Tumor Surgery

As a young woman, Kate Titus has endured more trials than most people will in a lifetime. In September 2007, at age 22, the Willoughby, Ohio, resident was diagnosed with Stage 4 non-Hodgkin's lymphoma, a cancer that begins in the cells of the lymph system – which plays a key role in the body’s natural defenses.

Following radiation and chemotherapy treatments, the cancer went into remission in January 2008. However, that's when a whole new ordeal began.

Shortly after her last round of chemotherapy, she developed a neutropenic fever — when white blood cells are low and the only signs of infection may be pain and tenderness.

She was admitted to a Cleveland-area hospital and spent the next three months being “poked and prodded with every imaginable diagnostic test,” but there was no progress. In fact, her condition was worsening by the day. Her fever never broke, regardless of the antibiotic used, and she was in excruciating joint pain.

After many meetings with many doctors, her family decided that it was best to move her to Cleveland Clinic. Their only contact at the hospital was neurosurgeon Edward Benzel, MD, to whom she had been previously referred because of a spine deformity.

“The day I was transferred to Cleveland Clinic was the first time I felt like I might have a chance,” Titus says. “Dr. Benzel came to my room late in the day one evening, shortly after I had arrived, and took my father aside and basically said, ‘I’m not the captain of this ship, but I’ll find you one.’ ”

She was placed on the palliative care floor, where the focus is on improving the overall quality of life for patients facing serious illness.

“Dr. Susan LeGrand took the reins and decided that she was going to treat me like the 23-year-old woman I was, not a bed to be flipped or, worse, a case of interest,” Titus says.

The pain became manageable and it was time to deal with infected tissue, muscle and bone discovered in Titus’s joints.

Cleveland Clinic orthopaedic surgeon Michael Joyce, MD, came up with the plan of attack on the infection. Every week, he would go in and scrape out the infected areas and leave the wounds “open,” placing a wound VAC over the incisions to suck out infected fluids as the body produced them.

After nearly 30 procedures — including three skin grafts — and intensive physical therapy, she was able to return home in March 2009. Her arduous rehabilitation regimen continued at an outpatient center nearby.

Though she still deals with some pain and had to learn to walk again, she is grateful to be alive and employed while working toward a social work degree.

“Dr. Joyce — along with many others — kept me alive because he wanted to give me a chance,” she says. “I was a very lucky girl to have found the right people at the right time and been at the right place.”

You might say Hannah Hicks is a walking miracle — literally.

Following a family ski trip in March 2009, a bump below the teen’s right knee was read by the radiologist as a stress fracture and treated initially as a stress fracture by a pediatric orthopaedic surgeon. She was eventually cleared to resume activities.

But the “bump” continued to grow and become increasingly painful. Her parents were assured that these symptoms were consistent with a stress fracture, but they couldn’t ignore what happened during the next few months. Hannah began to contract all sorts of viral infections, from blisters to the Swine flu.

The pediatric orthopaedist then ordered an MRI with contrast to be performed at Cleveland Clinic. The next day, Hannah’s mother, Cris, received an urgent phone call from the specialist informing her that he had made arrangements for them to meet with Cleveland Clinic orthopaedic surgical oncologist Michael Joyce, MD.

“After a day’s worth of testing and a bone biopsy under general anesthetic, we learned that our beautiful only child had osteosarcoma – bone cancer,” Mrs. Hicks says. The cancer in her right tibia was a Stage IIB osteosarcoma, a fast-growing cancer that had already spread outside the bone and into surrounding soft tissues.

Dr. Joyce immediately ordered that Hannah not use her right leg at all, to prevent a break. On July 24, a Mediport® device was implanted into Hannah’s chest to administer chemotherapy that very evening.

Following 10 weeks of drug therapy, Dr. Joyce performed a six-hour resection and reconstructive surgical procedure on Hannah’s tibia. Using donor bone and ligaments, he was able to salvage her knee and the upper and mid portion of her tibia, and completely remove the tumor.

Dr. Joyce was able to devise an operation that salvaged the surface of the joint and the cruciate ligaments, but replaced most of her upper and mid tibia with reattachment of the anterior patellar ligament that moves the knee and the medial ligament that stabilizes the knee.

“Hope was restored on Oct. 12, 2009, when Dr. Joyce unveiled the bandages for the first time,” Mrs. Hicks says. “We were amazed at how beautiful the scar looked…The man is a true genius, and Hannah’s leg is some of his finest work.”

Hannah resumed chemotherapy from November to April.

In January 2010, Dr. Joyce allowed Hannah to walk for the first time in nearly six months. Before long, she was walking beautifully without crutches, her mother reports.

Although healing had been amazing, Dr. Joyce was concerned about the point of fusion between Hannah’s tibia and the transplanted donor bone. The higher portion of the bones had fused nicely, but the thinner lower portion was being stubborn.

In August 2010, he performed a bone graft surgery that involved injecting a demineralized bone paste and patient's bone marrow directly into the fusion site. She once again was on crutches, but only for a few days this time.

