George Todd

In June 2003, George Todd was enjoying two of his favorite pastimes — hunting and a fine cigar — when one of the normally pleasant rituals suddenly turned painful.

"The cigar burned my throat," says George. It was the start of a nagging feeling that something wasn't right.

Within several days, George became hoarse. He went to see an ear, nose and throat specialist. The physician saw a mass on George's left vocal cord and scheduled a biopsy. The test revealed cancer of the larynx (voice box).

"As soon as you hear the word 'cancer,' you start wondering, 'How long do I have?'" says George. As he began investigating treatment options, another fear emerged: there was a chance treatment could permanently damage his voice.

"I make my living with my voice," says George, a financial adviser with Merrill Lynch in Spartanburg, S.C. Losing the ability to speak with his clients was another devastating possibility George now had to face. He decided radiation therapy offered the best chance of curing his cancer while minimizing the potential for damage to his voice box, and he began a six-week course of radiation therapy just after Labor Day 2003. Follow-up testing revealed no trace of cancer. George thought he was cured.

But a year after finishing treatment, he felt a lump on the left side of his neck adjacent to his larynx. The cancer was back. And this time it had invaded one of George's lymph nodes.

George's wife, Sarah, began researching treatment options. She discovered a surgeon at Washington University School of Medicine in St. Louis, Mo., who had expertise in treating head and neck cancers. The Todds traveled to St. Louis, and in a six-hour operation Bruce Haughey, M.D., removed 18 lymph nodes from George's neck, finding cancer in only one. But Dr. Haughey also discovered that the cancer had invaded tissue outside the lymph nodes. George wasn't out of the woods yet.

Back in Spartanburg, he met with his oncologist, Jay Bearden, M.D., who had been doing some research of his own.

"Dr. Bearden found a physician who was an authority on the recurrence of throat cancer," says George. "He told me to go see Dr. Foote at Mayo Clinic."

Robert Foote, M.D., and his colleagues were able to offer George Todd radiation treatment, based on research conducted at Mayo Clinic, that spared George his voice and gave him the best odds of beating his cancer.

One in a million-plus

Out of 1.4 million cancers diagnosed each year in the United States, fewer than 10,000 are cancer of the voice box. For the stage of disease that George had, approximately 2 percent will spread to or recur in lymph nodes. George Todd was facing a rare — and aggressive — cancer.

Many of the 500,000 people who come to Mayo Clinic each year face similarly daunting health issues, having been diagnosed with diseases that affect only a small percentage of the population. They come to Mayo in part because of the institution's reputation for successfully treating unusual medical conditions.

"Here at Mayo, the unusual is the usual," says Robert Foote, M.D., a radiation oncologist. "We tend to see rare cases, which makes it exciting to get up in the morning. Every day there's a new challenge."

On Oct. 17, 2004, the day's challenge appeared in the form of George Todd.

"One of the nice things about working at Mayo is getting to meet great people from around the country and throughout the world," says Dr. Foote. "When I met George, I was immediately struck by his southern hospitality. He was kind, friendly, and gentlemanly. And he insisted that I call him George — he told me 'Mr. Todd' was his father."

Dr. Foote was impressed by George's sense of humor and optimism in the face of a frightening diagnosis. George was impressed by Dr. Foote's confidence and experience. The team of physicians and support staff Dr. Foote amassed to help treat his cancer also impressed George.

"When Dr. Foote told me how we were going to treat the cancer, it was clear to me that he had done this before and I was in good hands," says George. "I knew I'd come to the right place."

In good — and many — hands

According to Dr. Foote, it's commonly believed that a person can only have radiation once in a particular location. Additional treatment is believed to harm healthy tissue. Research done by Dr. Foote and his colleagues at Mayo Clinic has shown otherwise.

"We've found that in carefully selected cases it is relatively safe and effective to do a second course of radiation therapy in the same location, provided you wait at least six months between treatments," says Dr. Foote. "In addition, the safety and efficacy improve when radiation therapy is given in two smaller doses each day, versus the standard single dose each day."

Dr. Foote and his colleagues have also found that adding chemotherapy to radiation makes it even more effective. So they designed a treatment plan that included radiation twice daily and chemotherapy once each week.

"We were able to offer George several things that greatly reduced his chance of cancer recurrence," says Dr. Foote. "We offered a unique combination of concurrent chemotherapy and hyperfractionated intensity-modulated radiation therapy, which enabled us to deliver radiation directly to the affected lymph-node area and spare surrounding tissue. We also offered a depth and breadth of expertise that I believe is unparalleled."

Dr. Foote and a small group of colleagues who subspecialize in head and neck cancers provided the depth of that experience. Staff throughout Mayo Clinic provided the breadth.

"The head and neck area is very difficult to treat because of all the vital organs and structures it contains," says Dr. Foote. "We collaborate with a tremendous support group to make sure all of our patients' needs are met."

That group includes head and neck cancer surgeons, physicists, dosimetrists, periodontists, prosthodontists, oral and maxillofacial surgeons, dietitians, social workers, psychiatrists, chaplains and specialists in physical medicine and rehabilitation, including physical therapists, speech therapists and swallowing therapists. Depending on a patient's specific needs, appointments a rearranged with one or more of the specialists.

And all patients receiving treatment for cancer benefit from the care of another important group: the nurses and radiation therapists who administer radiation and chemotherapy.

"The radiation therapists were incredible," says George. "They came in on Saturdays to accommodate me, so I could go home a week early. One of them even arranged for her husband to take me hunting." George narrowly missed an eight-point buck that day, but he didn't go home empty-handed. On his last day of treatment, the radiation therapists who cared for him presented George with a toy deer, telling him they couldn't let him leave Minnesota without his deer.

"Everyone at Mayo shows unbelievable caring toward patients," he says. "The first day I walked into the Gonda Building, I stopped to ask a woman sweeping the floor for directions. She put down her broom and walked me to my destination."

A blessing in disguise

A year after finishing treatment, George is back home and back at work. Though he spent six weeks living in Rochester, Minn., many of his clients never even realized he was out of town — or that he was sick.

"I love my job, and being able to work throughout my treatment helped distract me from some of the unpleasantness," says George. "When I felt well enough, I went in to the Merrill Lynch office in Rochester. When I didn't feel up to that, I made calls from my hotel room on my cell phone."

George racked up 3,000 minutes in one month on that cell phone, thanks to the innovative treatment that spared his voice.

"If I had to do this all over again, I wouldn't change a thing," he says of his decision to come to Mayo Clinic for treatment.

But George has made a few changes in his life. He no longer smokes cigars. And he's cut back on work, volunteer and social commitments to spend more time with Sarah and their three sons, Cameron, Hall and Clarke.

"It's a cliché, but since my diagnosis I've really tried to stop and smell the roses," he says. "Getting cancer was a blessing in that it helped me see that life is too important and too precious to rush through."