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Cancer treatment: Charting the course

​Control what you can. That's good advice when times are uncertain. For Bob Butler, of Ironwood, Mich., it's advice that's serving him well since he was diagnosed with cancer of the thymus gland. 

Despite changes in his course of treatment, Butler, 72, remains steadfast, focused and willing to try new therapies to gain the upper hand.

The trouble started while he was on vacation two years ago. "I was out of breath all the time," Butler said.

Because he had experienced a previous heart attack and heart surgery, his first thought was that it was a heart problem. "I thought I had another blockage, so I saw a cardiologist," Butler said. "Nothing was found, so I was referred to a pulmonologist. That's when the cancer was discovered."

Pulmonologist John Crump, M.D., and Cardiovascular Surgeon Hope Maki, M.D., at Marshfield Clinic, diagnosed Butler with thymic cancer and cancer in his lungs. Dr. Maki was able to surgically remove the lung cancer, but the thymic cancer was not operable. Butler was then referred to Stephen Toothaker, M​.D., an oncologist/hematologist at Marshfield Clinic Minocqua Center.

Thymic carcinoma is a rare cancer. It affects the thymus, a small organ under the breastbone that makes white blood cells to help fight infection. Thymic carcinoma cancer cells can spread quickly and be challenging to treat.

"The stage of the cancer was difficult to determine," Dr. Toothaker said "At the start the primary driver for treatment was the thymic carcinoma."

Butler began an intense course of chemotherapy treatments, three times a week, for six sessions. Between each session he had a three-week break. After the sixth session, new imaging showed that the cancer had turned up in his liver. A course correction in his treatment was needed.

"We got a mixed response with the chemotherapy and had to employ some out-of-the-box thinking," Dr. Toothaker said. "Our focus shifted to treating the non-small cell lung cancer that was in the liver. The same drugs also were effective in treating Bob's thymic cancer."

Learning his cancer had spread was not the news Butler wanted to hear. "I knew it was very serious," he said.

Having suffered a broken neck at age 23, from which he recovered to walk again, Butler knows how to pick himself up and keep going. But it wasn't easy. "It was depressing that they couldn't operate," he said.

At this juncture, another specialist, Baruch Kahana, M.D.​, a radiation oncologist at Marshfield Clinic Minocqua Center, joined his care team. Butler underwent 29 treatments of radiation to help shrink the thymic cancer following the chemotherapy.

Radiation therapy uses external beam radiation to provide a targeted, localized treatment.

"The technology allows the dose to be maximized to the area where it is needed and to minimize the dose to everything else," Dr. Kahana said. "Sometimes cancer takes a one-, two- or three-punch effort between surgery, chemotherapy and radiation oncology. Using a multidisciplinary approach helps to find the combination that's most effective and safe."

Butler's thymic cancer has shrunk considerably. His wife, Pat, and their grown children and grandchildren have rallied around him for support. Although the course for treating his cancer may change, his fighting spirit remains intact.

"Don't give up anything," Butler said. "I'm planning on many more years with as many vacations."