How an Israeli 20-year-old who never smoked got advanced lung cancer

At age 20, Geula Marx was diagnosed with lung cancer, despite her young age and that she had never smoked. The disease was discovered at stage 4 with brain metastases. Never ignore suspicious symptom

 Dividing cancer cell (photo credit: INGIMAGE)
Dividing cancer cell
(photo credit: INGIMAGE)

In 2019, 23-year-old Geula Marks from Mitzpe Yericho in Israel, a community between Jerusalem and the Dead Sea, finished her year of national service and planned to study for the psychometric examination, the standardized college entrance test in Israel.

One day, while running with a friend, she struggled to breathe. At first, she didn't think much about it, but slowly symptoms such as persistent coughing, shortness of breath, bloody discharge in phlegm etc. started to appear.

Marks went to a doctor who thought that her lungs had been slightly singed from breathing in fumes from cleaning products. After her symptoms persisted, however, Marks was sent for a chest X-ray.

When the results came in, the doctor said that it was pneumonia and Marks was put on antibiotics. She recalled that no one, certainly not her, had any idea that it was cancer.

When the situation still didn't improve, Marks was referred to a pulmonologist and told she needed to wait about five months for an appointment.

 Cancer Immunotherapy by  NIH Image Gallery. (credit: FLICKR) Cancer Immunotherapy by NIH Image Gallery. (credit: FLICKR)

Several weeks later, when she couldn't stand or walk, her parents took her to a local emergency medical center. The doctors there urgently referred her to Shaare Zedek Medical Center in Jerusalem for fear of acute pneumonia.

At the hospital, they drained fluid from her lungs, took a biopsy and performed a CT scan. Several days later, pathology results and the genomic test Oncotest showed that Marks had lung cancer.

At first, she was in denial, and insisted that it was only asthma, but soon enough, Marks accepted the diagnosis with a heavy heart.

The doctors can't explain how it happened

Marks said that doctors can't explain how it happened. She had never smoked and there was no family history of cancer so there wasn't any reason for her to be diagnosed with a cancer that usually affects adults who have smoked for decades.

At first, naturally, Marks had a hard time digesting the hard news and therefore preferred not to think about it and not read too much about the subject. She remembered that the day before she was hospitalized, she was supposed to start a course to prepare for the psychometric exam.

Despite the situation, Marks chose to study and took a preparatory psychometric course in between treatments.

A genomic test showed she had an epidermal growth factor receptor (EGFR) tumor mutation which fortunately allowed her to receive the biological drug Tagrisso, which has been in the health basket of drugs paid for by the health funds for several years. This allowed her to receive a slightly more affordable form of treatment.

Studies show this drug can delay the development of the disease, significantly extend the lives of patients treated with it and reduce mortality risk. Doctors recommended the treatment to Marks because they believed that it could dramatically shrink down her tumors.

"At first I received a normal dose, but then they discovered brain metastases and increased my dose."

Geula Marks

"Despite the cancer, this was the best year of my life"

At the beginning of her journey, when she was still trying to understand everything that was happening to her, Marks read a newspaper article about a young woman with lung cancer who mentioned the help she received from the Israeli Lung Cancer Foundation.

Marks joined the Facebook group "Friends of Breathing" for patients and family members. Instead of avoiding the bad news, she received a lot of information from the foundation, as well as tools which helped her feel secure and tranquil during this challenging period.

The foundation helped Marks join Zoom meetings and get to know other patients with lung cancer. She met amazing friends like Rachel, who was diagnosed with lung cancer at age 31 after a pregnancy.

When Marks spoke with Rachel, they formed a strong connection. They shared experiences and tips from each one's personal experience. This gave both women the strength to keep fighting.

Marks decided to avoid mountains of information, data and statistics, and instead made a conscious choice to deal with her situation with friendship and humor. She tried to have a comedic, lighthearted approach with friends during treatments - at least as much as possible with cancer. She said that this was the best year of her life.

"Even if the cancer returns, I know how to cope and beat it again"

Three years have passed since the diagnosis and Marks is still receiving the same treatment.

"At first I received a normal dose, but then they discovered brain metastases and increased my dose," she recalled. Three months later, her situation improved, and now she's been cancer-free for two years. "As it came, so it went," she added.

Marks said that her faith and optimism strengthened her in dealing with the disease during scary days and after receiving difficult news from doctors. "The optimism and faith were there the whole time," she said. "The fears joined in during the treatments. I remember, for example, when I did tests and waited a long time."

To cope, she said, she watched lots of movies to help with the difficult situation, which was not an easy one to handle.

Today, Marks is trying to move on with her life, get stronger and keep her faith. She's convinced that even if the disease returns, she'll beat it again.

Her optimism is also reflected in her professional ambitions. Marks is studying nursing and dreams of becoming a medical professional.

She said that the decision to choose this profession was influenced by her personal experience when she saw how her nurses acted and the great influence they had on her.

She is now finishing her second year of studies at Shaare Zedek, where she was treated just a few years prior, and in about two years, she will be a registered nurse. Marks is convinced that this is her vocation.