In August of 2009, 45-year-old Mark completed his first full (140 mile) Ironman in Louisville, Kentucky. Just over four years ago, he was dealing with the distinct likelihood that distance running of any distance might never be possible for him again. While shaving one morning in February 2005, Mark noticed a small lump on an upper lymph node by his ear and thought he “might be coming down with something,” like a cold or flu. When a week passed with no illness and no change in the lump, Mark visited a doctor who diagnosed him with a clogged saliva gland and prescribed a course of antibiotics. When the antibiotics didn’t help, Mark was referred to an Ear, Nose and Throat specialist who scheduled an operation to cut the lump out. A health-conscious endurance athlete and non-smoker, Mark was in such a low-risk category that no one mentioned the possibility the lump could be cancerous. Though Mark too hoped this was the case, he decided to get a second opinion before surgery. He enlisted the help of his sister, a critical care doctor, who referred him to the Brown Cancer Center at the University of Louisville Hospital where a needle biopsy was performed on the lump.
Diagnosis, Surgery and a Treatment Plan—All in the Same Month
A week later, in mid-March 2005, Mark was diagnosed with secondary squamous cell cancer. Though this was still a stage one (basic) cancer, the concern was that cell in the neck was a secondary cancer cell, which meant there was a primary cell the doctors had yet to locate. Understandably shaken by this news, Mark was grateful his sister had accompanied him to this initial meeting, as she was able to provide, in Mark’s words, ‘technical support,’ making sure he received the correct information and understood the medical terminology. Mark was then referred to Dr. Jeffrey Bumpous, an ENT (ear, nose and throat) surgeon and cancer specialist. On March 31, 2005, Mark underwent a bilateral tonsillectomy and a right modified radical neck dissection. The pathology demonstrated 3 nodes with metastasic squamous cancer in the upper neck and squamous cancer in the right tonsil. Though the doctors removed the cancer, Mark remained at risk for residual microscopic cancer. Therefore, radiation to the tonsil and neck was recommended. A husband and father to a 14-year-old daughter and 10-year-old son, Mark agreed with their recommendation: “Chances were good they got it, but because of my wife and children, I didn’t want to take any chances.”
“Don’t realize what you’ve got until you’re about to lose it.”
A tri-athlete and distance runner since high school, Mark had learned the side effects of standard radiation treatment to the neck and throat could include irrevocable damage to and/or loss of teeth, voice box and salivary glands. Justifiably, he was concerned that the athletic lifestyle he had enjoyed for so many years was about to become a thing of the past. With this information in hand, Mark started asking questions and doing research on the Internet (and with the help of his sister) to find out what he could do to avoid these consequences and maintain his quality of life. Mark was referred to Dr. William Spanos at the James Graham Brown Cancer Center in Louisville, Kentucky. Mark described Dr. Spanos as a ‘good listener,’ who understood how important it was to Mark that he be able to continue the athletic lifestyle he had come to value. The radiation team told Mark he was a good candidate for treatment on the TomoTherapy® Hi·Art® system—technology that was new to the hospital at the time. Explaining that the machine enabled them to better control where the radiation was going in order to preserve the teeth, voicebox and salivary glands, Dr. Spanos presented TomoTherapy as the best opportunity for a higher quality of life after radiation treatment. Mark agreed to the treatment plan without hesitation: “I’d reviewed his (Dr. Spanos’s) history and he had a pretty outstanding track record.” As this was new technology at the time (the Brown Cancer Center was among the first 15 sites to install the Hi·Art treatment system; today there are over 250 worldwide), Dr. Spanos was upfront about treatment being a collaborative process between Mark and the radiation team to devise the best way to keep him still during the radiation sessions. For Mark, the extra time and effort was well worth the chance to preserve his active, athletic lifestyle.
“Never missed a full day of work.”
A parts and service manager for a large RV store, Mark continued to work while undergoing radiation. With the treatment center just five minutes from his office, he was able to do most of the thirty-five treatments during his lunch hour. As Dr. Spanos had said, experimenting with ways to keep Mark still during treatment was a team effort. For the first few treatments they used a molded mask that bolted to the table (so shoulders, neck, head were in same position) and had Mark breathe through a small tube in the mask. Later they devised a denture-based, halo-type restraint that would keep Mark in place by locking to the top of his mouth.
“My body reacted well, or the system was that good.”
Mark credits TomoTherapy radiation treatments for keeping him on track with his active lifestyle. “Three weeks into treatment, things started tasting not so good,” Mark said. By week six, he was starting to tire more easily and everything had begun to take on a metallic, rust-like taste. As he could still taste vanilla and chicken, Mark drank lots of Ensure and water, and ate chicken and dumplings. Mark recollected some long dinners around this time where he “would sit down and make (himself) eat until it was all gone.” His perseverance paid off, and he lost only fifteen pounds during treatment. Mark understood his side effects were minimal when he compared them to what he saw in the waiting room during his lunchtime appointments: “I saw other folks doing treatments on different machines and they weren’t faring as well as I was. I could tell by the way their necks were swollen, blistered and by (their) eating tubes.” Beyond some markings on his neck, hair loss along the back of his head and mild weight loss, Mark doubts anyone would have known he was undergoing radiation.
“No doubt in my mind I received the best treatment possible.”
Two weeks after ending radiation treatment, Mark’s hair started growing back and he regained his sense of taste. After two months, Mark could eat or drink anything—including hot, spicy foods—and felt his life was almost entirely back to normal. Now almost five years cancer-free, everything is back to normal for Mark. In fact, he has continued distance running, and has successfully taken on the challenge of half- and full Ironman races. “Since 2007, I have competed in many races, so I can honestly say I haven’t lost a step,” said Mark. “I have run in the Kentucky Derby Marathon in 2008 with a finishing time of 3:56. In the fall of 2008 I ran in the Louisville Fall Half Marathon. In 2009, I started out with the triple crown races of the Kentucky Derby, a 3-miler, 6-miler, and a 10-miler. I also did the Oschner 70.3 Half Ironman in New Orleans. And, in August of 2009 I finished my first 140 mile full Ironman, the Ford Ironman in Louisville. I have no problem with dry mouth or any other of the side effects that you hear about when receiving radiation to the throat. I owe my quality of life to Dr. Spanos and his staff, and the wonderful folks at TomoTherapy.”