Acclaimed Vocalist to Perform After Mount Sinai Saves His Life—and Voice—From Cancer

Johannes Schwaiger, Mount Sinai patient and Broadway musician, with fellow Broadway musician and wife Tessa Lang

About a decade ago, Broadway musician Johannes Schwaiger noticed a hoarseness in his voice, which he initially dismissed as allergies. A visit to a doctor that spring identified the real culprit—a tumor in the back of his throat. The subsequent care Mr. Schwaiger received at Mount Sinai, which included minimally invasive surgery and voice therapy, saved both his life and his voice.

“Now, thinking back, 11 years ago, I am completely cancer free and have followed my passion of music, in my case, singing, with a newfound purpose—to bring people together, and find those things that unite us,” he says.

On Thursday, June 6, the singer, who has performed on Broadway, including in Cats, will tell his story—one about “all kinds of love”—in a performance titled “All the Love in the World,” at the Kaufman Music Center in New York City. Mr. Schwaiger will perform alongside his wife, fellow Broadway musician Tessa Lang, who encouraged him to see a doctor when he began experiencing symptoms and stayed by his side through cancer treatment and his journey back to health.

“She is my angel,” says Mr. Schwaiger, explaining that his ordeal with cancer was also hers. On stage, the couple will tell their story of love, hope, and survival through a selection of American, French, and Italian love songs.

“We’ve woven a tapestry of all the ways people love, and the journey that love takes, the highs and the lows, and the pursuit of love, no matter what the journey is,” says Ms. Lang of their upcoming performance.

For the couple, the journey began when Mr. Schwaiger received a diagnosis of stage IV head and neck cancer in 2013, and his worst fear—losing his voice—became a real possibility. “I underwent a CT scan, and the results were devastating,” he remembers.

Many patients who undergo surgery for head and neck tumors need a tracheotomy, a surgical opening in the neck that allows them to breathe through a tube.

“I walked around in a daze between disbelief and realty,” recalls Mr. Schwaiger.

The musician began singing at the age of nine in Munich, Germany, his hometown, and his international career went on to span operas, oratorios, concerts, and musical theater. The possibility of losing his voice “felt like losing my life,” he says.

The diagnosis also came as a shock to Ms. Lang. “Johannes was just so healthy, he grew up on a farm. There was never anything wrong with him, so that’s why this was just so unusual,” she says.

Mr. Schwaiger’s doctor referred him to Mount Sinai, where doctors performed laser surgery, a minimally invasive procedure, removing about 85 percent of the tumor without harming the surrounding tissue, eliminating any need for a tracheotomy. After the surgery, he underwent chemotherapy and radiation to remove the remaining cancer, which was provided under the expertise of his oncology team at The Tisch Cancer Institute at Mount Sinai.

“What I so much loved about Mount Sinai is they didn’t proclaim doomsday,” he recalls. “They said, ‘You have a good chance of healing, and that’s what we are going to do.’”

While the treatment cured him, the radiation to his throat made speaking and swallowing difficult, and Mr. Schwaiger’s voice was again in jeopardy. However, with guidance from Cathy Lazarus, PhD, Associate Professor, Otolaryngology, Icahn School of Medicine at Mount Sinai, he was able to keep his voice—and his career. In her research and clinical practice, Dr. Lazarus specializes in restoring function in head and neck cancer patients.

“It was tremendously helpful,” he says, adding that the therapy also helped him regain his ability to swallow and eat normally.

Mr. Schwaiger, who teaches at the American Musical and Dramatic Academy in New York City, describes the care he received from Mount Sinai as “divine intervention.” In 2015, he shared his story with fellow cancer survivors at a luncheon at Mount Sinai-Union Square. To show his appreciation for all who helped him during his ordeal, he decided to tell his story through a series of songs, which were “all about healing,” he says.

“I started to look at my voice from a different lens and found a new purpose within,” he says.

It is a new purpose Mr. Schwaiger will convey when he takes the stage with Ms. Lang for the All the Love in the World concert this June.

“This concert is a testament to the journey I walked through and the love that endured and helped me to overcome and heal,” he says.

Get Your Ticket to the “All the Love in the World” Concert

The “All the Love in the World” concert is a benefit in support of Dreamgates, a nonprofit organization that uses performing arts events to bridge cultural divides and embrace artistic co-creation in a global community. It will take place Thursday, June 6, at 7:30 pm at the Kaufman Music Center in New York City. Tickets are available here.

