• 2/7/2005
  • Rustburg, VA
  • Cynthia T. Pegram
  • The Lynchburg News and Advance

Stephen L. Thompson, M.D., looked relaxed and healthy sitting in his office this week. The husky timbre of his voice might have been the aftermath of a cold. But it was throat cancer, not a seasonal microbe, that added the bit of hoarseness to his voice and kept him away from the office from October to January.

On Jan. 5, Thompson began working a half-a-day a week in his family practice group, on his way back to full time. Nowadays patients will see him sip a glass of water he keeps nearby to combat the dry mouth after-effects of radiation treatment.

Although not seen as frequently as other cancers, cancers of the head and neck are not rare. The most recent data from the Virginia Cancer Registry reported 715 patients in 1999. During 2005 nationwide, nearly 10,000 new cancers in and around the vocal cords are likely to occur, according to the American Cancer Society. Tobacco use is a factor in about 80 percent of head and neck cancers.

Thompson, like most doctors, is part health educator – he wants people to be aware of throat cancer potential, so he gave permission for his doctors to talk about his treatment. Thompson, who has practiced in Campbell County for more than 30 years, was lucky. The cancer was found early, in part because of the odd way it turned up last spring.

It was Mother’s Day, he recalled. “I had a severe sore throat.”

It woke him up at 5:30 a.m. and hurt so bad he took a pain medication. His throat got better during the day, but he was puzzled that he didn’t have a fever or swollen lymph nodes. Within the next few weeks, he began to feel like he had something caught in his throat.

“The amazing thing is that I’m a physician and I did not self-treat. I don’t know why – but I didn’t. I think that was the good Lord doing something, or me being lucky.” Instead, he made an appointment with Dr. Christopher Mawn, an ear, nose and throat specialist in Lynchburg. What first seemed a minor inflammation didn’t go away with the usual treatment. A CT scan (a computer enhanced X-ray) followed.

“It showed an abscess,” said Thompson. The abscess was on the throat wall, very near the vocal cords and the area that leads directly to both the lungs and the esophagus. That same day, he was hospitalized and the abscess opened and drained. Some bacteria were detected, but a biopsy showed no cancer and a CT scan also looked clear. Even so, Mawn kept close tabs on Thompson.

“So everything went very good until September, until I had a recurrent soreness in my throat,” said Thompson. Mawn sent him for a third CT scan. It showed a mass under the surface of the throat lining. This time things didn’t go as well – the mass presented problems and the biopsy triggered bleeding related to his anti-clotting medication. The next day he learned the diagnosis: cancer. Probably treatable, and probably with a fairly good outcome.

“To be told you have cancer, especially in throat, was obviously very upsetting,” said Thompson. “I think I had my moments of crying, there for a time. And then my family came in and of course, more crying.” Thompson didn’t have the usual array of symptoms of squamous cell cancer of the throat – trouble swallowing, hoarseness, coughing up blood, and pain. Mawn said that some cancers develop slowly, over years, but others can be very aggressive, over a period of months. Having an abscess as a herald is uncommon, but because it triggered monitoring “we found it early,” said Mawn.

Mawn said that each year he sees 10 to 15 cases of throat cancer, usually in people over age 50 who have used tobacco. Thompson, who started smoking heavily when he served in Vietnam, quit about 25 years ago. Thompson opted for chemotherapy and radiation rather than surgery.

Radiation to the throat is difficult. “There are a lot of important things packed into the neck in a small area,” said Mawn. “You have to worry about complications to nerves, blood vessels, salivary glands and teeth, as well as the tongue.” Lynchburg cancer specialist Dr. Dwight S. Oldham said chemotherapy used today makes radiation treatments more effective. Thompson had three cycles of chemotherapy and 35 radiation treatments.

Head and neck cancer treatment is a little more difficult to treat. “You get a sore mouth, and can’t swallow – it’s pretty uncomfortable,” said Oldham. A feeding tube through the abdominal wall makes it possible to receive adequate nutrition, even with a swollen throat. A tracheostomy makes it possible to breathe. Thompson had both at one point, and was able to speak by use of a specialized valve in the trache. He also lost about 20 pounds.

“The problem is that you lose your appetite,” said Thompson. “You have a huge amount of mucous from the radiation – coughing, pain.” His treatment began in October and continued through early December. He couldn’t swallow pills until near Christmas.

“I’ve improved daily since then,” Thompson said.

“He did better than a lot of people,” said Oldham. And in Thompson’s case, being a physician was a plus. “I’d say he was easier to treat than average.” Dr. Robert L. Driskill, Lynchburg radiation oncologist, said Thompson’s course of treatment was aggressive.

“That’s a very difficult and challenging treatment for a patient to go through – it’s quite effective, but difficult from the point of view of side effects.” Head and neck cancers include throat, larynx, mouth, tongue and tonsil.

“It’s been well shown that the addition of chemotherapy with radiation leads to a much better response and cure rates for those types of cancer,” said Driskill. Radiation works by damaging rapidly growing cells and killing them off. But that also affects normal tissue.

“Side effects depend on what part of the body is treated,” said Driskill. “People treated with radiation for cancer of the throat have the worst side effects.” All three of his physicians said Thompson was a good patient.

“Part of it is that he’s such a delightful guy to work with,” said Driskill. While the long-term outcome remains to be seen, “We’re very hopeful.” Thompson said that at one point he was ready to quit, “because I was so miserable. But I have a fairly strong family who stayed on me pretty severely – my daughter, my wife and my stepdaughter.” Thompson also found support from others. “When I went to treatment, a lot of those patients getting treatment were patients of mine. They were people either cured, and just followed up, or were actually being treated, so it’s kind of like home week when I went for treatment because I knew a lot of people.”

At work, he recently saw a patient who’d had cancer of the vocal cords and undergone radiation.

“He had all the side effects I had: he can’t taste, dry mouth, lack of appetite. I did ask him how long it took him to get his taste back – a year and a half.”

“That did not help my disposition,” Thompson said with a laugh. “But I suppose if you think you might have beaten cancer, it’s not much of a loss.”