Pope Leo's prognosis favourable, Canadian doctor says

As Pope Leo XIV continues to recover from surgery that confirmed his early-stage lung cancer diagnosis, already back on his feet and celebrating Mass in Gemelli Hospital’s temporary chapel, a leading Canadian thoracic surgeon says the outlook is far more positive than initial public worries suggested. 

“Looking at the reality of having early-stage lung cancer that was detected, a successful surgery and reports that he is recovering well, I anticipate that (Pope Leo) is going to make a good recovery on that trajectory,” Dr. Vaibhav Gupta told The Catholic Register. 

“So long as the pathology does not give other information that would change the staging, then he has all the chances to live his normal life the way he was before. It is very likely that this is not going to affect his day-to-day functioning at all, nor his length of life.” 

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Reassuring words for Catholics across the globe, who were taken by surprise by the Vatican announcement that the Holy Father had a nodule on his lung on Oct. 11. By Thanksgiving Monday, Oct. 13, it was confirmed that the nodule was indeed lung cancer, with the pontiff undergoing surgery to remove the lower lobe of his right lung. 

Tests confirmed the specific diagnosis of lung adenocarcinoma, the most common subtype of non-small cell lung cancer, which accounts for nearly 40 per cent of all lung cancer cases. Interestingly, it is also the most frequent type of lung cancer found in non-smokers, a fact that Gupta, chief medical advisor at Toronto’s Lung Health Foundation, consultant thoracic surgeon at the London Health Sciences Centre and assistant professor of surgery at Western University, hopes more people become aware of. 

“In a way, the Pope being open about his lung cancer diagnosis is a very positive thing, as there is so much stigma around lung cancer — this helps to reduce it. Our tagline in thoracic surgery is that anybody with lungs can get lung cancer, and in fact, in Canada and in many parts of the world, the fastest-growing demographic for lung cancer is young women who have never smoked who get lung adenocarcinoma,” he said. 

While adenocarcinoma is not unique in formation to non-smokers, often caused through the standard pathway of cells undergoing genetic changes and forming tumours, he stressed that early-stage lung cancers often cause no symptoms. 

“It is like having a pea in a pillow — you are not going to feel it until it gets bigger. So many times early-stage lung cancers like Pope Leo’s are found incidentally,” he said, with the Holy Father’s case having followed suit when the nodule was spotted during routine checkups. 

”That is a very classic way that lung cancers are initially found.”  

The Pope’s surgery that removed the lower lobe of his right lung “to ensure a radical resection” took roughly 90 minutes to complete. Gupta said the procedure is one of the most common done by thoracic surgeons. 

“When you have early-stage lung cancer, if it's less than two centimetres and if it's on the edge of the lung, then the studies suggest that removing or slicing out a wedge is adequate. That is different to a lobectomy. If it's bigger than two centimetres or one or two centimetres but not at the edge of the lung, then the standard operation is to remove the lobe.”

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It is also important to note that losing the right lower lobe is unlikely to have any significant impact on everyday breathing or oxygen levels. While it “brings down the ceiling” of maximum lung capacity, if the person is not operating near that ceiling, daily life is largely unaffected. While over many years everyone loses some lung function naturally, the loss of one lobe may only become more noticeable much later in life through high-demand activities.

Pope Leo’s post-operative recovery reportedly allows him to carry out his normal daily activities completely on his own, according to a medical update signed by the pontiff’s personal physician, Dr. Luigi Carbone, and Dr. Stefano Margaritora, the head of thoracic surgery at the Gemelli Hospital. For  Gupta, it’s a reality that points to why early detection combined with surgery can lead to such favourable outcomes. 

“Surgery is considered definitive or curative treatment for an early-stage lung cancer if all of the margins are negative, meaning all of the cancer is removed when they look at it under the microscope. If lymph nodes that are sampled during surgery are negative, meaning there's no cancer spread, then surgery is considered curative,” he said. 

“Typically, there's no further chemotherapy, radiation, immunotherapy or targeted therapy — you just go on with monitoring that typically continues for five years.” 

Typically, lung adenocarcinoma patients are up and walking the same or next day following surgery, as in Pope Leo’s case. Oftentimes, a chest tube is placed and is removed in one or two days if drainage is minimal and the lung has sealed. Gupta stressed that most patients are even able to go home the next day or shortly after this type of surgery, with the Pope’s plans of a full week in hospital not being the medical norm, but likely extra caution in this specific case.

While Vatican spokesman Matteo Bruni confirmed the Pope will make his first public appearance on Oct. 18 to deliver the first post-surgery Angelus, the Catholic world awaits further news on whether additional treatment will be needed. 

Still only officially referred to as “early-stage,”, Gupta shared what next steps are likely to be as the pathology continues.  

“Stains and diagnostics are likely being done on the removed portion, which will give us more information. Patients who are non-smokers who get lung adenocarcinoma are very likely to have a favourable mutation, and if they have that mutation, then their survival is typically even better than otherwise,” he said.

“There is also a pill that works on that mutation which improves survival further. Doctors will also be looking at those removed lymph nodes to confirm that there isn't any spread. If there isn’t any (spread), this remains a stage I cancer.” 

Prayers will surely continue to pour in from around the world as Pope Leo XIV’s recovery progresses in the coming days and weeks. For Gupta, this period also carries the vital reminder of lung cancer remaining the most commonly diagnosed cancer in Canada. Yet stages 1, 2 and 3 are often curable, and even advanced disease is highly treatable with today’s options.

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Early detection and timely treatment can make all the difference, with seven provinces in Canada offering screening centres where patients who are eligible can be tested via CT scans. 

“Oftentimes, when people get symptoms, it’s not until the later stages. The Pope's early detection is a good moment to advocate for expanding lung cancer screening in Canada so that more patients can be diagnosed early and have good outcomes as well,” Gupta said.