically seen in people who smoke, even though these patients had never smoked a cigarette. Despite the promising findings in the study, more research is still needed to substantiate further the suggested link between air pollution and people diagnosed with lung cancer who’ve never smoked cigarettes.

Stoll’s treatment included robotic surgery that removed a section of her right lung’s lower lobe.

SurvivorNet experts say robotic surgery is minimally invasive; the only external scars will be from the very small incisions made to get the surgical tools inside the body. It’s less painful than it would be to heal an incision the length of the entire abdomen, but patients can still expect some soreness and cramping from the internal surgery.

In some facilities, patients can often go home the same day as the two- to four-hour procedure, and will quickly return to their regular diet and daily routine, often without requiring prescription painkillers.

“I was just shocked at the fact that it could happen to me, disappointed that it could happen to me,” Stoll said.

Understanding Lung Cancer and Why It’s Hard to Catch Early

Lung cancer forms when cancer cells develop in the tissues of the lung. It is the second most common form of cancer and the leading cause of cancer deaths in both men and women in the U.S., SurvivorNet experts say. It’s “completely asymptomatic,” says thoracic surgeon-in-chief at Temple University Health System Dr. Joseph Friedberg.

“It causes no issues until it has spread somewhere. So, if it spreads to the bones, it may cause pain. If it spreads to the brain, it may cause something not subtle, like a seizure,” Dr. Friedberg adds.

WATCH: Detecting lung cancer in the absence of symptoms.

Scans such as X-rays can help doctors determine if a shadow appears, which can prompt further testing for lung cancer.

Lung cancer often doesn’t cause symptoms until it has already spread outside the lungs, according to SurvivorNet’s experts.

There are two main types of lung cancer, which doctors group together based on how they act and how they’re treated:

Non-small cell lung cancer (NSCLC) is the most common type and makes up about 85% of cases.

Small cell lung cancer (SCLC) is less common, but it tends to grow faster than NSCLC and is treated very differently.

Some people with lung cancer may experience symptoms such as:

• A cough that doesn’t go away, that gets worse, or that brings up bloody phlegm
• Shortness of breath
• Fatigue
• Chest pain
• Hoarse voice
• Appetite loss
• Weight loss

If you are experiencing these kinds of symptoms consistently, contact your doctor for further tests.

Smoking and Cancer Risk

Lung cancer is the leading cause of cancer deaths for men and women in the United States. Nonsmokers still get lung cancer, but cigarette smoking is the number one risk factor for the disease. Tobacco smoke contains a mixture of more than 7,000 different chemicals, at least 70 of which are known to cause cancer, the Centers for Disease Control and Prevention (CDC) says.

The CDC says cigarette smoking is linked to about 80 to 90 percent of lung cancer deaths, and people who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who don’t smoke. Additionally, secondhand smoke can cause lung cancer.

Smoking is, of course, the primary cause of lung cancer, but nonsmokers can and do develop this disease. Researchers have made progress in understanding the differences between lung cancer in smokers versus nonsmokers, says Dr. Ronald Natale, a medical oncologist at Cedars-Sinai Medical Center, and they’re developing targeted treatments that will be able to address the genetic drivers of lung cancer in nonsmokers.

“Among patients who are nonsmokers, or former very light smokers, we identify a mutation that we can target with pills in about 60% to 70% of them. That leaves 30% or so, 40%, in whom we either have a target for which we do not have a successful treatment,” Dr. Natale tells SurvivorNet.

“Among patients who are smokers, who have more complex cancers that have hundreds, sometimes thousands of mutations, don’t have a driver mutation that we can give a pill for, which is only a tiny percentage of lifelong smokers. Chemotherapy is the primary treatment in most patients,” Dr. Natale explains further.

WATCH: Does smoking marijuana pose health risks?

New research published in Cancer Journal for Clinicians suggests that although the number of cancer cases is expected to rise, by eliminating tobacco use, millions could significantly reduce their cancer risks.

According to researchers, the number of annual cancer diagnoses will jump from roughly 20 million today to 35 million by 2050. The figure puts added pressure on cancer awareness advocates and healthcare practitioners because some of these cancer cases are preventable, according to experts.

