The Case of the Invisible, Painless Lump

Dr. Bradley McGregor of the Dana-Farber Cancer Institute saved a patient from Maine diagnosed with the country's only known case of a rare cancer.

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Image via Getty/alessandro0770

Alex was living the dream. He’d just returned from a relaxing honeymoon in the Caribbean and was settling down on a small farm in southern Maine with the love of his life. He had no reason to suspect anything was wrong when he went in shortly after his trip for a routine physical with a new doctor; he felt fine—great, in fact. During the exam, though, his doctor felt a lump in his testicle and immediately scheduled him for an ultrasound. When he met with a specialist the following day, he couldn’t believe the news: He had testicular cancer and would need to go under the knife at once to remove the lump.

From there, the news only got worse: The surgery at Mass General additionally revealed Alex had an extremely rare type of cancer, called a primitive neuroectodermal tumor (PNET), that had spread to his stomach and the lower part of his lungs. It was so rare, in fact, that his was the only known active case in the United States. Now armed with a diagnosis, Alex’s mystery was no longer what was wrong with him—it was how to fix it.

After meeting with doctors at a handful of Boston-area hospitals, Alex quickly came to the realization that most lacked experience dealing with such an uncommon disease. He heard a wide range of suggestions for how best to attack the tumor—some indicated longer rounds of chemotherapy, while others suggested different types of chemo. But without a medical background, he was at a loss for how to proceed. That is, until an oncologist at Dana-Farber Cancer Institute made him feel a little less alone. After reviewing Alex’s case, Bradley McGregor, who specializes in genitourinary malignancies, was upfront with his newest patient when they met on Christmas Eve in 2018, admitting there was no consensus on how to treat his cancer. “I don’t have all the answers,” he said, but “I’m going to talk to the best minds around the country and determine a treatment plan.”

And that’s exactly what happened. As he gathered new information from research institutions near and far, McGregor constantly tweaked his patient’s regimen. His initial strategy had been to solely target the rare tumor, but a second surgery revealed the testicular cancer was still present. So McGregor decided to administer a combination of chemotherapy directed at both cancers, then adjusted the order in which the medicines were given when things didn’t improve. Thankfully, testicular cancer is highly curable, McGregor says, but “we wanted to make sure we gave the right dose of chemotherapy at the right time.”

After months of chemotherapy, Alex’s treatment ended last June. While he still goes in for blood tests and monthly checkups, he’s back at work at a commercial real estate company and feels his future is bright. He credits McGregor, who went out of his way to check on him regularly over the last year. “He’s literally out there curing cancer, and yet he finds time for you,” he says.

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