From Nosebleeds to a New Lease on Life: How Jean Parker Overcame HPV-Related Head and Neck Cancer

It all began with a nosebleed. Charleston resident Jean Parker, 78, wasn’t initially concerned. But when she noticed a slight, intermittent drip of blood from her nose, she started keeping notes for her doctor. “I’m someone who rarely got sick growing up,” she says.

“Then one day, my nose really started dripping – I needed tissue after tissue,” Jean recalls. She quickly got in to see her primary care doctor, “but the blood was pouring, so he referred me right away to an ear, nose, and throat doctor (ENT).”

On the way to the ENT, the blood suddenly stopped completely, but the ENT referred her to MUSC Health the same day, where doctors ordered a magnetic resonance imaging, or MRI, immediately, followed by a computerized axial tomography (CAT) scan.

“They saw a little spot on the CAT scan, so they sent me to MUSC Health Head & Neck Tumor Center at Hollings Cancer Center. There she met W. Greer Albergotti, M.D., who would be the first of several specialists on her treatment team.

Unusual bleeding or pain in the nose, mouth, or throat can be one of the symptoms of head and neck cancer. In Jean’s case, it was determined she had human papillomavirus (HPV)-related head cancer – specifically in her sinus cavities.

In South Carolina, HPV-related head and neck cancers are on the rise and have surpassed cervical cancer as the most diagnosed HPV-related cancer in the country. The HPV virus can spread to the head and neck area through oral sex or intimate kissing, and while nearly all of us will be infected with HPV in our lifetime, most people clear the virus within a couple of years and never know they had it. The good news is that these head and neck cancers are curable with early detection and proper treatment.

“Dr. Albergotti explained that the scan showed a little spot, and they didn’t want to take chances,” explains Jean. At this point, she recalls, she couldn’t breathe out of her left nostril.

“Jean had an HPV-related sinonasal cancer involving her sinus cavities and also spreading out toward the nasal bones,” Dr. Albergotti noted. “These are challenging tumors to manage because we are operating near the eye and brain. It’s important to detect these early to prevent spread to these areas. In Jean’s case, we had a team-based approach to her surgery to remove the cancer entirely and make sure she got the best cosmetic outcome possible because of the involvement of her nose.”

Dr. Albergotti removed the tumor through an incision hidden along the side of the nose. Next, head and neck microvascular reconstruction surgeon Alexandra Kejner, M.D. rebuilt the inside of Jean's nose using a free flap—a piece of tissue taken from her thigh and connected to blood vessels in her neck. Finally, facial plastic and reconstructive surgeon Krishna Patel, M.D. performed bone grafting and complex nasal reconstruction.

“One of the most important aspects, from a reconstruction standpoint, is to preserve function and protect important structures – in Jean’s case, this was the brain,” explains Dr. Kejner. “With the help of William Vandegrift, M.D., a neurosurgeon who specializes in tumors advancing toward or into the brain, we were able to create a barrier between the nose and brain. We then covered this with tissue from the leg. This tissue is like a transplant with its own artery and vein, except it comes directly from the patient.”

Because of the complexity of the reconstruction, patients stay in the hospital for at least a week to make sure everything heals and that the reconstruction has a good blood supply. Drs. Kejner and Patel were able to reconstruct the covering over the brain and rebuild the inside of the nose completely.

“It was a serious surgery,” Jean notes. “They had to rebuild the interior of my nose. I thank God it was successful. It was a miracle for me.”

After the surgery, she had 15 minutes of radiation therapy two times a day for about a month to kill any remaining cancer cells that could potentially cause the cancer to return. “While it wasn’t pleasant, it was something I could handle,” Jean says with her characteristic optimism. She says her experience was tolerable thanks to Bhisham Chera, M.D., an expert in head and neck cancer radiation oncology who created her treatment plan. Dr. Chera is at the forefront of research to create less intensive radiation and chemotherapy treatments for patients with HPV-associated head and neck cancer.

“After radiation, I got tired, off balance sometimes,” says Jean. “I had to learn to get up slowly and take a few minutes to get my breath and my balance.”

She also lost her sense of taste, a common temporary side effect of radiation therapy, which caused her to stop eating almost completely. “Food had no taste and made me gag,” she says. “I just couldn’t get any food down.”

Jean lost 20 pounds, so doctors placed a percutaneous endoscopic gastrostomy, or PEG, feeding tube directly into her stomach. The PEG was about the size of a pen, and Thelma was able to puree her meals and receive nutrition through the tube.

“Soon, I realized my taste buds were coming back as I started eating a little bit.” The PEG was removed, and Jean began eating normally again.

Throughout her recovery, Jean says, everyone she encountered at MUSC Health was wonderful. “MUSC has the sweetest people working there. I felt comfortable with each visit, not scared or worried. They were all friendly, they explained everything, and they didn’t leave any details out. They break it down so you can understand it. They all know your name!”

Nearly a year after surgery, Jean has no evidence of cancer. Her medical team is closely monitoring her with physical exams and CT scans, as well as testing her blood for circulating tumor DNA. This is a new test shown to be a reliable marker for HPV-related cancers.

At her recent checkup with Dr. Chera, she told him, “I feel great, I can breathe much better.”

“Keep doing what you’re doing and we’ll see you in July!” he replied.

Signs and symptoms of head and neck cancer include:

• Pain when swallowing
• Pain in your neck or throat that doesn’t go away
• Swelling in or around your jaw
• Unusual patches in or around your mouth and tongue
• Constant pain or ringing in your ears
• Trouble hearing
• Trouble breathing
• Trouble speaking
• Blocked sinuses that do not clear
• Constant sinus infections
• Nose bleeds
• Swelling in your eyes
• Pain or paralysis in your face muscles or neck

---

The head and neck cancer program at Hollings Cancer Center is a top program in the country, providing every specialist needed to treat patients under one roof. To schedule a visit or get more information, please call 843-792-9300.