“[Eliminating] tobacco use alone could prevent 1 in 4 cancer deaths or approximately 2.6 million cancer deaths annually,” said Dr. Ahmedin Jemal, senior vice president of surveillance & health equity science at the American Cancer Society and senior author of the study.

Tobacco, more specifically smoking cigarettes, is a significant risk factor for lung cancer, which is “the most commonly diagnosed cancer and leading cause of cancer death overall and in men worldwide,” the American Cancer Society says.

Advancements In Lung Cancer Treatment

Lung cancer treatment is still evolving, offering the promise of hope for people living with this type of cancer. Research presented at the 2024 American Society of Clinical Oncology (ASCO) showed that (generic name: durvalumab) (brand name: Imfinzi), a type of immunotherapy drug, could reduce the risk of death for patients with limited-stage small cell lung cancer (LS-SCLC) by 27 percent.

The study demonstrated that the use of Imfinzi improved overall survival and progression-free survival (the time a patient lives without their disease getting worse) in patients.

“SCLC is one of the most aggressive types of lung cancer. The ADRIATIC trial is a landmark study and provides a new standard of care with the addition of immunotherapy for patients with early-stage SCLC who are being treated with the goal of curing their cancer,” said Dr. Lauren Byers, thoracic section chief in the Department of Thoracic-Head & Neck Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston.

Dr. Byers pointed out that Imfinzi helped patients live for years compared to many other treatment approaches, where the benefits were measured in months.

WATCH: Understanding Immunotherapy in Lung Cancer.

Another treatment option that has shown great promise is the drug Rybrevant, which is approved by the U.S. Food and Drug Administration for non-small lung cancer (NSCLC) and has a specific genetic mutation your doctor can identify through testing.

“When a patient comes in, we immediately sequence the tumor. We are doing panels that might include three, four, or 500 genes, the ones that are most likely. Some sort of next-generation approach is the best standard of care these days – it has to be done,” Dr. Herbst explains.

The active ingredient in Rybrevant is amivantamab-vmjw. It belongs to a class of drugs known as biologics, which are made from living cells.

The drug works like a guided missile, finding and sticking to the bad cancer cells. It targets and attaches to two specific proteins in cancer cells, disrupting their growth signals and activating the immune system to fight the cancer.

Once it finds its target, it blocks the signals the cells need to grow and spread. This stops the cancer from worsening and helps patients feel better for longer.

Rybrevant is different from older cancer treatments because it is a targeted drug therapy. It doesn’t just attack all rapidly dividing cells like traditional chemotherapy does. Instead, it goes after the cancer cells with the mutation it was designed to treat while avoiding the healthy surrounding cells. This means it can be more effective and might have fewer side effects than other treatments.

WATCH: Imfinzi offering hope to patients.

Lorlatinib and crizotinib are other lung cancer treatments known as tyrosine kinase inhibitors. These drugs target ALK, a signaling protein inappropriately present in the tumors of about five percent of patients with NCSLC.

“It is encouraging that the upfront benefits of lorlatinib over crizotinib continue for several years in more than half the patients. It is also encouraging that patients receiving lorlatinib had much fewer incidences of brain metastasis, which can be devastating,” Dr. Leslie Busby, an oncologist at Rocky Mountain Cancer Centers, told SurvivorNet.

Five-year PFS, or the percentage of patients who lived five years without any evidence of cancer growth or death, was 60% among patients who received lorlatinib compared to only 8% among patients who received crizotinib—an absolute difference greater than 50%.

Coping With Chemotherapy Lung Cancer Treatment

Lung cancer often doesn’t cause symptoms until it has already spread outside the lungs. Doctors may suspect lung cancer after seeing a shadow on a routine chest X-ray that requires further evaluation.

Once a lung cancer diagnosis is confirmed, it’s important to find out whether the cancer has spread. Depending on the part of the body being scanned, additional scans may include a CT scan, PET scan, or MRI.

The PET/CT scan combines two imaging tests in one. CT stands for computed tomography. It uses X-rays to take pictures of the body from many different angles.