The 15-year-old was able to return to Solon High School on Aug. 24 — after a year’s absence — in some pain, but completely whole and with a good prognosis.

“We will forever be grateful for the love and support that we received from friends and family during the past 13 months,” Mrs. Hicks says. “However, we are equally thankful for the strangers who became friends at Cleveland Clinic. We are so fortunate to have been cared for by such true and caring professionals.”

Matt Cordy was a typical teenager health-wise. He stayed active lifting weights and playing sports, and, in his words, was full of energy and life.

But in the winter of 2006, at age 16, he began to feel pain in his left shin and knee area.

That March, he was diagnosed with osteosarcoma – an aggressive bone tumor-- on his left proximal tibia, the upper part of the shinbone. The condition is the most common primary bone malignancy that is considered for limb salvage, according to the American Academy of Orthopaedic Surgeons.

The average age at diagnosis is 15. Boys and girls have a similar incidence of this tumor until late adolescence, at which time boys are more commonly affected.

Matt had limb-surgery surgery at Cleveland Clinic in June 2006; the year after a family member had been treated there for cancer and recovered well.

Steven Lietman, MD, head of Cleveland Clinic’s Musculoskeletal Tumor Center performed the surgery. Matthew’s complex surgery involved removing the tumor and enough surrounding tissue to ensure no cancer cells remained. He also received an allograft knee replacement, a type of replacement that uses donor tissue.

He reports being pleased with his treatment at Cleveland Clinic, from everyone. “Dr. Lietman was very personable, down to earth and on point … and allowed me to be active in the decisions regarding the multiple options that were presented, as far as how and what type of replacement I would receive,” says the Elyria man, now 20.

“I had a wonderful experience, from the smiling and sociable receptionist to the phenomenal nursing staff, to the attentive doctors who regularly checked on my condition the days following surgery.”

Four years later, the University of Toledo student reports having a clean bill of health.

“My quality of life and health is as great as it was before surgery, if not better. I am able to be just as active, enjoying working out, swimming, bike riding, and anything from sand volleyball to golf to jumping on a trampoline; I have nearly no limitations,” Matt says.

“I greatly look forward to my annual checkups to show off how well I’m doing, how well I’m walking and how far I’ve come. Thank you to all who made my continued life and quality of life possible!”

Cleveland fundraising professional Lance Colie considers himself a lucky man. For the Cleveland fundraising professional, a life-changing diagnosis turned out to be a gift.

In August 2006, at age 50, he noticed a sizeable lump in his left thigh. He was referred to Steven Lietman, MD, Director of the Musculoskeletal Tumor Center in Orthopaedic Surgery at Cleveland Clinic.

An unusual diagnosis
An MRI and biopsy revealed a small, highly aggressive malignant tumor inside a football-sized, less aggressive fatty tumor: a stage III, level IV liposarcoma.

Liposarcomas only respond to radiation therapy and surgery. Radiation kills cancer cells so they won’t spread during surgery but can damage surrounding tissue. Surgery was scheduled several weeks after Mr. Colie completed six weeks of radiation therapy at Cleveland Clinic's Taussig Cancer Center. “My radiation oncologist was wonderful,” he says.

Complex surgery
In the past, amputation was the rule for large tumors that involved blood vessels, as Mr. Colie’s did. Today, surgeons do everything possible to save the leg. Unfortunately, Mr. Colie’s malignant tumor sat right on top of the main vein in his thigh, and the two could not be surgically separated.

Vein grafts to restore his circulation were not an option because he had had radiation. So the main vein came out, leaving Mr. Colie with just one large artery in his upper leg. Despite valiant efforts to improve his circulation, it proved to be inadequate to save the leg, and Dr. Lietman suggested that Mr. Colie consider amputation.

Mr. Colie agreed to amputation at the hip in order to get rid of all possible cancer, noting “we had already talked about that possibility.” After surgery, he went to Euclid Hospital for was just 10 days of rehabilitation. “The rehab program was fabulous,” he says.

Mastering an artificial limb
Next, Mr. Colie was fitted for a full-leg prosthesis in Cleveland Clinic’s Center for Prosthetics and Orthotics, where he found expert help.

“Many amputees don’t use their prosthesis because they don’t fit right or they don’t feel comfortable. I wear mine 12 to 14 hours a day. I can pretty much do everything, except that I run differently as an amputee,” says Mr. Colie.

A new perspective
Three years past his surgery, Mr. Colie sees his entire experience as a gift. “First, it helped me live each day as fully and joyfully as I can, and not worry about the future. I work full-time. I’m a single dad. I hike, I work out and I do Yoga. I have an active social life. I volunteer for several organizations.

“Second, people came out of the woodwork to help. They drove me to appointments, helped me shop. I had meals coming into my house for over a year! It was incredible…an experience of love unlike anything I’d ever known.”

Today, Mr. Colie is giving back as a “4th Angel” for Taussig Cancer Center, where he mentors a patient with a cancer like his own. He also offers support to cancer survivors and amputees in other settings.