Vocal cord cancer patient still talking strong

Lawyer and politician defeats vocal cord cancer with the help of UCI Health specialists

Todd Spitzer’s career pivots on his voice. A lawyer, he has argued cases before judges and juries. As an elected official, he debated bills as a state assemblyman in Sacramento and he tackles public issues as a member of the Orange County Board of Supervisors. His calendar is filled with public speaking engagements.

“I speak for a living,” he says. “My voice and voice quality are absolutely critical. It is how I connect with our community.”

So when he was diagnosed with cancer on his left vocal cord in the summer of 2009, Spitzer was devastated. The word "cancer" packed an extra punch because his mother had died of colon cancer the year before. “Then I got diagnosed. It was horrible.”

Also called laryngeal cancer, vocal cord cancer is diagnosed in nearly 13,000 people each year in the United States. It has a cure rate of about 90 percent if caught early and Spitzer’s tumor was in the earliest stage. Immediately, the resident of Orange began researching the disease and seeking doctors throughout Southern California, determined to find a cure that also would allow him to maintain his voice.

“Voice preservation was critical to me,” explains Spitzer, who was 48 when he was diagnosed. “I didn’t want to lose my voice or sound  gravelly my entire life if I could help it. That really was a driving force in my decision-making matrix.”

Top laryngeal cancer experts he interviewed mentioned one name repeatedly: UC Irvine's Dr. William B. Armstrong, a head and neck surgeon with the Chao Family Comprehensive Cancer Center, Orange County’s only National Cancer Institute-designated comprehensive cancer center. Unsure whether he wanted surgery or radiation therapy, Spitzer met with Armstrong and UCI Health radiation oncologist Dr. Jeffrey Kuo and grilled them like the seasoned courtroom attorney he is.

“With this type of tumor, the decision for treatment isn’t always clear-cut,” explains Armstrong. The quality of a patient’s voice is not as predictable after surgery as it is after radiation because it’s not known how much vocal cord tissue must be removed until the operation occurs.

“Someone who makes his living with his voice may make a different decision from what a person who doesn't use his voice professionally might decide,” says Armstrong, who leads UCI Health ear, nose and throat services, as well as head and neck surgery.

Armstrong and Kuo “walked me through the pros and cons of each methodology in a very professional, objective manner,” Spitzer says. “There were no egos involved.” He chose radiation therapy “even though I knew it was going to be a much more strenuous journey.”

It was tough indeed. Every day for nearly 1½  months Spitzer underwent treatment with the cancer center’s precise Varian Trilogy linear accelerator. While he was immobilized on a special table, the high-powered machine revolved around his head for about 10 minutes and sent two focused radiation beams at the voice box, hitting only the cancer.

There were side effects. His throat became so painful he could barely swallow. He drank protein shakes and ate gelatin when he could eat at all. He gargled with a painkilling liquid. Soon he couldn’t talk because of the trauma the radiation caused to his vocal cords. Next, the skin on his neck “went completely reptile,” discoloring and peeling, leaving him with red and raw skin.

Everyone at the cancer center impressed Spitzer—not only the doctors, but also the nurses, radiation technicians and support staff. “They know their worst day is better than whatever you’re going through as a cancer patient, and they are all so caring.”

Through it all, he went to work every day. “I was counseled by former cancer patients that attitude and a will to survive is critical to the treatment process.” As an assistant district attorney in Orange County, he was leading a team that was preparing for trial.

Treatment was a trial as well, but Spitzer marvels that everything at the cancer center—right down to the valet parking service—ran like clockwork, enabling him to complete each treatment during his lunch break.

The radiation therapy was successful. “His cancer is in complete remission,” says Kuo. “And his voice quality is good.”

Spitzer has regular follow-up visits with Armstrong, who says that because the cancer was caught so early, the chances for a complete cure—defined as cancer-free for five years—are very good.

Spitzer also was treated by a UC Irvine gastroenterologists for acid reflux — a condition for which he was treated elsewhere before cancer was diagnosed. In a highly specialized procedure, a probe was implanted in Spitzer's esophagus that confirmed the acid reflux. Spitzer had never suffered from heartburn, the most common symptom of acid reflux, but he did suffer from another symptom — extreme hoarseness. “The acid was coming up while I was sleeping and sitting on my vocal cords, cooking them,” he says.

Today, in an effort to keep the acid reflux under control, Spitzer maintains a strict “best practices” dietary regimen. The key: no food or drink three hours before sleeping. His vocal cords tell him when he breaks his own rules.

“If I am hoarse or clearing my throat in the morning, I know I blew it,” he says. “As long as I keep acid irritation to my vocal cords at a minimum, I am confident that cancer will not reoccur.”

He feels deeply indebted to the medical experts who saved his voice. “I feel strongly that UCI Health is among the finest in the nation. My doctors teamed together to advise me about the best course of action to preserve and maintain my voice. Because of their personal dedication, I will have a strong voice for years to come.”