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Second Opinion on Salivary Gland Tumor Paves Way to Motherhood
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When Bryna Halloran was diagnosed with a salivary gland tumor that didn't align with her age, gender or medical history, she turned to Mayo Clinic for a second opinion. At Mayo, Bryna found a physician who listened to her concerns, and she was offered a treatment plan that exceeded her expectations.
When first-time mom Bryna Halloran looks at her young daughter, Willow, she is filled with wonder and awe. Underscoring Bryna's amazement at Willow's existence is gratitude for the life-changing medical treatment that cleared the way for Willow to be born.
Bryna's path to motherhood wasn't easy. It involved the removal of her fallopian tubes and took her through the process of in vitro fertilization and a failed embryo transfer. Then her journey almost was derailed when Bryna discovered a lump on her cheek next to her ear.
After consulting with local doctors, Bryna was dubious about her diagnosis of a rare, benign tumor. So she went to Mayo Clinic. There she met Jeffrey Janus, M.D., in Otorhinolaryngology/Head and Neck Surgery.
Dr. Janus removed the mass, and Bryna learned that it was cancerous. Three months after the surgery, she returned to Mayo Clinic for a follow-up scan. The results showed no trace of cancer cells. A short time later, Bryna underwent another embryo transfer. This time, the transfer was a success, and Bryna became pregnant. The following December, Willow was born.
Peculiar diagnosis, nagging doubt
When Bryna first noticed the lump on her cheek, she and her husband, Michael, who lived in Amana, Iowa, paused their fertility program so the lump could be examined. That exam led to an ultrasound, which revealed a mass. The mass was biopsied and diagnosed as a Warthin's tumor.
Having never heard of that type of tumor, Bryna immediately researched her diagnosis. She learned Warthin's tumors are benign growths in the salivary glands that typically affect older men with a history of smoking.
"I've never smoked. At the time, I was 35. I didn't fit the profile," says Bryna, who brought her concerns to a local ENT physician. "I said, 'Don't older people get this? I'm young.' And he said, 'I've never heard that.' At that point, alarm bells went off because it was contrary to everything I'd read."
"I'd already had a great experience with Mayo and knew they really take care of you there."
Bryna Halloran
Sitting in her car after that appointment, Bryna called Mayo Clinic and made an appointment. Two weeks later, in February 2016, Bryna traveled to Mayo Clinic's Rochester campus for a second opinion.
As she decided to get another perspective on her diagnosis, Mayo Clinic was the obvious choice, Bryna says, explaining that when she was a teenager, a family member underwent successful brain surgery at Mayo Clinic. "I'd already had a great experience with Mayo and knew they really take care of you there."
Experienced providers, precision care
Bryna's research had informed her that not all tumors that affect the salivary glands are malignant, but some of them are. She wanted a provider with ample experience with these tumors who could give her a definitive answer on her case. At Mayo Clinic, Bryna's found experienced providers who not only listened to her, but did so without judgement.
"Absolutely not at Mayo — but as a woman, sometimes doctors see you as hysterical or alarmist," she says. "I think women should follow their intuition even if somebody says differently."
"Bryna is a smart lady and had done her research," Dr. Janus says. "She saw that she wasn't the typical person who gets Warthin's tumors. She's 35. She hasn't smoked. And she wanted a second opinion."
"Dr. Janus was really interested in listening to my story and looking beyond what the history was," Bryna says. "And he agreed with me that it would be really weird for someone my age to have a Warthin's tumor."
"Dr. Janus really put me at ease. He knew what he was talking about. He was experienced in the field and had seen this before."
Bryna Halloran
Dr. Janus informed Bryna that he either could perform another needle biopsy of the mass, or he could remove it, and then definitively confirm its nature with laboratory testing. Bryna opted to have it removed.
"Dr. Janus really put me at ease," Bryna says. "He knew what he was talking about. He was experienced in the field and had seen this before. I felt so comfortable with him that I was happy to have it out as soon as possible."
The next day, Feb. 1, 2016, Dr. Janus removed Bryna's parotid gland — the salivary gland that contained the tumor — as well as 21 neighboring lymph nodes.
"It was a sizable mass," Dr. Janus says. "We had the benefit of frozen section pathology during her operation, which determined it was an intermediate to high-grade malignancy, and thus took all of her parotid gland."
Removing the parotid gland is a delicate procedure because the nerves for facial expression run through the middle of the structure. During the surgery, Dr. Janus removed the diseased tissue above and below the facial nerve, while preserving the nerve's main trunk and branches.
It's common for patients to have weakness after surgery, but Bryna did not experience that side effect during her recovery. "She healed absolutely beautifully," Dr. Janus says. "She's doing really well. There is no evidence of recurrence or residual disease."
After Dr. Janus took out the tumor, Mayo Clinic pathologists determined that — as Bryna had suspected all along — it was not a Warthin's tumor. It was it was an acinic cell carcinoma of the parotid gland.
New perspective, fresh appreciation
Bryna will continue to receive follow-up scans for the next several years to monitor the area for cancer recurrence. While the chance of her cancer coming back is low, the episode has given Bryna a new appreciation for life.
"At first, I was a lot more aware of my mortality, for better or worse, because it's something you don't think about on a day-to-day basis," Bryna says. "I really just think about how I can be a better person in general. I've added a few lifestyle changes and am eating a mostly a vegan diet now and trying to be the best mother I can be to my baby."
Sweetening Bryna and Willow's story is the appreciation that it could've ended so differently for them. "The really frightening part of this is that if I'd have watched the tumor and waited to treat it, I would've just gone ahead and done another embryo transfer with a tumor in my face," Bryna says.
"Do your research, and trust your intuition, and find the best person that you feel comfortable with for your health."
Bryna Halloran
Because Bryna's bout with cancer was so intertwined with Willow's creation story, she plans to tell her daughter about it when Willow is old enough to understand.
"I just want her to know the whole story. I believe in being honest with children," Bryna says. "When I have to go in for a follow-up, she'll know that I was sick, and that I just need a checkup every once in a while to help me stay well."
The episode also has reinforced Bryna's trust in herself and following her instincts, especially as it pertains to her body.
"Sometimes we see doctors as infallible, and they definitely are not," Bryna says. "They are human. Some are more experienced than others. Do your research, and trust your intuition, and find the best person that you feel comfortable with for your health."
HELPFUL LINKS:
- Learn more about salivary gland tumors.
- Visit the Department of Otorhinolaryngology/Head and Neck Surgery.
- Explore Mayo Clinic.
- Request an appointment.
