A new esophagus
Singing Mayo's praises after cancer care
He thought it was heartburn. But a routine endoscopy showed precancerous cells in the esophagus. Jorge Rivera, a 47-year old singer and father of three in Puerto Rico, was stunned.
Rivera led an active life, singing sacred music and playing guitar in his church, raising his rich tenor voice every Sunday for the parishioners at Maria, Madre de mi Señor Parrish in Guaynabo, Puerto Rico. Rivera's father accompanied him, playing the cuatro, a ten-string lute-like instrument native to Puerto Rico.
Cancer of the esophagus was clearly not in his plans. "I was scared because the doctors explained to me that my voice would be damaged," says Rivera.
The esophagus is the muscular tube that passes from the pharynx down the neck between the trachea and the spinal column to the stomach. Its health is essential to singing.
Cancer had spread
The initial endoscopy revealed that Rivera's cancer had spread beyond his esophagus. Cancer cells also were found in his sphincter, the valve between esophagus and stomach, and in the upper part of his stomach.
Suddenly, Rivera needed to make decisions about major surgery and esophageal cancer treatment.
Benigno Varela, M.D., Rivera's oncologist in Puerto Rico, suggested a visit to Mayo Clinic in Jacksonville, Fla., where surgeons were performing a new, minimally invasive surgery for cancer of the esophagus.
"So far from my country"
"Jacksonville was an unknown place to me and so far from my country," says Rivera. "But my doctor in Puerto Rico contacted Mayo Clinic by phone and everything started to move smoothly."
Within a month, Rivera was under the care of several Mayo Clinic specialists, who confirmed his diagnosis and pinpointed the location his cancer. "We assessed the esophagus both through an endoscope as well as a special ultrasound endoscope, which uses sonar or ultrasound to measure the depth of the cancer, says Michael Wallace, M.D., a Mayo Clinic gastroenterologist who cared for Rivera.
Unfortunately, Rivera's pathology report revealed troubling news. He had an aggressive type of esophagus cancer, and his cancer cells were at high risk of spreading to other organs and lymph nodes
Minimally invasive esophagectomy
Rivera's team of doctors recommended complete removal of the esophagus. Historically, esophagectomy involves major surgery, but at Mayo Clinic the procedure does not always involve the traditional technique of opening the chest, which is associated with greater risk and greater pain, sometimes long-term.
"The surgical procedure that we can offer at Mayo is a minimally invasive procedure that's done through small laparoscopic ports," says C. Daniel Smith, M.D., chair of the Mayo Clinic Surgery Department. "We use a technique that enables us to remove the esophagus from the chest without needing any chest incisions. This allows patients to avoid many of the complications associated with entry into the chest."
In April 2010, surgeons removed Rivera's esophagus and part of his stomach through a small incision in the neck, just behind the collarbone, and small incisions in the abdomen.
The stomach tissue was shaped into a tube to form a new esophagus for Rivera and to restore his digestive system.
"Patients tend to have less pain and better healing with a minimally invasive esophagectomy," says Dr. Smith. "They tend to get out of hospital sooner and get back to their activities quickly."
In Rivera's case, he was released from the hospital in one week and began eating solid foods a month after the surgery.
Close coordination despite distance
Rivera's chemotherapy and radiation plan were administered in Puerto Rico, with close coordination with his Mayo Clinic physician, Gerardo Colon-Otero, M.D., Hematology/Oncology.
"Mayo doctors are very available, even from Puerto Rico," says Rivera. "One of the most important things to me is the availability of my doctors. I can send them an e-mail to ask about my health, and they answer me in a very short time frame."
Cancer-free, singing, kickboxing
A year after surgery, Rivera has his life back. He is cancer-free, eating well, playing music, singing and even kickboxing.
"It is a spectacular cardio routine," laughs Rivera, who picked up the sport after taking a class at his job.
And his voice? "At the beginning my voice was very affected," says Rivera. "I persevered in wanting to sing again, and today I am fully recovered. I can actually handle higher notes now.
"I received first-rate treatment, which contributed to the new chance at life that I have today."
Rivera came to Mayo Clinic because it is one of the world's leading medical centers for esophagectomies, performing more than 200 procedures each year. Studies have shown that people who had esophagectomies at low-volume centers, those performing four or fewer procedures annually, had a much higher risk of dying from the operation than people treated at high-volume centers, those performing more than 19.
Other Mayo physicians responsible for Rivera's diagnosis,surgery and care were Candido Rivera, M.D., and Herbert Wolfsen, M.D.
"I just want to thank the Mayo team for ... bringing me another opportunity at life," says Rivera.
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