Are you a cancer patient?

Free tickets will be set aside for the first 10 cancer survivors who contact Mount Sinai. Those interested should email David Schwab at david.schwab@mountsinai.org with the subject line: “All the Love in the World.”

Questions to Ask Your Doctor About HPV-Related Oral Cancer

To make an appointment with Raymond Chai, MD, call 212-844-8775.

Did you know that the human papillomavirus (HPV) can cause cancers of the oropharynx (tongue, tonsils, and back of the throat), similar to how HPV causes cervical cancer?

Most oral HPV infections can clear naturally without treatment. But if the virus persists in the system, it could incite more serious health issues, such as these cancers. Additionally, the incidence is low, with about 12,000 new cases of these HPV-associated cancers diagnosed each year in the United States, but 80 percent affect men.

Raymond Chai, MD, a head and neck surgeon at the Mount Sinai Union Square location of the Head and Neck Institute/Center of Excellence for Head and Neck Cancers, answers some frequently asked questions about oral HPV infections.

What are my options for treatment?

The two main approaches are upfront radiation treatment with chemotherapy versus a primary surgical approach.

Do you offer transoral robotic surgery (TORS)?

This technology has largely replaced traditional surgery, which typically required splitting the lip and cutting the jaw to access the tumor.

Do you have a true multidisciplinary approach to this disease?

Both surgical and non-surgical treatments should be on the table and discussed. In select cases, the use of TORS can either completely eliminate postoperative radiation, lower the dose of postoperative radiation, or eliminate the need for chemotherapy.  This may reduce the risk of long-term side effects from high-dose radiation and chemotherapy.

What is your experience level with TORS? How many cases have you performed?

Experience matters with this new technology and as with any new surgery, there is a learning curve. Even seasoned surgeons who are experts with open approaches need to have the appropriate training and experience to become proficient in performing this surgery. Robotic surgery does not have the same tactile feedback that surgeons typically rely on in performing procedures. In addition, in TORS, complex anatomy needs to be re-learned from the inside-out, since the surgeon is now operating from inside the mouth instead of outside from the neck.

What is your rate of complications, particularly bleeding?

TORS has been shown to be very safe in expert hands, with a low rate of postoperative bleeding of 2-4 percent.

What is your average length of stay for TORS patients?

Studies have demonstrated that for high-volume TORS practices, patients on average leave the hospital two days following surgery.

Do you work closely with a swallowing therapist?

Whether the treatment is radiation with chemotherapy or surgery, the best post-treatment swallowing outcomes are seen when patients are followed closely with a seasoned speech-language pathologist.

 What are your research efforts with TORS?

Across the country, investigators are actively recruiting patients in clinical trials that are using TORS as a platform for de-intensifying their cancer treatment. Mount Sinai was one of the early adopters of TORS and continues research activities related to the reduction of complications.  We are leading efforts in de-intensification with the SIRS 2.0 trial, which relies on a novel blood test evaluating circulating tumor DNA (ctDNA).  If HPV ctDNA becomes undetectable after surgery, patients are either observed without additional treatment or receive a highly de-intensified regimen of chemotherapy and radiation.

What is your protocol for follow-up care?

Nearly 100 percent of distant metastases for classic head and neck cancers related to smoking occur within the first two years of treatment. However, for HPV-related throat cancers, recent studies have suggested that distant metastases can occur even five years following treatment. Patients with this disease require long-term close follow-up. Mount Sinai has been a pioneer in the use of ctDNA for follow-up care. This highly accurate test can allow for earlier detection and treatment if the cancer recurs.

Should I get a second opinion?

The answer should always be ‘yes.’ Patients need to be able to fully explore their options and to familiarize themselves with centers that have the most experience with all treatment options for this disease, whether that be TORS or non-surgical therapy.

Do I Need a Biopsy or Surgery for My Thyroid Nodule?

Thyroid nodules are very common. These masses within the thyroid gland are composed of tissue and/or fluid and are estimated to be present in more than 50 percent of those aged 50 and older.  Nodules can run in families, are more common in women, and increase in frequency with age.

Patients diagnosed with a thyroid nodule often ask if their nodule needs to be biopsied or surgically removed. Sometimes the answer is yes, but often the answer depends on a number of patient and nodule-related factors. Catherine Sinclair, MD, FRACS, head and neck surgeon at Mount Sinai West, explains why your nodule may, or may not, need special attention.

How do you know if you need a biopsy?

