Then, she started having a constant cough and scheduled an appointment with her family physician. Dugan, of Spartanburg, was told she had acid reflux, but the cough wouldn't cease, even with medication. She began to notice her voice was becoming a bit hoarse, but delayed seeing a gastroenterologist about the acid reflux because of a trip scheduled to visit her parents. Then, the cough got worse, and she started having trouble swallowing.
Once Dugan returned home, she made the appointment with the gastroenterologist and learned she had laryngeal cancer shortly before Thanksgiving 2008.
She and her husband, Sean, immediately left the gastroenterologist's office to have an ear, nose and throat doctor perform a biopsy and was told the cancer was Stage 4, the most advanced form of laryngeal cancer.
“We thought she was going in for a normal checkup, and the last thing we thought we'd hear was she had cancer,” said Dugan's daughter Jaime Huffman, a Spartanburg native who appeared on the CBS show “Survivor: China” in 2007.
The cancer is in remission, but Dugan and her family have experienced a roller coaster of emotions since the diagnosis nearly two years ago. There have been appointments with doctors in Spartanburg, Winston-Salem, N.C., and Houston at the M.D. Anderson Cancer Center. There were also weekly visits to a speech pathologist in Columbia.
An emergency tracheotomy was scheduled once the severity of the cancer was determined. That involved creating a surgical airway by making an incision in her neck. Her voice box and a small portion of her esophagus were also removed during the 2008 holiday season. She lost her voice, and her family quickly learned to read her lips.
The cancer was believed to be in remission. Then, tumors were found in her lungs and they were told she would live three months to a year. However, Dugan, who wasn't very tech savvy, started doing research on the Internet and the family scheduled an appointment with a doctor at the M.D. Anderson Cancer Center.
Dugan credits the relationship between M.D. Anderson and Spartanburg Regional Medical Center's Gibbs Cancer Center with her being able to continue her life now that the cancer is in remission after chemotherapy and radiation.
Throughout this ordeal, her family has been amazed to see how the stubbornness they've been accustomed to won't give in to cancer.
“Mom is very stubborn, and it came in handy this time in her life,” Jaime said.
Head and neck cancers are rare, and Dugan's case is even more odd because she's not a smoker.
Amy Curtis, a radiation oncologist at the Gibbs Cancer Center, said smoking and exposure to some chemicals are the most common causes of head and neck cancers. Curtis said 5,000 people in the United States are diagnosed with head and neck cancers a year compared to 170,000 people who are found to have lung cancer. Plus, people tend to brush off the small lump they might feel on their neck.
“Most of these are caught later because people feel a knot on their neck and think it will go away,” Curtis said.
Curtis said physicians often can't see the larynx, which is a 2-inch-long, tube-shaped organ in the neck used to breathe, talk and swallow. Patients are advised to see an ear, nose and throat doctor who check for laryngeal cancer by using a mirror comparable to ones used by dentists to see the back of the throat. Endoscopes are sometimes used, too. Curtis said smokers are most likely to have a doctor begin checking for laryngeal cancer. Initially, patients who have never smoked are often prescribed antibiotics, and they could be asked to give their voice rest if hoarseness is one of the symptoms being presented.
Curtis said if laryngeal cancer is caught in Stage 1, patients have a 95 percent survival rate after having part of the vocal chord removed or seven weeks of radiation. She said between 25 and 40 percent of patients diagnosed with laryngeal cancer in Stage 4 survive. Like any cancer, it's important to stop the spread of the disease, so that's why a voice box with cancerous cells is often removed.
“It's a difficult surgery to go through,” Curtis said. “We try to use organ prevention as much as we can.” Once a person loses their voice box, they have to find a new way to communicate. Dugan whispers, and she carries a dry erase board with her. Her younger daughter, Jenna, a psychology major at USC Upstate, would often drive 20 minutes from campus to check on her mom between classes because phone calls and texts often didn't work.
“When she wouldn't text me I didn't know if she was OK, so I would drive 20 minutes to check on her for five minutes,” Jenna said.
However, there is hope of speaking again, and Dugan is determined to do it.
Erica McCarthy, a speech pathologist with the Gibbs Cancer Center, said there are four options laryngeal cancer patients can choose from to begin orally communicating again. Three of the options include using devices, such as an electrolarynx that vibrates words out after a person mouths them. McCarthy said esophageal speech, the option chosen by Dugan, is the most difficult option. It involves forcing air into the esophagus to speak with a new voice.
“That says something about her wanting to try something others might throw off and not consider,” McCarthy said of Dugan.
McCarthy said Dugan is one of the most dedicated patients she's had, but they stopped meeting so Dugan could work with a Columbia speech pathologist specializing in esophageal speech. However, that process has been hindered because of the scar tissue formed in her esophagus after six weeks of radiation, which caused her throat to shrink. She visits a doctor every six weeks to have her throat stretched. Dugan wrote that the goal is to get her throat a certain size so she'll be able to eat solid foods again and receive a trachea esophageal puncture, which will allow her to redirect air to speak.
She's been touched by the many people who've taken time to read her lips and those who've done nice things for the family, including pray.
The whole experience has made her family even closer. Jenna, who was attending school in Wilmington, N.C., returned home to help Sean care for Dugan. He works in Charlotte, N.C. Huffman and her husband, Erik, a Greenville native also appearing on “Survivor” returned to the area from Nashville, Tenn., to be closer to the family. The Huffmans live on Lake Lure. They're also expecting a son in about five weeks. He'll be the Dugans' first grandchild.
“That's another huge reason to fight my illness,” Dugan wrote in an essay describing her experience. “I want to see him and hopefully others grow up.”
