Perfect Timing

Story by Maryann Brinley  •  Portraits by Nick Romanenko         View the complete magazine | Subscribe to Cancer Connection

The diagnosis of a rare and highly aggressive type of skin cancer anywhere on your body is frightening enough but when it is found inside your nose, the road to a cure can look ghastly.  

Tony Spadora and his wife CathyThis was the situation for Tony Spadora of Union Township, New Jersey, in the summer of 2015. “Timing is everything,” admits this happy, 62-year-old father, husband, grandfather and business executive. He’s been with L’Oréal USA for 32 years where he is vice-president of corporate compensation. As he tells his story, he still can’t put the word cancer front and center. “I don’t even like typing the word when I’m saving files on my computer. I never thought of myself as being sick.” But his wife Cathy interjects, “It didn’t immediately sink in how serious this was.”

There was a tiny bump, less than a quarter inch, inside his left nostril and when his regular dermatologist wasn’t available last May (2015) for his annual checkup, Spadora found another doctor. “This person didn’t think it was remarkable but told me I’d need to see an ear, nose and throat (ENT) specialist to have it removed.” A week after the bump was excised, the call came with the lab results. “The doctor was honestly surprised,” recalls Spadora. “He wasn’t that familiar with Merkel cell carcinoma, but he had researched it and found Dr. Howard Kaufman, chief surgical officer at Rutgers Cancer Institute of New Jersey, who is a leader in the field doing clinical trials on this condition.”  The words “rare and aggressive skin cancer tumor” were all that Spadora heard.  A visit to Howard L. Kaufman, MD, FACS, who is also a professor of surgery and a professor of medicine at Rutgers Robert Wood Johnson Medical School, was the next stop.

Spadora’s cancer journey hinges on a series of what-ifs so intricately timed that as he looks back, he is amazed. “As we get older, all sorts of things can happen to us. I am realizing just how lucky I am,” he says. For six months, each medical step he took looks perfectly logical and predictable in hindsight but what if they hadn’t occurred just when they did? His wife shares the scariest thought, “Some doctors told us that if it weren’t for our specially trained surgeon, a part of Tony’s nose might have been taken off.” The timing was so perfect that when the couple first sat down to discuss Spadora’s case with Kianoush Sheykholeslami, MD, PhD, FACS in August 2015 after meeting with Kaufman, this doctor was so new to Rutgers Cancer Institute that his business cards hadn’t been printed yet. A few weeks earlier and the two lives might not have crossed.

Worldwide Journey

Kianoush Sheykholeslami, MD, PhD, FACS“Dr. Shey,” as he is affectionately known, is the new Director of Head and Neck Surgery, Director of Trans-Oral Robotic Surgery and Co-Director of Skull Base Surgery at Rutgers Cancer Institute. He is also an associate professor of surgery at Rutgers Robert Wood Johnson Medical School and an attending physician at Robert Wood Johnson University Hospital (RWJ), which is the flagship hospital of Rutgers Cancer Institute. One of the few specialists in the world who is board-certified in otolaryngology / head and neck surgery as well as facial plastics and reconstructive surgery, along with sleep medicine, Sheykholeslami has taken a career path from Iran to New Jersey so long and winding that it includes a PhD in neuroscience studies from Tokyo University School of Medicine.  It was a pursuit he began despite knowing hardly a word of Japanese.

A graduate of Shabid Babai Ghazvin Medical University where he earned his MD, Sheykholeslami was the emergency room chief at one of the busiest Iranian hospitals by the time he was in his early 20s. But emergency medicine didn’t interest him for the long-term. “I wanted to know what happened to my patients and be able to follow up on them,” he explains. So Sheykholeslami went looking for an international program that would include patient care as well as research.

