Chattanooga Times Free Press

‘Extraordin­ary’

Chattanoog­a doctors remove rare 34-pound tumor

- BY ELIZABETH FITE STAFF WRITER

“It’s just a miracle I’m alive. I mean, there’s no other way I can put it.” – MAURICE “SONNY” SWANSON

CHI Memorial surgeons successful­ly removed a rare 34-pound tumor measuring 29 inches long from a man who said he’s feeling much better now without the mass, which had grown undetected within his abdomen for what was likely several years.

Maurice “Sonny” Swanson of McDonald, Tennessee, said he’s always been a large person, but since surgeons removed the tumor and affected tissues in September, he’s gone from weighing 403 pounds to 299 pounds.

“It’s just a miracle I’m alive,” 67-year-old Swanson said via phone Friday. “I mean, there’s no other way I can put it.”

In May, providers discovered a mass in the tissue that surrounded Swanson’s kidney behind his intestines during a CT scan related to kidney stones. Further testing revealed a rare form of cancer, a liposarcom­a, which is an overgrowth of fat.

“It was by accident, in a way, they found it,” Swanson said, adding that he never noticed any symptoms other than about 50 pounds of unexplaine­d weight gain over the past two years and a slight bulge on his left side.

Dr. Justin Wilkes, a surgical oncologist at CHI Memorial who operated on Swanson, said that type of tumor can be difficult to see until it reaches a certain size due to the amount of fat in the abdomen. They’re also dangerous and need to be removed because they can spread to other areas of the body and eventually cause symptoms, such as difficulty eating.

Aside from being a rare cancer in itself, Swanson’s liposarcom­a far exceeded the typical size and was bigger than any tumor his doctors at CHI Memorial had ever seen. Studies show liposarcom­as in the abdomen are on average about 20-25 centimeter­s, with the largest ones reaching 60 centimeter­s. Swanson’s was 73 centimeter­s long, according to records from CHI Memorial hospital.

In addition to the tumor, surgeons needed to take out his left kidney, spleen, part of his colon, left adrenal gland and the tail of his pancreas in order to remove all the cancerous tissue. Swanson also has some other chronic conditions, including heart disease, that made the surgery more complex.

Wilkes said he used a program designed to assess surgical risk. Calculatio­ns showed Swanson’s chance of dying from surgery was about 8% or 9%, with a 40% risk of serious complicati­ons and almost surely being discharged to rehab or a nursing home.

“I don’t do very many surgeries where the risk of death is over a couple percent, so 8 to 9% was pretty high, but he didn’t have a lot of other options,” Wilkes said.

Liposarcom­a removal usually takes place at larger, more specialize­d medical centers, but because Wilkes had completed a two-year fellowship at one of those centers, he felt like he could perform the surgery in Chattanoog­a.

“I told him, ‘I’m happy to take care of this here. I was trained to do it, but I definitely need to let you know that the recommenda­tion is you should consider going somewhere bigger that takes care of these more frequently, because they’re rare,’” Wilkes said.

Swanson said he decided to stay local because he was familiar with the hospital and had faith in the providers’ ability.

“I was at peace with whatever was fixing to happen, and the good Lord just got me through it,” he said.

A TECHNICAL CHALLENGE

Swanson’s cancer team spent many hours preparing and consulting with other specialist­s to develop his treatment plan.

Before undergoing surgery, Swanson received radiation to reduce the chance the tumor would grow back. Dr. Tru-Khang Dinh from Tennessee Oncology performed the radiation therapy.

Because the tumor was so large, Dinh said in a phone interview, there were areas where even the best surgeons could accidental­ly leave “crumbs” of microscopi­c tumor cells.

“The idea of radiation is to sterilize the surgical margin to make sure nothing grows back because even one tumor cell left behind will over time grow into a tumor,” he said.

As he was designing the radiation plan, Dinh said he consulted with Wilkes, who walked him “slice by slice” through Swanson’s CT scan so he would know the high-risk areas where the radiation should be directed.

Another challenge came when Swanson’s tumor was larger than the opening on the machine where radiation passes through. To put it into perspectiv­e, Dinh said the typical target for radiation is about a liter or less in volume. In this case, the target was 25 liters.

“Every patient that gets radiation gets a customized, tailormade radiation treatment that only they can get. Essentiall­y, it’s just tailored to their body shape and where their tumor is,” Dinh said. “But for him, it was definitely several degrees of complexity beyond that, because the size made it impossible to fit in one total field.”

To work around that issue, Dinh designed the radiation treatment in two separate frames he stitched together.

Swanson then had to be sent to another facility in Georgia that’s part of CHI Memorial’s parent health system because he exceeded the weight limit of the robotic couch at the Chattanoog­a-based cancer center. The couch moves patients to ensure radiation is pinpointed with millimeter precision.

Both Dinh and Wilkes said it took a team effort — from nurses and nutritioni­sts to social workers and cardiologi­sts — to prepare Swanson for surgery and see him through the process.

“I think it was an extraordin­ary effort on the part of our department here, and it’s definitely a memorable one,” Dinh said.

ROAD TO RECOVERY

It’s been nearly five months since Swanson’s surgery, which lasted around four hours. Wilkes said many clinicians assisted, including his partner Dr. Rishabh Shah and urologist Dr. Jeffrey Mullins, so that they could minimize the time Swanson was under the knife given his other health conditions.

Swanson spent about 10 days in the hospital post-surgery before being transferre­d to a nursing home for rehab. He got home the Tuesday before Thanksgivi­ng.

“He did remarkably well,” Wilkes said. “We sent him to the ICU for a couple of nights. He might have required one blood transfusio­n, but there was never any major bleeding during the case.”

At his three-month checkup in December, Swanson’s cancer was at bay and he was healing better than expected. He’ll go back in March for another checkup.

“All and all from what I’ve been through, I’m well pleased so far with the outcome of everything,” Swanson said.

In the years leading up to the surgery, he said he was taking three to four medication­s daily to control his high blood pressure. Now, his blood pressure is on the low end as his body continues to heal from the surgery.

“I still have good days and bad days. But overall, I’m slowly getting better,” he said. “Dr. Wilkes and anybody that’s seen me can’t hardly believe how well my recovery has gone.”

Swanson said he attributes part of his success to being willing to push himself to get better.

“I’m just the type of person that likes to stay moving, and I know that’s what’s helped me get through this,” he said.

Aside from trusting in the Lord, he said he advises people not to put off their health concerns.

“If they’ve got a problem or think they’ve got a problem — go to the doctor and have it checked out,” Swanson said. “Because, the sooner they can catch something, the better.”

 ?? STAFF PHOTO BY OLIVIA ROSS ?? Doctors Tru-Khang Dinh, Justin Wilkes and Rishabh Shah stand in front of CHI Memorial's Rees Skillern Cancer Institute on Friday.
STAFF PHOTO BY OLIVIA ROSS Doctors Tru-Khang Dinh, Justin Wilkes and Rishabh Shah stand in front of CHI Memorial's Rees Skillern Cancer Institute on Friday.
 ?? CONTRIBUTE­D PHOTO ?? CHI Memorial surgeons stand behind the rare 34-pound tumor.
CONTRIBUTE­D PHOTO CHI Memorial surgeons stand behind the rare 34-pound tumor.

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