In the middle of the COVID-19 pandemic, Rodel Rutger began experiencing chest pain when breathing. On several nights, he was awakened by sharp pain near his heart. After about a week, his wife Tabitha, a registered nurse, insisted he see his doctor. Based on his symptoms, his doctor recommended him to go straight to the emergency department at an academic medical institution near their home.
He was admitted for three days while a variety of tests were run, one of which was to rule out COVID-19. Instead, they found a large 14 cm x 12 cm thymic tumor adjacent to his left lung and cardiac chambers. A biopsy of the mass confirmed cancer, but it was not lung cancer. Rather, pathology results showed cancer of the thymus, which is a small organ that lies in the upper chest above the heart and under the breastbone. It is part of the lymph system and makes white blood cells, called lymphocytes, that help fight infection.
Luckily, the tumor did not appear to spread beyond the thymus. However, Rodel’s case was complicated by a concurrent illness called toxoplasmosis – an existing fungal infection that was affecting his eye.
Doctors initially recommended that Rodel begin chemotherapy treatments to shrink the tumor, but Tabitha was concerned. As a registered nurse, she knew that chemotherapy would compromise his immune system, and limit his ability to fight the infection that was already impairing his vision. She sought a second opinion from another academic center. But the result was the same – a chemotherapy-first approach.
“I knew there had to be a better answer for him, so we decided to try one more opinion,” says Tabitha. As an employee at Long Beach Medical Center, she turned to Dr. Amir Abolhoda, a cardiothoracic surgeon with the MemorialCare Todd Cancer Institute. He immediately involved oncologist and medical director of the MemorialCare Todd Cancer Institute, Dr. Nilesh Vora.
“Dr. Vora’s office called us almost immediately and had us come in,” says Tabitha. “It was such a change from the experiences we had at the other hospitals.”
After hearing the complexities of Rodel’s case, Dr. Vora took his case to the multi-disciplinary tumor board. Tumor board meetings allow a physician to present a case to a room of other physicians, nurses and supportive staff, so together the group can collaborate and design a treatment plan that addresses the unique needs of that individual patient.
“In this meeting, we were able to get the opinions of multiple oncologists, surgeons, radiation oncologists, pharmacists and more – all at once,” says Dr. Vora. “We consulted one of our infectious disease colleagues to ensure that we were taking the best approach for Rodel’s overall health.”
The prevalent consensus was to proceed with surgical resection, if feasible, reserving chemotherapy to future as needed. Dr. Abolhoda performed a Hemiclam shell thoracotomy, a combination of sternotomy and anterior thoracotomy. A sternotomy is a midline incision in breast bone to access heart and chest cavity.
“Going into surgery, we had to consider that the tumor could be intertwined with and invading cardiac structures and/or left lung,” says Dr. Abolhoda. “However, it was well encapsulated, and we were able to remove the tumor completely – without removing any vital structures.”
Throughout the entire treatment and surgical process, the care team kept Tabitha updated on her husband’s progress. Having a serious illness is stressful at any time, but particularly during a pandemic when she was unable to be by his side.
With a successful surgery behind him, Tabitha could breathe a sigh of relief when Rodel returned home just three days later. He would still have to overcome the hurdle of treating his infection, but with his immune system left uncompromised, his chance for a full recovery was likely.
“The communication and collaboration we witnessed was amazing,” says Rodel. “They took the time to look at the whole picture and design a treatment plan that gave me the best possible outcome.”
Individualized care is a cornerstone of the MemorialCare Todd Cancer Institute, and the multi-disciplinary model of care supports that philosophy. “Cancer is not one size fits all,” says Dr. Vora. “Our team is driven by knowing that we can raise the bar for our patients by combining our collective expertise with the latest technology and advanced treatments.”