Military veteran beats the odds against esophageal cancer

By Jessica Hirst

If you saw Brett Nowlin today, you might see a vibrant 38-year-old out for a six-mile walk, playing disc golf at the park on a sunny day, or visiting Yellowstone with his family. You probably wouldn’t realize the obstacles he has overcome over the past few years to get to that particular moment.

The trouble began in the summer of 2018, when Nowlin noticed that he was having a hard time swallowing. At first the problem was just a minor annoyance, but as the weeks went on, he started to lose a noticeable amount of weight and find it more and more painful to eat rougher foods like broccoli.

At 35, healthy and strong, Nowlin figured that he likely had a straightforward case of acid reflux, which runs in his family. With three small children and a full-time job, life was busy and Nowlin put off visiting the doctor for about five months.

Finally, during a visit to the gastroenterologist in the fall, a scope revealed that in fact Nowlin had a mass in his esophagus that was consistent with esophageal cancer.

Facing an unexpected trial

“I’d never been to the doctor for any health reason at all until then. I played sports, ran 5ks, roughhoused with my kids, and rode a motorcycle. I didn’t have any family history of this type of cancer. My wife and I just looked at the doctor and didn’t know what to say. We were pretty shocked,” says Nowlin.

After more visits to specialists, Nowlin found out that his cancer had spread beyond the esophagus into a lymph node by his aorta and as a result was categorized as stage 4, the most advanced stage possible.

Esophageal cancer is cancer of the tube that runs from the throat to the stomach. It’s most frequently diagnosed in people between the ages of 64 and 74, and patients younger than 45 represent only 3.2 percent of all cases. Regardless of age, though, esophageal cancer tends to grow aggressively and be difficult to treat. It’s the sixth deadliest type of cancer worldwide.

Having served in the military for 10 years including two tours to Afghanistan, Nowlin was used to dealing with tough and uncertain situations. But this one felt different. “Why had I returned home from six years away only to face this new challenge? Was I going to even see my children become adults?” Nowlin wondered.

An innovative strategy

After being referred to Prakash Gatta, MD, FACS, board-certified and fellowship-trained esophageal surgeon at MultiCare Cedar Surgical Associates, and Daniel Mumme, MD, cardiothoracic surgeon at MultiCare Pulse Heart Institute, the three settled on an innovative plan for treatment. Not one to avoid a challenge, Nowlin opted for a more aggressive approach not typical for esophageal cancer patients.

“Brett is the youngest patient we’d ever seen with esophageal cancer up to that time,” says Dr. Gatta. “For patients who have metastatic stage 4 esophageal cancer (cancer that has spread beyond the margins of the esophagus into other areas of the body), the textbook approach is to shrink the tumor just enough to give them a better quality of life. But with Brett being so young and in the prime of his life, we believed he could handle a more aggressive course of chemotherapy and radiation, and ultimately surgery if that went well. We felt we could offer more to him, but there was no precedent to this approach anywhere in published literature, which is what makes his case unique.”

Nowlin began a four-month course of intensive chemotherapy and radiation with the fervent hope that it would shrink his tumor enough to make it operable afterwards. To alter the course of a fast-growing cancer like his, the treatment had to be especially aggressive, and the process wasn’t always easy on Nowlin. He faced profound fatigue and at times was unable to eat orally due to swelling from the radiation.

Still, he persisted—and the difficulty paid off when he received a call letting him know that his tumor was finally small enough to be surgically removed.

A few weeks later, Nowlin underwent a complex 12-hour surgery involving his abdomen and chest. Dr. Gatta and Dr. Mumme worked closely together to perform a delicate resection of Nowlin’s esophagus, removing the primary tumor mass with clear margins. They were able to use a minimally invasive robotic technique requiring only tiny incisions for the lower portion of the surgery.

“This was a technically difficult procedure even for a young patient due to scarring from the radiation and the behavior of Brett’s particular cancer. He had a very aggressive tumor, almost five centimeters in size even after treatment. But we were very satisfied with the outcome of the surgery, including the sizeable margins we were able to capture and how well Brett handled the procedure. Knowing that he’s starting to feel better now and able to spend more time with his family is so rewarding,” says Dr. Mumme.

There for me “every step of the way”

Recovering from this type of surgery typically takes 2-3 weeks in the hospital and another 12-16 weeks at a rehab center. But Nowlin was at Tacoma General Hospital for just one week and then released directly home.

“MultiCare has been amazing throughout this whole process,” says Nowlin.”

After surgery, the team was there to check in on me every hour and even just sit and chat with me when I needed that. Everyone who had a hand in my care let me know what was going on every step of the way and what I needed to do to reach my goals.”

He recalls one day just after he had completed chemotherapy, when the prospect of surgery was still uncertain. “I was sitting in Dr. Gatta’s office, and he just set the paperwork aside and said, ‘How are you doing?’ We sat and talked for 30 minutes and he was able to listen and reassure me that he was going to do everything he could at every point. Not many doctors do that,” he says.

After recovering from surgery, Nowlin underwent a final round of radiation to shrink the cancer still left in his lymph nodes. Today, even though he won’t technically be in remission until the five-year mark, his scans show no sign of cancer.

With the help of MultiCare specialists, he’s continuing to work on rebuilding strength and gaining weight, and he is making progress every day. “Compared to where I was two years ago, it’s night and day,” he says. “I’m working three days a week, outside doing things I love every weekend, and spending more time with my kids. This has really helped me appreciate what’s most important.”