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May 29, 2019

Two Cancers, One Unified Multidisciplinary Care Team

By SharingMayoClinic
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Joyce Gabbert and Garret Choby, M.D.

Joyce Gabbert came to Mayo Clinic for treatment of a rare form of head and neck cancer. But she soon learned that wasn't the only cancer diagnosis she was facing. At that point, a coordinated care team came together to create a treatment plan that put Joyce on the path to becoming cancer-free.


It all started with a stuffy nose. "After a week or so, I thought I must have a sinus infection because it just wasn't going away," Joyce Gabbert says.

Joyce decided to seek the medical counsel of a nurse practitioner. "I told him that I thought I must have a sinus infection, so he gave me an antibiotic," she says. "But he also said that if it didn't get better, I should make an appointment with an otorhinolaryngology specialist."

After another month without any improvement, that's what Joyce did. "I'd actually gotten worse during that time," she says. "In fact, I'd worsened to the point where I had a runny nose that I couldn't stop. It got so bad that I'd have to continually pack my nose with Kleenex just so I could continue to function at work."

When the day of her otorhinolaryngology, or ENT, appointment came, Joyce was hoping for a quick diagnosis and an easy fix. But as the appointment went on, she realized she wasn't going to get either.

"The ENT I saw thought I might be suffering from nasal polyps and that I might need corrective surgery," she says. "But they only do their surgeries at a hospital that's not very convenient for me location-wise, so I thought, 'I'm just going to switch ENTs and get a second opinion.'"

Joyce found another ENT specialist closer to her home in Burnsville, Minnesota. He began her evaluation with a CT scan. "When he looked at the results, he knew right away it wasn't nasal polyps because the problem wasn't uniform. It was concentrated to one side of my nose," Joyce says. "At that point, he inserted a small scope into my nose, so he could get a better look at what was going on."

What appeared to be going on didn't look good. The physician suspected Joyce had a tumor. He recommended surgery to investigate further and determine if it was cancer. "That's when I started to worry," Joyce says.

From worry to action

The surgery uncovered a rare form of head and neck cancer known as a sinonasal malignancy. Joyce's doctor suggested she seek care at a larger medical center and recommended several, including Mayo Clinic. "I thought: 'My goodness, Mayo Clinic is one of the best — if not the best — hospitals in the world. Why would I not go there?'" Joyce says.

"(Dr. Choby) is so personable and compassionate, and you just know he truly cares about his patients. You're not a clinic number to him. You're a person."

Joyce Gabbert

At Mayo Clinic, Joyce met Garret Choby, M.D. in the Department of Otorhinolaryngology/Head and Neck Surgery. "He's wonderful," she says. "He's so personable and compassionate, and you just know he truly cares about his patients. You're not a clinic number to him. You're a person."

Dr. Choby moved quickly to assess Joyce's condition and determine next steps. That assessment revealed another unpleasant surprise. "We did a PET scan with Joyce before her surgery to ensure her tumor hadn't spread. During that scan, a lesion lit up in her left lung," Dr. Choby says. "We then had to biopsy that to ensure it wasn't a spread of her sinonasal cancer. It wasn't, but it did turn out to be a second primary cancer of her left lung."

Joyce was stunned. "I couldn't believe it," she says. "I felt fine. I had no symptoms of lung cancer whatsoever. I would have never known I had this cancer, as well, without that PET scan."

All hands on deck

Dr. Choby consulted with Mayo Clinic thoracic surgeon Stephen Cassivi, M.D. Now dealing with two cancers instead of one, they had to decide which took top priority.

"This is part of the beauty of Mayo Clinic," Dr. Cassivi says. "I was able to meet with Dr. Choby, and we discussed Joyce's different medical issues. We felt that her lung cancer was able to be put on the back burner a bit because it was an early-stage cancer, so we thought it would be best to deal with it after Dr. Choby took care of her sinonasal tumor and after she finished her corresponding radiation treatments."

With that plan in place, Dr. Choby then brought in fellow ENT surgeon Eric Moore, M.D., and neurosurgeon Michael Link, M.D., as well as medical oncologist Katharine Price, M.D.

"For patients like Joyce, who have tumors in this location — right at the base of the skull where the brain cavity is separated from the nasal cavity — we always work as a team at Mayo Clinic," Dr. Link says.

Before moving forward with surgery to remove the tumor, the team discussed the possibility of a craniotomy — taking out part of Joyce's forehead to allow access to the tumor. Instead, they were able to perform surgery through her nose, and a craniotomy wasn't necessary.

"I love their coordination of care, and how everyone is on the same team and the same page at all times."

Joyce Gabbert

"We were very pleased with that," Dr. Link says. "Working together with Drs. Choby and Moore, we all felt good that we had the right plan in place, and we were able to execute that plan the way we wanted to."

All three surgeons were involved in the complex procedure, which took more than eight hours. When it was over, they were confident in the result, as was Joyce. "They did such a wonderful job," Joyce says. "Drs. Choby, Moore, Link and Price all worked together to get all of that cancer out of there for me."

With her initial surgery complete, Joyce spent the next six weeks in Rochester undergoing proton beam therapy treatments before meeting up, once again, with Dr. Cassivi.

"Once Joyce finished her radiation treatments, we rechecked everything to make sure nothing had changed," Dr. Cassivi says. "I then brought her back into the operating room to do a minimally invasive removal of the lower left lobe of her lung to remove her early-stage lung cancer."

Joyce's second cancer surgery went just as well as the first. "I can't say enough about my surgeons and my entire care teams at Mayo Clinic," Joyce says. "In addition to everything else, I love their coordination of care, and how everyone is on the same team and the same page at all times."

Partners in compassionate care

Joyce also was pleased and relieved to find Mayo Clinic's coordinated care went beyond just her, as the patient, and extended to her family, as well, including her daughter, who came to many of Joyce's Mayo Clinic appointments.

"She was, of course, very afraid throughout much of what I had to go through. She asked Drs. Choby, Moore, Link, Price and Cassivi so many questions about everything. They were all so patient, and they took the time to show her my scans and explain what everything was and what everything meant," Joyce says. "They went out of their way time and time again to reassure her that my prognosis was good. That was a tremendous help because when it was coming from me, I think she thought she was getting it through rose-colored glasses. But hearing it from them, she took that seriously."

"The ability for all of us to work in concert as partners on the same team working on Joyce and her daughter's behalf is, to me, what Mayo Clinic is all about."

Stephen Cassivi, M.D.

The team took providing that kind of coordinated, compassionate care seriously, as well. "It was great," Dr. Cassivi says. "The ability for all of us to work in concert as partners on the same team working on Joyce and her daughter's behalf is, to me, what Mayo Clinic is all about."

And that's why Joyce — whose scans now show to be cancer-free on all fronts — says she'll continue driving to Mayo Clinic for her medical care.

"I feel so blessed to live so close to Rochester and Mayo Clinic. Right when you walk into Mayo, you get this comforting feeling that you're in the best possible hospital in the world," she says. "My care teams at Mayo Clinic saved my life. I have no doubt about that. The skill and compassion of Drs. Choby, Moore, Link, Cassivi, Price, and everyone else up and down my care teams, are truly remarkable and so very much appreciated."


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Tags: Cancer, Dr. Eric Moore, Dr. Garret Choby, Dr. Katharine Price, Dr. Michael Link, Dr. Stephen Cassivi, ENT/Audiology, head and neck cancer, Head and neck surgery, Mayo Clinic Cancer Center, Neurology & Neurosurgery, thoracic surgery

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