Freshman Cory Schmitt is no stranger to medicine and doctors. The 18-year-old has lived with Type 1 diabetes since he was eight, which is probably why when he was diagnosed with papillary thyroid cancer about one month into his first year of college, he took it in stride.
The list of cancers most commonly found in adolescents and young adults (AYAs), defined as people between the ages of 15 and 39, is not a short one. The National Cancer Institute cites lymphoma, leukemia, germ cell tumors such as testicular and ovarian cancer, melanoma, central nervous system tumors, sarcomas and breast, cervical, liver, thyroid and colorectal cancers as cancers commonly found in AYAs.
AYAs account for 72,000 cancer diagnoses per year, which is one diagnosis every eight minutes, according to Stupid Cancer, a website devoted to helping young people cope with and manage their diseases. The I’m Too Young For This! Cancer Foundation, which started the Stupid Cancer website, is devoted to providing information and resources to young adults living with terminal illnesses.
In June, Schmitt’s doctor discovered an unusual lump on his thyroid during a regular diabetes checkup. In September, he received an ultrasound and biopsy of the lump. On Oct. 6, he learned there was a three-centimeter malignant tumor on his thyroid gland. The cancer had also spread to his parathyroid glands, the organs that regulate calcium in the blood.
Although his life did not immediately flash before his eyes upon diagnosis, Schmitt admits to having a bit of an existential crisis.
“I was pissed off,” he said. “With diabetes and then that, it felt like everything was raining down on me. It was like, ‘What next?’”
Schmitt scheduled surgery to remove the tumor the week before Thanksgiving, which left him with a two-inch scar across his throat.
“It was a really uneventful experience,” he said of the operation. “Its biggest impact on me was that it disrupted my establishing a routine in college.”
In January, he underwent radiation and drank radioactive iodine to remove all remaining thyroid tissue.
“Radioactive iodine is used after surgery to look for cancer that has spread to other organs and is used to treat other areas where it has spread,” professor Robert Zitsch said. Zitsch is also the MU Health Care chairman of the otolaryngology department, which studies head and neck diseases.
After a successful treatment, Schmitt now takes medication to perform the tasks of healthy thyroids.
The thyroids, located in the front of the neck below the voice box, absorb iodine in the bloodstream to produce thyroid hormones, which help control heart rate, blood pressure, body temperature and weight.
Thyroid tumors are usually visible without any medical equipment. Schmitt said once his doctor pointed it out, he could feel the tumor protruding from his neck. He was not concerned with the lump before because he thought he had always had a large Adam’s apple, he said. Schmitt later learned thyroid tumors grow very slowly, and his tumor might have been disguised as an abnormally large Adam’s apple for quite some time.
“The paranoia was worse before I was diagnosed because I could feel the lump every time I swallowed,” he said.
The most common presenting sign of thyroid cancer or lymphoma is a neck mass, Zitsch said. Unfortunately for Schmitt, his was one of the few cases whose mass appeared in the center of the neck, therefore thinking it was a normal organ, and not further to the left or right.
Common reasons cancers go unnoticed in adolescents include the young adult believing he or she is invincible to such a serious illness, therefore dismissing the symptoms, or doctors delaying diagnosis because of low suspicion of cancer in the age group.
“Overall, progress in AYA oncology has been hampered because cancer risk and adverse cancer outcomes have been under-recognized in this population,” stated the National Cancer Institute’s 2006 Report of the Adolescent and Young Adult Oncology Progress Review Group.
This report, titled “Closing the Gap: Research and Care Imperatives for Adolescents and Young Adults with Cancer,” is the first of its kind. It opens with a statement that the AYA age group “has seen little or no improvement in cancer survival rates for decades” when compared to younger and older age groups.
“These patients too frequently fall into a ‘no man’s land’ between pediatric and adult oncology,” the report continues.
Another reason AYAs often do not receive treatment is their lack of insurance and understanding of the health care system.
An international business major, Schmitt was initially advised to withdraw from school in order to recover from surgery, which leaves most patients extremely fatigued. Schmitt chose not to take the advice and took on 14 credits his first semester, achieving a 3.67 grade point average. He only missed three days of class.
“It was hard, but I really wanted to keep going to class and going to school,” he said.
After his surgery in November and before the radiation treatment in January (read: finals week), Schmitt said he felt exhausted all the time because he had not yet started his thyroid medication. Even going up stairs was a draining activity.
“It was a struggle to get to class,” he said. “You just have no energy whatsoever. You’re just content sitting there doing nothing.”
His choice to move away from home and start a new chapter of his life was an even bigger step after an incident that occurred over fall break. Four days after surgery, Schmitt was eating dinner with his family when he had a stomachache and took some Tums. Suddenly he collapsed to the floor and blacked out for several seconds.
He was taken to the emergency room on a stretcher, where the doctors discovered he had abnormally high levels of calcium. The Tums, in addition to his medication, had provided his body with too much calcium and caused him to faint.
Schmitt has a very lighthearted attitude toward his cancer experience. He is very open about it and answers all questions regarding the ordeal. He even has a sense of humor about it.
“I’m sorry my cancer wasn’t life-threatening enough to really make that interesting a story,” he said after explaining his cancer had a 95 percent survival rate.
For college-age students, cancer prevention methods are not easy to come by, Zitsch said.
“Most of these cancers occur because of genetic abnormalities or bad luck,” he said. “People this age haven’t lived long enough to have created such a high risk for cancer for themselves.”
Many say the key to survival in a dire situation like Schmitt’s is to remain optimistic and remember you are more than just your cancer diagnosis, Schmitt said.
Schmitt was able to use school and Homecoming events to keep him distracted during his days before surgery. He claims he didn’t even think about surgery until the day before.
“I didn’t let it dictate my life,” he said.