Putting Patients First

Robert D. Aiken, MD Every day, Robert D. Aiken, MD, the new Director of Neuro-Oncology at Rutgers Cancer Institute of New Jersey, walks over to the labs. “There are so many evolving therapies in germination now. In the past, it wasn’t really clear that treatment apart from radiation was substantially better than chemotherapy plus radiation, but that has changed.” Though the majority of his time is devoted to patient care and clinical trials, “my real interest is in the early developmental therapies, the really new ideas, being translated out of the labs.”

A recognized leader in brain cancer and neuro-oncology, Dr. Aiken joined Rutgers Cancer Institute in August 2015 for the opportunity to develop a comprehensive program within a National Cancer Institute (NCI)-designated center. He says when it comes to treating patients, it is important to remember “that a patient is part of a larger whole. There is the patient. There are his or her wishes and aspirations. And there is his or her network of family and friends. My objective is to improve life and to make the quality of that life commensurately better.” Aiken can’t stress this kind of patient support and care enough. “I don’t want people out there floundering. I want them to have a whole network available with the best of standard care as well as the best of investigational care.”

Aiken was the Director of the Comprehensive Brain and Spine Tumor Program and Director of the Section of Neuro-Oncology at Rush University Medical Center in Chicago before joining Rutgers Cancer Institute. Happy to be back on the East Coast now, he spent 20 years in Philadelphia at Jefferson Medical College and was also on the faculty at Mount Sinai School of Medicine in New York. Here in New Brunswick, he is an associate professor of medicine at Rutgers Robert Wood Johnson Medical School. He’s closer to family now and proximity to the cluster of pharmaceutical companies in New Jersey is also key. “I’m trying to develop a thrust in the brain tumor arena. A lot of cancers are more common and profitable but that doesn’t mean it’s not worthwhile to consider working on orphan brain tumors like glioblastomas. So part of my job is to convince these companies that developing strategies for orphan tumor therapies is potentially promising. Having them nearby makes it easier to follow up a telephone call with a personal visit.” For him, Rutgers Cancer Institute means being “in the right place at the right time.”

Aiken’s research is supported by numerous philanthropic and health entities including Gateway for Cancer Research, Voices Against Brain Cancer and a recent $10,000 gift from inVentiv Health.

When a friend in Japan studying for a PhD in ophthalmology opened a door there, Sheykholeslami left home for a three to six month observership in the ENT department of Tokyo University School of Medicine. He is fluent in Farsi, Azeri and Turkish. The woman sitting next to him on the airplane taught him, “Have a good day” and “Good afternoon” in Japanese. That was the sum of his Japanese language skills. But he persevered and taught himself Japanese and English by listening to the radio. Eventually he won a graduate scholarship and later earned another to continue his studies in neuroscience, neuro-otology and neurophysiology.

In Japan, Sheykholeslami earned his PhD in 2001, and continued with postdoctoral research on the auditory vestibular system and the metaphysiology of balance. “Hearing and balance were my areas and I actually invented a new technique called VEMP using bone-conducted clicks delivered to the ears and recorded from the sternocleidomastoid muscle. We published extensively on that.”  Other international research brought him into contact with the Case Western Reserve University Medical Center in Ohio, where he applied for a prestigious medical residency in otolaryngology, head and neck surgery and was told, “Good luck. Foreigners never get in.” But, Sheykholeslami was successful. “It was very hard surgical training and I got really good hands-on experience. I ended up chief resident.” Later, he added courses to his medical - surgical repertoire in Pittsburgh doing skull base work as well as obtaining board certification in sleep medicine.

Along the way, he got frustrated. “I could take cancer out of my patients but I had to ask another surgeon to do the reconstruction for them.” So in July 2014, he decided to add reconstructive and plastic surgery to his expertise. This brought him to New Jersey where he studied at Robert Wood Johnson. Shey had just completed that training in June 2015 when he got the opportunity to build the head and neck cancer program at Rutgers Cancer Institute.

