By Jocelyn Selim
Public radio host and folklorist Nick Spitzer finds the Creole in cancer treatment
By Jocelyn Selim
The specialist scheduled him for a biopsy. The results weren’t encouraging. Spitzer was never the type of guy who did things by the book, but this seemed bizarre: He had a grapefruit-size germ-cell tumor growing next to his heart. Germ cells develop in the embryo and eventually become sperm in men and eggs in women. And while the vast majority of germ-cell tumors in men develop in testicles, a few, much less predictably, develop somewhere else: in the lower back, the chest or even the brain.
No one is quite sure how these tumors get outside the gonads, but one school of thought holds that they develop from unwelcome leftovers of early embryonic development—small islands of misplaced cells that are somehow triggered to transform into tumors at a later date. They are extremely rare: Only about two new cases of extragonadal germ-cell cancers are diagnosed each year among every 1 million people in the United States, according to data from the Surveillance, Epidemiology and End Results (SEER) Program at the National Cancer Institute.
While Spitzer was mulling over his diagnosis, a man in the hospital bed next to him had a heart attack. The doctors wheeled in a crash cart, and Spitzer was moved out of the room. “So all of a sudden I’m at the end of this dark hallway of a hospital. I’m by myself. I’ve just been told I have cancer, terrible cancer. The guy next to me is dead. I’m all alone, no friends, no nothing, and I’m thinking, ‘What the hell is going to happen?’ ”
Spitzer soon found his way to Frederic Billings, a medical oncologist in Baton Rouge, La., where Spitzer lived at the time. “He told me that I knew a lot about folklore, but I didn’t know everything, and that he knew a lot about cancer, but he didn’t know everything. And that he didn’t know what was going to happen, but that he would tell me straight whether I should go watch all the sunsets I had left,” says Spitzer. “And he said something that really stuck with me: He said that we were playing for all the marbles.”
Extragonadal germ-cell tumors aren’t staged like traditional testicular tumors. Instead, they’re divided into three prognosis groups—good, intermediate or poor—depending on the type and location of the tumor, whether it has metastasized, and the concentration of chemical tumor markers in the blood. Spitzer’s tumor was a dangerous type called a nonseminoma. It was located around his heart and was invading his lungs. Today, more than 80 percent of patients diagnosed with good or intermediate nonseminoma tumors survive at least five years. Spitzer’s chance of being alive in five years hovered around 50 percent.
After doing exploratory surgery to look at Spitzer’s tumor, Billings decided the cancer probably couldn’t be removed and started him on an aggressive chemotherapy regimen. “It was bad,” says Spitzer. “My chest wound wouldn’t heal because of the chemo. I’m throwing up. My hair is falling out. I’m sleeping in the same room with my mother. I’m feeling degraded and like my life is going down in flames around me and I was just trying my best to keep breathing.”
Then, Spitzer began to get really depressed. “When chemo strips away everything … you get sort of hypersensitive to [Pink Floyd’s] Dark Side of the Moon, and I start thinking, ‘I’m an artist of death and I’m OK with that.’ And the people around me started to get alarmed.”