PET is an acronym for positron emission tomography. It uses a radioactive form of sugar that cancer cells absorb more than healthy cells, helping to distinguish healthy cells from cancer. A PET scan can help determine the extent of the cancer’s spread and its stage before treatment.

WATCH: Understanding PET and CT Scans.

A scan of the chest, abdomen, pelvis, and brain to see if the cancer has started to spread outside of the lung.

Treatment varies depending on the type and stage of cancer you have. If the cancer is local — meaning just in the lungs — surgery may be an option. However, if cancer has spread to the lymph nodes, a combination of radiation (use of X-ray-like beams focused on cancer cells to kill them) with chemotherapy, followed by immunotherapy (a treatment method where the immune system is re-engineered to target cancer cells and kill them), may be the best option.

Once the cancer has spread outside of the lungs, chemotherapy and/or targeted drugs are used to control its growth as much as possible.

Surgery is more optimal for early-stage lung cancer, meaning the cancer has not spread beyond the lungs. For more advanced stages of lung cancer, adding chemotherapy and other treatment methods may be ideal.

Chemotherapy and Lung Cancer

Chemotherapy is often recommended in patients with high-risk features such as tumors > 4cm or in poorly differentiated tumors. There are other factors your clinical team will also consider when deciding whether chemotherapy is right for you.

Chemotherapy alone used to be the mainstay of treatment for stage 4 lung cancer. It is often used with other treatment options, such as immunotherapy, radiation therapy, or targeted medications. Chemotherapy is important in stage 4 cancer because often, more localized treatment options, like focused radiation or surgery, are no longer possible due to the extent of the disease and how much it has spread to other parts of the body (also called metastasis).

WATCH: How targeted therapies can be used for advanced lung cancer.

Systemic treatment of the body with chemotherapy is helpful to slow the progression of further growth of the primary cancer, prevent future metastasis, and relieve symptoms associated with existing tumors. However, chemotherapy works by killing all cell types, healthy or cancerous, that are multiplying quickly, so it does have significant side effects for the healthy tissue.

Some patients may also be considered for other therapies, including the targeted agent osimertinib and the immunotherapy drug atezolizumab. These drugs are very different from chemotherapy and are often much better tolerated. However, to receive these drugs, the tumor must test positive for certain biomarkers that allow these drugs to be effective. Genetic testing helps distinguish specific biomarkers in cancerous tumors and determine effective treatments.

How Molecular Testing Helps Lung Cancer Patients

Lung cancer treatment has seen notable progress, partly because of molecular testing and profiling. This type of testing helps better understand specific genetic alterations and mutations that drive the growth, development, and progression of cancer cells. Some of these molecular characteristics can be targeted using precise and effective new therapies to improve patient outcomes. Ultimately, understanding the molecular profile of each person’s cancer allows oncologists to use customized and personalized treatments.

RELATED Next-Generation Sequencing in Lung Cancer

There are several next-generation sequencing (NGS) tests you may encounter, depending on where you are getting treatment and what you are getting treatment for. Here are some of the common ones currently on the market:

• FoundationOne®CDx looks at 324 genes in solid tumors and says results can take up to 12 days. Test results include microsatellite instability (MSI) and tumor mutational burden (TMB) to help inform immunotherapy decisions.
• OmniSeq Insight provides comprehensive genomic and immune profiling for all solid tumors. It looks for 523 different genes. Test results include microsatellite instability (MSI) and tumor mutational burden (TMB), as well as PD-L1 by immunohistochemistry (IHC).
• Cobas EGFR Mutation Test v2 identifies 42 mutations in exons 18, 19, 20, and 21 of the epidermal growth factor receptor (EGFR) gene. It is designed to test tissue and plasma specimens with a single kit, allowing labs to run tissue and plasma simultaneously on the same plate.

Questions for Your Doctor

If you find yourself diagnosed with lung cancer and are concerned about the long-term impacts, here are some questions you can ask your doctor.

• Has my cancer spread to other parts of the body?
• Based on my cancer stage, what are my treatment options?
• What are the side effects of my recommended treatment?
• Are there ways to help minimize the effects of treatment?
• How long will I be unable to work or carry out my daily activities?
• What financial resources are available to get the treatments I need?

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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