More than 95 percent of thyroid nodules are non-cancerous, although a family history of thyroid cancer in a first-degree relative or whole-body/neck/chest radiation exposure may increase the risk. Nodules have a low cancer risk, so whether to biopsy depends on the size and ultrasound appearance of the mass.

Over the past decade, many nodules smaller than one centimeter have been incidentally detected on imaging (CT, MRI) that was ordered for another reason. Often these nodules were inappropriately biopsied, and, if the biopsy was positive for thyroid cancer, overly extensive total thyroid surgery was performed. Recent data from Japan and the United States suggests that appropriately selected thyroid cancers can remain stable over time. Termed “microcarcinomas,” these cancers are less than one centimeter in size and may be adequately managed without surgery or with limited thyroid surgery.

How is risk measured?

In an effort to reduce “incidentally diagnosed” microcarcinomas, the American Thyroid Association (ATA) Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer classifies nodules into risk categories for biopsy based on thyroid nodule size and ultrasound appearance. Those classified as high-risk nodules should be biopsied when more than one centimeter in size, whereas low-risk nodules—depending on their appearance on ultrasound—should not be biopsied until they are one and a half to two centimeters in size. Many thyroid surgeons perform their own ultrasounds and use the ATA risk classification system (along with any biopsy results) to determine who should have a biopsy, which nodules should be operated on, and which nodules can be safely observed.

What are the symptoms and treatment for thyroid nodules?

In addition to posing a cancer risk, nodules may also need to be removed if they grow very large (greater than four centimeters) and cause symptoms like difficulty swallowing, neck discomfort, hoarseness of the voice, and airway compression with shortness of breath. Frequently, a thyroid lobectomy—the removal of a portion of the thyroid gland—may be adequate treatment for a non-cancerous thyroid nodule as well as for small cancerous nodules that are less than four centimeters. However, patients should speak with their surgeon in detail beforehand about the many additional factors affecting surgery, such as the status of the other thyroid lobe, your age, and your personal preferences.

In summary, a thyroid nodule may require an operation if there is a high risk of the nodule being cancerous or if the non-cancerous nodule is large and causing symptoms.

Non-cancerous nodules that are asymptomatic should be observed with intermittent ultrasound follow-up when appropriate. If surgery is necessary, the least aggressive option that will effectively treat the nodule should be chosen.

Catherine Sinclair, MD, FRACS, is a head and neck surgeon at Mount Sinai West, at 425 West 59th Street on the 10th floor. She is a board certified and fellowship-trained surgeon at the Head and Neck Institute, and treats all stages of thyroid disease and parathyroid disease.

Thyroid Cancer Pathology Reports

Urken_headshotGuest post by Mark Urken, MD, Chief of Mount Sinai Beth Israel’s Division of Head and Neck Oncology. To make an appointment with Dr. Urken, call 212-844-8775.

Thyroid cancer is the most common endocrine cancer and it is one of the few cancers that has increased in incidence over recent years. Thyroid cancer occurs across all age groups, but is more common among people ages 20 to 55 and occurs more frequently in women. Before treatment begins, it is important to make sure your disease has been diagnosed accurately to ensure that the treatment options offered are right for the specific disease. (more…)

Thyroid Cancer: It’s Not Simply a Pain in the Neck

Guest blog written by Deena Adimoolam, MD, Assistant Professor, Department of Medicine, Division of Endocrinology, Diabetes and Bone Disease

The thyroid is a butterfly-shaped gland with two sides that sits in front of your windpipe and when it is functioning normally you don’t even know it exists. The main hormone it secretes is thyroxine, which helps to regulate metabolism, growth and development, as well as body temperature. The thyroid gland should not be mistaken for the parathyroid glands, which are completely different entities with separate functions. (more…)

Low-Risk Thyroid Cancer: Surveillance or Surgery?

Guest post by Ilya Likhterov, MD, Assistant Professor of Otolaryngology – Head and Neck Surgery and member of the Division of Head and Neck Oncology at Mount Sinai Beth Israel. To make an appointment with Dr. Likhterov, call 212-844-8775.

Ilya Likhterov, MDThyroid cancer diagnosis is becoming more and more common among patients of all ages, but in the vast majority of cases, thyroid cancer is slow growing and rarely causes symptoms while it is small. Although there is potential for thyroid cancer to spread to the lymph nodes in the neck, overall prognosis is excellent even in the high risk, advanced stages of disease. (more…)

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