Complex neck surgery for medullary thyroid cancer restores health and hope

Mac McCorkle of Durham couldn't understand why he was feeling so rundown during meetings or after playing tennis in the fall of 2010. He had severe bouts of diarrhea, but thought they were a sign of irritable bowel syndrome.

“I was feeling incredibly tired and old and beat up,” said McCorkle, now 60, and a professor who runs the masters program at the Duke-Sanford School of Public Policy. 

In early 2012, McCorkle went to see a gastroenterologist who spotted swelling in his neck. "I hadn't noticed anything but the doctor said, ‘do you have trouble tying a tie?’ He sent me to Dr. Esclamado." The next week McCorkle learned he had medullary thyroid cancer.

Medullary thyroid cancer comprises less than 10 percent of thyroid cancers. It starts in cells that release a protein called calcitonin into the blood stream. Abnormally high calcitonin causes diarrhea, which can be mistaken as a sign of irritable bowel syndrome, explained Dr. Ramon Esclamado, MD, a head and neck surgeon at Duke. “It’s pretty rare for medullary thyroid cancer to be the first thing that comes to mind.”

“To get a diagnosis of advanced cancer on a Monday morning after playing three sets of tennis on Sunday afternoon was shocking,” McCorkle said. “But Ray’s quiet confidence gave me the hope I needed.”

Watch McCorkle talk about his experience with the rare form of cancer. 

Lumps in the neck that don’t go away within two weeks should not be ignored. “People tend to think you shouldn’t worry if you have a lump in your neck and it doesn’t give you symptoms,” said Esclamado, who is chief of the division of head and neck surgery at Duke. But that’s exactly what should cause concern. “Ninety percent of persistent lumps in the neck in an adult, particularly if it is only on one side, are some type of tumor, and need to be evaluated by a head and neck surgeon.”

McCorkle’s swollen neck was due to the tumor on his thyroid, as well as enlarged lymph nodes in both sides of his neck. He was lucky that was as far as his cancer had spread. Abnormally high calcitonin levels are often an indication that cancer has spread beyond the thyroid and neck to other parts of the body. “When calcitonin levels are as high as his were, the literature suggests the medullary thyroid cancer is not curable and surgical treatment can never get the calcitonin down to zero,” Esclamado said.

Esclamado carefully removed McCorkle’s thyroid (technically known as a thyroidectomy), as well as lymph nodes along his windpipe and esophagus which surrounded most of his parathyroid glands.  The cancer had also spread to many lymph nodes in both sides of his neck. The complex procedure requires a high degree of skill and expertise to navigate the area and remove all of the cancer in lymph nodes without causing any cosmetic deformity, permanent skin numbness or injury to nerves that control voice, speech, swallowing, and shoulder movement.

“The surgeon has to be very familiar not only with thyroidectomy, but also with the different variations of neck dissection that preserve important non-lymph node bearing structures while removing all the cancer in the neck,” Esclamado said. Thanks to surgical advances in the field of head and neck surgery, “we can often get the cancer out and leave the patient with very few, if any, side effects from the neck surgery.  This is important not only in medullary thyroid cancer, but also in papillary thyroid cancer which is the most common form of thyroid cancer and frequently spreads to lymph nodes in the neck.”

After a short hospital stay, McCorkle underwent radiation after surgery because the cancer spread in the lymph nodes was extensive. He was back to hitting tennis balls, and teaching in the Fall of 2012. Now, more than three years since completing treatment, McCorkle’s calcitonin levels remain undetectable.

“Since his calcitonin is zero, this is an excellent indicator that he is cancer-free,” said Esclamado. “His only side effect is the need for calcium and Vitamin D supplementation because his single remaining parathyroid gland does not produce enough hormone to sustain his calcium levels in a normal range. I am thankful he is doing well.”  

McCorkle is thankful too. “I’m extremely grateful,” he said. “My quality of life has improved dramatically. I feel better than I did five years ago, that’s for sure.”

“You never know what’s going to happen in the future, and technically I’m high risk because it was advanced,” he added. “But I may have dodged a bullet thanks to Dr. Esclamado. Some doctors may not have been as aggressive as he was.  My family and I have two words to describe Ray – our hero!”

The McCorkle family expressed their appreciation in words as well as action through a generous financial gift to the Division of Head and Neck Surgery & Communication Sciences Research Fund.