Comprehensive Reach

“I call it one stop shopping,” he jokes describing the surgical experience at Rutgers Cancer Institute for patients with any kind of head or neck pathology. “In the past, patients would leave their first surgery with a big bandage for at least two to three weeks until they could get back in for reconstruction. I am equally good in all these specialties. My work is difficult, complex, time-consuming and there aren’t a lot of people interested in doing this kind of thing. Here we have a team of multi-disciplinary oncologists and reconstructive surgeons.” This includes neuro-oncologists, medical and radiation oncologists, rehabilitation specialists for speaking, hearing, swallowing or eating and “we are also bringing a psychiatrist on board,” he adds.

Among his first lucky patients at Rutgers Cancer Institute was Spadora, who recalls, “I was given three alternatives: Do nothing. Go immediately to radiation and chemotherapy. Or opt for surgery to remove the tissue that would be extensive. This surprised me. It was just common sense to have surgery first but I guess some patients are scared.” Spadora, on the other hand, “just wanted to get this thing out.” Sheykholeslami explained that it looked like the cancer had been caught early but the nature of skin inside the nose, which is mucosal and sensitive, made this a special case. “Merkel cell carcinoma is not supposed to be there,” the doctor explains, “but once it happens, it’s like melanoma and though it might be tiny, it can spread across your body. This is frightening for both patients and pathologists.” Everyone has Merkel cells in their body. Exposure to sun is what usually makes them cancerous and they look like a flesh-colored or bluish-red nodule then.  In addition to sun exposure, many, if not all, Merkel cell cancers are associated with the presence of a virus that has been called the Merkel cell polyomavirus.

Before the surgery, Sheykholeslami described his plan. “Tell me again,” Spadora remembers asking. His wife recalls, “A lot of doctors can be stiff and cold but you just feel Dr. Shey’s compassion and patience. He told us that one reason he became a surgeon is that he used to sew his socks when he was a kid,” she laughs. This doctor also promised to do his very best to preserve Tony’s nose. “He was very serious about that,” she says. “People often tell me that I don’t look my age, but frankly, that was the least of my concerns,” Spadora adds. The couple has two sons: Dan, 30, is a social media manager and married to Maggie, a financial services manager. They have two young children, Michael and Abigail. Their son David is 25 and lives in New York City pursuing a career in the entertainment industry as an actor/musician. “What a pleasant, supportive family,” Shey says. “His wife was always there for him.”

Right Hands, Right Time

Tony SpadoraOn August 30, 2015, before the procedure, Spadora’s nose was injected four times, twice inside and twice outside, with a chemical to track cancer cells that might have spread. “That was painful,” he recalls. Sheykholeslami planned to take out nodes in Spadora’s neck if needed. The good news: there was no spread. So in a four and half hour procedure, Sheykholeslami cleared the original area of the tumor cutting away any remaining cancer and then reconstructed the nose. “The nose needs cartilage so I borrowed some from his ear to put inside. Then I took skin from his shoulder to reconstruct his ear.”

In recovery later that afternoon, Spadora awoke to a labyrinth of plastic tubes inside and outside his nose, packing stitched and stuffed everywhere, swelling, and the outside of his ear stapled to a bunch of gauze bandages. “The nurses mentioned they had never seen anything like it before,” he laughs. He spent several uncomfortable weeks recovering. He didn’t really sleep well those first few nights. And two months later, he was still sore. But Cathy Spadora says, “He looks so good that no one would ever understand how bad it was.”

At the follow-up appointment, Spadora was told that there was no need for radiation or chemotherapy. He was cured. “I am tremendously grateful to Dr. Shey and the oncology team at Rutgers Cancer Institute for their skills and to my family and friends for their prayers and support,” he shares.

“Dr. Shey is a big guy and I asked him, ‘How did you get inside my nose to do everything in there?’ His response, ‘Would you like to see the pictures I took?’” but this patient respectfully declined. “I’ll continue to get regular scans for a couple of years and there will always be a little bit of doubt in the back of my mind whispering, ‘Is this thing going to come back?’” he admits, “but I trust these doctors.” ■

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