From Diagnosis to Cancer-Free in 14 days: How Hoag's highly specialized interventional digestive care experts treated aggressive esophageal cancer and won

Rick Letterman’s passion for golf spans decades. Now 77,he’s been perfectinghis swing since high school, when he worked as a caddy at a local country club in Kentucky.

“Golf is a very self-challenging game,” he said. “You align with your target in the distance, and you take your shot. When I received the diagnosis, a new target came into view, and that target was becoming cancer free.”

A retired air traffic controller, TSA Officer,Navy veteran, husbandand father of three, Rick was diagnosed with Barrett’s esophagus in 2005, a condition in which excess stomach acid creates changes inesophageal tissue. Cancer would touch his life some years later, when Gloriane, his wife of 54 years,battled Non-Hodgkinlymphoma. She is now in remission.

Everytime we face something difficult, Rick will say to me, ‘We’ll get throughit,’” said Gloriane, or “Gigi,” as her sixgrandchildren refer to her. “He has always been incredibly optimistic.”“

But 14 days in 2024 would prove to be one of the most pivotal periods of their lives.

A routine blood test showed Rick’s iron levels were low. A follow-up fecal test showed blood in his stool. 

He quickly met with Hoag Gastroenterologist Dr. Lino DeGuzman, who performed an endoscopy and colonoscopy. The colonoscopy results were normal. The endoscopy, however, revealed something disturbing — a four-centimeter-wide mass burrowed deep in his esophagus. A biopsy confirmed it was aggressive adenocarcinoma, an invasive cancer.

Due to the size and depth of the tumor, Rick was at risk of losing his esophagus. Known as an esophagectomy, the removal of the esophagus and its subsequent replacement with another organ is a complex procedure accompanied by a fatality rate of nearly 10 percent, and an overall five-year survival rate of 30 to 45 percent after esophagectomy. 

Furthermore, patients are often faced with residual complications and a weakened quality of life. 

“It was really frightening,” Rick said. “The word ‘cancer’ is the last word you ever want to hear. I quickly realized the magnitude of what I was dealing with.”

He was immediately referred to Dr. Kenneth Chang, James & Pamela Muzzy Executive Medical Director Endowed Chair in GI Cancer, Digestive Health Institute. A pioneer in the field of interventional endoscopy and endoscopic oncology, Dr. Chang is one of few physicians nationwide with the required training, skillset and procedural volume to perform an Endoscopic Submucosal Dissection, an advanced and highly specialized technique in which a tumor is removed en bloc — entirely in one cut — instead of in pieces. 

In the case of Rick’s tumor, cutting too close to the mass meant not all margins could be cleared for disease by pathologists. Incisions too far away or too deep meant a high risk of complications including bleeding, stricture formation, infection, perforation and damage to surrounding organs.

Before they could proceed with the Dissection, Dr. Chang had to determine if the cancer had spread to any lymph nodes. A diagnostic process he helmed in the 1990s called Endoscopic Ultrasound-Guided Fine-Needle Aspiration confirmed it hadn’t.

“If the cancer had spread a few microns deeper, it would have gone into the muscle, and we would have had to perform an esophagectomy,” said Dr. Chang. “There was no margin for error if we were going to spare him from losing his esophagus.”

The dissection would take three hours to complete, each incision around the tumor demanding careful attention and impeccable precision. 

“These were some of the slimmest margins I’ve ever worked with in my career,” Dr. Chang said. “And the outcome was truly miraculous.”

Not only was Dr. Chang able to remove the tumor in one piece, but he had also managed to eradicate all cancerous tissue without any complications.

“The cancer stopped two millimeters from where I had made my incision,” he said. “It was literally on the cutting edge.”

Reflecting further on what Rick’s case meant to him, he shared, “If sparing his esophagus and delivering this unbelievable outcome was what all my life’s work amounted to, it would be worth it for me.” 

The following week, Hoag’s Tumor Board confirmed the results: this was a curative resection. Without any need for chemotherapy, radiation or organ-removing surgery, Rick found himself back where he had been the day of his diagnosis just two weeks earlier; on the golf course. He participated in a tournament and won.

“This experience has really cemented my faith in Hoag’s incredible doctors,” he said. “I don’t think I’ve ever had more confidence in a doctor than I have in Dr. Chang. Because of him and Hoag’s Digestive Health Institute, I’m cancer free.”

To learn more about Rick’s experience, watch his full story here.

Learn more about the Hoag Digestive Health Institute here.