A Case for Second Opinions in Cancer Care

October 19, 2018 6:00 AM

After a serious diagnosis elsewhere, a patient turned to Michigan Medicine, where a surgeon’s careful review found only precancerous cells with no major surgery needed.

Jim Sitko expected minor surgery to remove a small lesion that his dentist discovered under his tongue during a routine checkup in July 2017.

An oral surgeon near his home in Clarkston, Michigan, took several samples to biopsy, a procedure that left Sitko’s tongue badly damaged. Resulting pain left the patient barely able to swallow for more than a week.

And the pathology report revealed devastating news: squamous cell carcinoma of the tongue.

Treatment, Sitko was told, would include major surgery to remove a portion of his tongue and rebuild it with veins and tissue from other parts of his body. Rehabilitation would be extensive and might also require radiation therapy once the patient healed.

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Because he had received successful treatment for prostate cancer six years earlier at the University of Michigan Rogel Cancer Center, Sitko opted to return and meet with surgeon Steven Chinn, M.D., MPH.

Sitko’s mouth was still healing from his initial surgery, so Chinn relied on the outside pathology report to prep for the complicated surgery ahead. He ordered additional pathology testing by Rogel Cancer Center head and neck specialists an essential step to confirm an advanced cancer diagnosis.

Meanwhile, the thought of having tongue cancer overwhelmed Sitko.

“The complications aside from taking care of the cancer were unbelievable,” the 70-year-old says. “I might have a breathing tube and feeding tube. I took a retreat to my condo in northern Michigan to review 25 pages of paperwork for two clinical trials, but I did not quality.”

Sitko and his wife, Jane, a master gardener, had been planning a 50th anniversary celebration in Vancouver and Victoria, British Columbia, world-renowned for its gardens. Because of his tongue cancer diagnosis, the couple canceled their plans.

But everything changed for the better one month later when Sitko and Chinn were preparing for surgery.

A second opinion and ‘tears of joy’

During the first of five preoperative meetings, Chinn was able to examine Sitko’s mouth, which had healed remarkably well for a person with tongue cancer.

Chinn called for Sitko’s prior pathology labs from the outside hospital for a careful review and comparison with the new results from the U-M pathology lab.

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“My years of training taught me be thorough and make sure you are working with the best information possible,” says Chinn, an assistant professor of otolaryngology at Michigan Medicine. “As part of my standard of care, I make sure all pathology is reviewed by head and neck specialists here at U-M.

“This is what makes our head and neck oncology program one of the best in the world.”

Sitko and Jane had again retreated to their northern Michigan condo. They were just unpacking their bags when a phone call with good news from Chinn came.

“He told me with cautious optimism that he saw no cancer in the pathology report but needed to verify with new samples taken at U-M,” Sitko says. “We agreed I’d go in on my scheduled surgery date. I would be in the surgical suite for an hour or 12 hours, depending on what they found.”

To begin, Chinn took three additional section samples for biopsy. Pathology results found no cancer.

Chinn took two more samples. No cancer.

"My years of training taught me be thorough and make sure you are working with the best information possible."
Steven Chinn, M.D., MPH

He then used laser treatment to remove abnormal, non-cancerous cells from Sitko’s tongue. Surgery was over.

“We were in tears of joy,” Sitko says. “I am certainly indebted to U-M and specifically Dr. Chinn and the manner he handled my case. He could have done the complete surgery and I never would have known I didn’t have cancer."

Jim Sitko and his wife, Jane, vacationing after a second opinion found no cancer.

Life after a cancer scare

In hindsight, Sitko sees that his original tongue surgery did far more damage to his tongue than necessary.

It still surprises him that he was able to stop to eat dinner and have a beer after his surgery by Chinn. He experienced none of the discomfort.

Over the past year, he and Jane have resumed their normal retirement activities, including golfing, biking, hiking and snow skiing. They also rescheduled their wedding anniversary trip.

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“We decided to kick off with a trip out East, where we spent our honeymoon,” Sitko says. “We went to Bar Harbor, Acadia National Park, Nova Scotia and New Brunswick. We drove 2,900 miles in 11 days, going from hotel to hotel.

“It was like revisiting our honeymoon 50 years later.”

Because of the abnormal non-cancerous cells found on his tongue, Sitko continues to see Chinn for follow-up and monitoring. There have been so signs of cancer.

A careful, specialized approach has guided treatment throughout.

“Having a team that’s only focus is head and neck cancer is critical to making the right diagnosis and management in a complex disease,” Chinn says. “In this case, when there was a discrepancy between the outside report and our review, I felt it prudent to do additional biopsies to make sure the initial one wasn’t a sample error and that we were, in fact, missing an advanced stage cancer.”