John’s Story: Innovative one-of-a-kind surgery for thyroid cancer.

Three teams work together to give John Koke a fighting chance against an aggressive Thyroid Cancer.

thyroid cancer patient john koke talking through electrolarynx
John uses an electrolarynx to help him speak since his voice box was removed in surgery. Carol, his wife is often translating for him.

John and Carol Koke recently came to the Henry Ford Cancer Institute to treat John’s Stage 4 Thyroid Cancer. His thyroid cancer came back years after his original diagnosis and treatment – but this time it was aggressive. The cancer had spread.

It would take three teams and a few surgeries to create an equally aggressive treatment plan – to give him hope for survival.

The first go-round

In 2014, Carol noticed a lump on the side of her husband’s neck. Living in Swartz Creek, Mich., they went to their local doctor for a biopsy. The biopsy confirmed that John had thyroid cancer. It was treatable.

The team at the local hospital removed the tumor and the thyroid gland, followed by radiation. It was thought that the radiation had taken care of it all. Unbeknownst to John’s physicians, three years later during John’s annual CT scan, they would discover the thyroid cancer penetrated the wall of the windpipe. The cancer had spread, John was told.

“’The cancer is back and it’s serious,’ they told us. Those words pierced us like a knife,” Carol says. “We couldn’t believe what we were hearing. He had been doing so well – but we now had a new reality.”

The local hospital told Carol and John that they were not equipped to handle this advanced cancer and referred the couple to the Henry Ford Cancer Institute.

Aggressive cancer calls for aggressive steps and innovative surgery

thyroid cancer patient john koke looking at mobile phone with his wifeAt the Henry Ford Cancer Institute, John first met with Michael Simoff, M.D., Chief of Bronchoscopy and Interventional Pulmonology at Henry Ford Hospital in Detroit. Dr. Simoff used laser surgery to debulk the tumor in the trachea, to allow John to breathe better.

The rapid growing cancer was relentless. It had obstructed John’s voice box, metastasized (spread) to the lung, and penetrated the esophagus. His voice box was no longer working properly.

The team at Henry Ford knew they would have to do something extensive to give John a chance of survival.

Two teams from within the Henry Ford Cancer Institute –otolaryngology/head and neck surgery and thoracic surgery - quickly came together to determine how to best approach John’s cancer. After several tumor board meetings, they created an aggressive and innovative surgical plan and approach for treatment.

The teams strategized on how to work together to reconstruct the esophagus and trachea, after completely removing the cancer from the trachea, voice box, and esophagus. Surgery was set for October 3, 2017.

“Our local oncologist said that even by Henry Ford standards, John’s case was extremely out of the ordinary,” said Carol. Henry Ford gets the serious cases, she was told.

Thyroid Cancer Treatment

We offer expert diagnosis and advanced treatments for thyroid cancer. Our thyroid surgeons at the Henry Ford Cancer Institute perform more than 500 thyroidectomies each year, making them the most experienced in Michigan.

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thyroid cancer patient john koke laughing with his wifeJohn’s surgical dream team included otolaryngologist/head and neck surgeons Tamer Ghanem, M.D. Ph.D., and Suhael Momin, M.D. , and Zane Hammoud,  M.D., Chief of Thoracic Surgery.

Dr. Ghanem removed the voice box, a portion of the esophagus and trachea with the help of Dr. Hammoud, who removed a portion of the collar bone and sternum to access the area through the chest.

This is very unusual and challenging procedure to perform; reconstruction of the trachea and esophagus is not typically done through the chest cavity.

To rebuild John’s trachea and esophagus, Dr. Momin harvested skin tissue and blood vessels from the thigh. The blood vessels were connected in the neck through an intricate procedure, and muscle from the thigh was used to rebuild the other structures in the neck, which was then covered with a skin graft.

During recovery from the surgery, John saw pulmonologist Javier Diaz-Mendoza, M.D. Dr. Diaz-Mendoza was tasked with finding the appropriate tracheostomy tube for John since the one he had did not fit correctly. He recommended two different customized tracheostomy tubes and was finally able to find one that fit and was comfortable.

After surgery, John was on a feeding tube and could not eat solid food for a six months. He had a few complications which lead to an additional four months of being on-and-off the feeding tube. He has fortunately been free of the feeding tube since July 2018 – and is grateful for that!

“We attempted chemotherapy but the treatment was harsh and it opened the esophagus back up,” Carol explained.

Since John had radiation prior to surgery this is no longer an option for treating John’s cancer.

There is still a small tumor that had metastasized on the lung, away from the original tumor. John is undergoing surveillance of that with Ding Wang, M.D., a medical oncologist.

Grateful for the team at the Henry Ford Cancer Institute

thyroid cancer patient john koke posed with train set
John with his train set around the holidays.

John uses an electrolarynx to help him speak since his larynx (voice box) was removed in the surgery. Carol is often translating for John, helping him communicate with others. They are thrilled that friends and family are starting to get used to the trach, and can understand John without Carol’s help. “It helps to watch his lips as he speaks,” she says.

Carol gives a heartfelt recap of what the team at Henry Ford means to them:

“It has been a long journey and John has been through a lot. We are so thankful for the many doctors and health professionals who have brought John this far. Without them, he would have already been gone.

thyroid cancer patient john koke posed with train setHe now gets the pleasure of seeing his nephew and godson graduate from high school this year. He can play trains with his other little godson, Elias, which has brought him so much joy. And, he will have the privilege of watching Carol’s daughter, Jill, walk down the aisle in June.

Having just returned from Germany in May of 2017, right before learning that his cancer had returned, Carol and John would love to travel there again someday.

When asked what has got them through this diagnosis, they point to their strong faith. “Faith has carried us through and helped us put it in God’s hands. God has put the right people in our paths. No matter the outcome we still know he is walking with us to help carry us through.”

John continues to follow-up with Dr. Ghanem, Dr. Mendoza, and Dr. Wang., along with his local physicians in Flint.

Diagnosed with Cancer?

At Henry Ford, you can expect a multidicplinary team approach, like John received.

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