Cancer Diagnosis Gives UAMS Medical Student New Perspective

By Susan Van Dusen

“It was a really tough exam. I had been studying for weeks,” the 27-year-old UAMS College of Medicine student said.

An Atlanta native, Norton landed at UAMS after his brother, then a resident in the Department of Otolaryngology, suggested he give it a look.

“Little Rock wasn’t even on my radar, but he gave me a tour and I was really impressed,” he said.

After being accepted into the college in 2016, Norton left his job at the Centers for Disease Control, moved to Arkansas and delved headfirst into the challenges of medical school.

“My brother was getting excellent training in his residency at UAMS, so I felt confident the College of Medicine would also be a good choice for me,” he said.

It was about two years later, after Norton completed his first licensing exam and was preparing to enter his third year of med school, when he noticed something alarming: a bump had developed on the back of his testicle.

With his newly acquired medical knowledge top of mind, Norton immediately knew he fell squarely in a high-risk group for testicular cancer. According to the American Cancer Society, about half of testicular cancers occur in men between the ages of 20 to 34, and the cancer is more common in white men than in African-Americans or Asian-Americans.

“Knowing I fit into that category, I was a little worried,” he said.

A visit to Norton’s primary care physician temporarily eased his fears when he was told the bump appeared to be a simple cyst. When it began to hurt a few weeks later, the same doctor determined it to be a condition known as epididymitis, an inflammation of the tube at the back of the testicles that stores and carries sperm.

But for Norton, the diagnosis of epididymitis didn’t ring true.

“I didn’t really think that was the problem,” he said, since epididymitis is most commonly caused by sexually transmitted diseases he does not have.

However, Norton followed the doctor’s orders and tried an over-the-counter pain killer, hoping it would relieve the increasing discomfort.

As days went by and the pain worsened, Norton decided it was time to see a specialist and made an appointment in the Urology Clinic at UAMS.

His treatment began with a round of antibiotics, but they offered no relief. It was then that an ultrasound was performed and revealed the true cause of Norton’s pain: a tumor of about 2.5 centimeters in his testicle.

“The ultrasound was on a Friday, and then it was a whirlwind,” Norton said. His family arrived from Atlanta, and there was talk over the weekend of going home for treatment. Ultimately, though, Norton decided that UAMS was where he was meant to be.

“I’m a med student here. People know me, and I know the doctors and nurses. There was a level of familiarity that was comforting. Plus, I knew I would get the best care here,” he said.

Early the next week, Norton met with his surgeon, Mohamed Kamel, M.D., and surgery was scheduled for Wednesday, a mere five days after his diagnosis. Norton also made the decision to bank his sperm prior to surgery, as treatment for testicular cancer can lead to infertility.

“I can’t say enough about Dr. Kamel. He answered all of my questions, even the simple ones. He was really in my corner and pushed to get things done on my behalf,” he said.

Kamel is an associate professor in the UAMS College of Medicine Department of Urology.

After the surgery, it was determined that Norton’s cancer, which had already spread to his lymph nodes, was a nonseminoma tumor with a high embryonal component, meaning it was an aggressive form of the disease that affects the precursors to sperm cells known as germ cells.

Genetic testing also determined him to have the isochromosome 12p gene mutation, which contributed to the tumor’s invasive and aggressive nature and, at times, its resistance to treatment.

Rashmi Verma, M.D., a medical oncologist in the UAMS Winthrop P. Rockefeller Cancer Institute, oversaw Norton’s chemo regimen, which included four stays in the hospital, as well as outpatient treatments.

“Chemotherapy for testicular cancer involves three drugs that require the patient be monitored around the clock,” said Verma, assistant professor in the UAMS College of Medicine Division of Medical Oncology.

While low blood counts delayed Norton’s treatment for a few days, Verma’s close attention to his condition allowed her to restart the chemotherapy regimen as soon as his counts were back up.

“We monitored his blood counts every 48 hours and started chemo again as soon as it was safe to do so,” she said.

Verma also worked closely with Norton and his family to ensure he avoided any potential risk of infection while home between hospital stays. Had he contracted an infection or pneumonia, his treatment could have been delayed for weeks, resulting in the possible development of residual cancer, she said.

“Dr. Verma was always very straightforward, and I appreciated that,” he said.

Finally, about four months after his surgery, Norton received the call he had been waiting for.

“I had a CT scan on January 31, and Dr. Verma called the next day to tell me I was cancer free. I was beyond relieved,” he said.

In total, Norton took about a five-month leave of absence from the College of Medicine and will return full time to his studies in March 2019.

“Everyone at the College of Medicine has been very supportive. At first I wanted to power through and avoid falling behind in school, but they reassured me I didn’t need to feel guilty for taking time off to care for my health,” Norton said.

With his treatment successfully completed, Norton said he’s now ready to put this experience behind him and get back to life, using his own experience as a patient to help guide his future as a more empathetic and understanding physician.

“Being a med student, I had to remind myself that it was OK to be the patient. Cancer makes you accept new roles in life that you never expected,” he said.