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January 31, 2018

Quick Action Paves the Way for Healing and Recovery

By SharingMayoClinic

In their quest for clear answers and an accurate diagnosis, an Illinois couple received prompt attention and compassionate care at Mayo Clinic.

In their quest for clear answers and an accurate diagnosis, an Illinois couple received prompt attention and compassionate care at Mayo Clinic.


When Keith Kuzelka arrived at Mayo Clinic in August 2016, he was shocked to learn he had a form of throat cancer called HPV-related oropharyngeal squamous cell carcinoma. Just days earlier, he and his wife, Laura, had been told by physicians back home in Chicago that the mass on Keith's neck was likely an infection or possibly lymphoma, and it could be biopsied in a week. Instead, his Mayo care team found it was a cancerous tumor that had completely obstructed Keith's jugular vein and was pressing against his carotid artery.

"It was heartbreaking news to give to your children," Laura says. "They saw their dad fighting for his life."

For all of their distress at the diagnosis, Keith and Laura also felt validation and relief. In Chicago, they hadn't been comfortable with the idea of waiting for a biopsy, and then waiting again for results, so they traveled to Mayo Clinic.

The team at Mayo Clinic's Rochester campus shared their sense of urgency about Keith's care. Not only was he given an appointment in the Department of Otorhinolaryngology – Head and Neck Surgery just two days after Laura called the appointment request line, but the day after their initial visit, the mass in Keith's neck was biopsied and a diagnosis made.

Four days later — the day his biopsy would have happened had the coupled remained in Chicago — Keith underwent surgery to remove cancerous tissues from his neck and throat. Now, more than a year later, follow-up scans show the cancer is gone.

"Honestly, I would probably have died had I not gone up to Mayo," Keith says.

A higher caliber of care

From the moment they arrived at Mayo Clinic, Keith and Laura were relieved by the promptness of the care he received.

"When we saw the first doctor, he said, 'It's head and neck cancer, and we need to speed you along your way,'" Keith says.

Keith next saw Kerry Olsen, M.D., a head and neck specialist at Mayo Clinic. He discussed with the couple the type of cancer Keith had, explained its severity and outlined the next steps.

"To be told that in four days you're going to come back up and get your neck operated on doesn't give you a lot of time to get things in order," Keith says. "But maybe that's a good thing because you're not thinking about things. There wasn't any time to sit back and sulk."

The pace of Keith's treatment was driven by the life-threatening nature of the cancer, says Kathryn Van Abel, M.D., a Mayo Clinic head and neck surgeon.


"There wasn't any time to sit back and sulk." — Keith Kuzelka


"I was worried about how close things were to his carotid artery," Dr. Van Abel says. "His internal jugular vein was completely obstructed. The tumor on the back of this tongue looked relatively small, but he had bulky lymph node disease on both sides of his neck."

During a six-hour surgery Dr. Van Abel, in conjunction with Eric Moore, M.D., who specializes in transoral robotic surgery, removed the tumor from around Keith's carotid artery and the base of his tongue. They also removed 47 lymph nodes from Keith's neck — the largest of which was 4.5 centimeters.

Despite the tumor's small appearance, it was quite infiltrative, says Dr. Van Abel. That meant, even though the edges of the mass removed during surgery looked clean, the pathologist in the operating room could see that the cancer had grown through blood vessels and lymphatic vessels under the surface. As a result, more tissue needed to be taken out. Keith's left internal jugular vein, 11th cranial nerve and a portion of his sternocleidomastoid muscle, which moves the neck, also were removed.

"I don't normally have to take those structures out," Dr. Van Abel says. "But his tumor was growing into them, so I had to remove them in order to get the cancer out."

A comprehensive approach

Keith came through the surgery without any serious complications. The news wasn't all good, however. Because the tumor extended into the lymph nodes, it couldn't be completely removed. That meant Keith would need radiation and chemotherapy.

"We had a choice of where we wanted to seek treatment. We could do it back at home or here," Laura says. "It was well-known that we were going to do it at Mayo."

While he was in the hospital, Keith received a visit from radiation oncologist Daniel Ma, M.D., who explained the radiation protocol. A few weeks after his surgery, Keith got his first dose of radiation, which was given weekdays for six weeks. He also received weekly chemotherapy infusions.

"They told me what to expect, and they were straight up," Keith says. "They said, 'We'll get you through this,' and they did."

People who receive radiation to their head and neck typically lose their sense of taste, get mouth sores and develop thick saliva, says Keith's oncologist Ashish Chintakuntlawar, M.B.B.S., Ph.D. That range of possible side effects calls for comprehensive care from a multidisciplinary team.


"We really tried to get him off the feeding tube, so he was able to attend his son's wedding and eat with the guests." — Daniel Ma, M.D.


"The ancillary care patients receive from a team that includes dentists, speech pathologists, nutritionists and dieticians is actually what makes some centers better than others that treat head and neck patients," Dr. Chintakuntlawar says.

The support Keith received from his team at Mayo Clinic enhanced his recovery, says Dr. Ma. For example, whereas some medical centers might fit patients with feeding tubes even before radiation therapy begins, Mayo Clinic's approach is to wait.

"Unless the patient is in medical need of the treatment, we try not to do that," Dr. Ma says. "We wanted to keep him swallowing as long as possible with his natural swallowing mechanism."

Keith, who lost 45 pounds during the course of his treatment, did need a feeding tube placed for nutritional support. But after a year — and just in time for his son's wedding — the tube was removed.

"We really tried to get him off the feeding tube so he was able to attend his son's wedding and eat with the guests," Dr. Ma says.

A new normal

As a side effect of the treatment Keith received, eating now requires twice as much time as it used to. But he believes that's a small price to pay.

"I could sit here and be totally upset that I can't eat like I used to," he says. "It happened. Who knows why? It was a little bump in the road that took a year to figure out. Every day I wake up and it's getting easier."

Family also played an important role in his recovery, Laura adds.

"When we got home after treatment, they were there. We couldn't have done it without their love and emotional support," she says. "We enjoy every minute and cherish life together."


"Their attitude and zest for life is really just amazing. I've been honored to take care of Keith." — Kathryn Van Abel, M.D.


Laura says Keith's progress is far beyond what they had hoped for.

"He's started to put on weight. His skin looks great. You wouldn't know that he has head and neck cancer," she says. "This has changed our lives tremendously. There's a new normal now. But he's here, and I know for a fact that he wouldn't be here if we hadn't gotten to Mayo."

Until Keith reaches the five-year mark, he will return to Mayo Clinic every six months for exams. After that, he will have annual follow-up appointments. But right now, the cancer is gone.

"At this point, it is my hope that he's cured of this cancer and it will never come back," Dr. Van Abel says. "Their attitude and zest for life is really just amazing. I've been honored to take care of Keith."


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Tags: Cancer, Dr. Ashish Chintakuntlawar, Dr. Daniel Ma, Dr. Eric Moore, Dr. Kathryn Van Abel, Dr. Kerry Olsen, ENT/Audiology, Head and neck surgery, otorhinolaryngology, Robotic Surgery, throat cancer

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