A month after contracting COVID-19 in January 2021, Nicholas Pastuovic was tired, had a severe cough, suffered from hot flashes and woke up in the middle of the night “soaked in sweat.” She was worried she had a problem known as long COVID, which is a long-term sequelae of the disease, and made an appointment with a doctor.
Tests revealed the surprising cause of his symptoms: a watermelon-sized tumor in his chest.
“Hearing that you have cancer is scary,” Pastuovic, 61, told .com. “I thought, I’m going to figure out what I have to do and I’ll do it.”
Shortness of breath and fatigue
After contracting and recovering from COVID-19 in early January 2021, Pastuovic felt well enough to take his annual trip to Florida with his wife. During dinner on the last day of the trip he felt very bad.
“I thought I was getting a cold because I was getting hot flashes,” he explained. “I would go to bed and wake up in the middle of the night drenched in sweat.” He also had a “terrible cough” and felt exhausted all the time and started to lose weight. Over the next few months, his symptoms came and went.
“Probably the worst thing you can do is… use the Google search engine,” he said. “It seemed like what I had found on Google was what people were experiencing post-COVID. “It was long COVID.”
In June, Pastuovic’s wife insisted he go to the doctor. The office nurse ordered a blood test and scheduled a CT scan. His blood test revealed an elevated tumor marker, indicating he might have some type of cancer. The CT scan revealed the location of a tumor in the chest.
“A couple of weeks went by and they did another CT scan (Computerized Axial Tomography) and the thing had grown significantly in two weeks,” he said. “It grew very fast.”
The tumor grew to the size of a small watermelon. Doctors did a biopsy to find out what type of cancer it was and discovered it was something called a germ cell tumor, a cancer that forms from nascent reproductive cells. Pastuovic stated that his tumor was not staged. Although germ cells normally migrate to the reproductive organs, some of Pastuovic’s did not, which is why the tumor grew in her chest.
“These germ cell tumors typically come from the reproductive organs,” Dr. Zaid Abdelsattar, director of the division of Thoracic Surgery and Lung Transplant at Loyola Medicine, told .com.
“(Pastuvic’s tumor) was in his chest and specifically in the center behind his sternum.”
Doctors still don’t know why Pastuovic developed a germ cell tumor in his chest.
“I wish we knew why these things happen,” says Abdelsattar. “There are not enough cases worldwide to establish a correlation or association with various risk factors. So it’s very difficult to know.” And in his case, he never had a family history of this.”
In retrospect, Pastuovic realized that he had trouble breathing for a while.
“Breathing became more difficult. That was apart from the chronic cough, like a dry cough,” he said. “It was very difficult to breathe deeply.”
Pastuovic met with doctors at Loyola Medicine in Chicago to learn about his treatment plan, which included inpatient chemotherapy. For six days, I would be in the hospital receiving various chemotherapies five of the six days. On the last day he received fluids before he could go home. In total, he spent four weeks in the hospital.
“It was brutal,” he said. “Between a week and 10 days after the first round, I had the paramedics at my house taking me back to the hospital because all my numbers, especially my white blood cells, were going down.”
He was able to stay home after subsequent rounds of treatment, although he received a blood transfusion to help boost his white blood cell count. Between rounds, he cut his hand and developed a blood infection that required another hospitalization. Doctors removed the chemotherapy port because they feared the infection would settle there. Luckily, he didn’t need it anymore. Chemotherapy during the COVID-19 pandemic isolated him at times, but Pastuovic is grateful for the kindness of the nurses on the oncology floor. He also focused on a goal that kept him motivated during treatment.
“My focus was, ‘I want to go to Florida in February,’” he recalled.
Before going to the beach, Pastuovic had to undergo surgery to remove the remains of cancer. By then, the tumor was the size of a softball.
“The severity of the operation was considerable, because there were large blood vessels intertwined with the tumor,” he explained. “When they put me in the operating room, I thought they were having a party because there were probably 15 or 20 people there.”
After a nine-hour operation in which doctors opened Pastuovic’s chest “as if it were an open-heart operation,” staff informed Pastuovic’s wife that the operation had gone well. After a few days in the hospital, Pastuovic returned home.
“It was a piece of cake compared to chemo,” she said. “You’re sore, but the recovery wasn’t that bad, frankly.”
Treatment of a rare breast cancer
Pastuovic’s tumor was located in an area where if it continued to grow it could create many problems.
“Anything that grows in that area has the potential to invade the heart, the main blood vessels, the lungs on both sides or even the bone,” said Abdelsattar, who operated on Pastuovic. “It is a rare type of tumor.”
Pastuovic’s tumor grew in the pericardium, the sac that surrounds the heart, part of a blood vessel that goes to the lung and his lung. That meant Abdelsattar and his team had to surgically remove the tumor from his chest. But before they could do that, they treated the cancer with something called VIP chemotherapy, which is “very strong” and works for this type of cancer.
“Helps reduce the size of cancer and it kills most of it,” he explained. “There’s still residual disease after it’s reduced, and we go ahead and resect it.”
In Pastuovic’s case, doctors removed everything, including some structures.
“We remove the cancer, we remove part of the blood vessel that supplies the lung and we remove part of his lung,” Abdelsattar said. “It all came together in one big block.”
This allowed the team to remove all remaining cancer cells.
“The body is amazing, so it can take care of most of these things without replacing anything,” Abdelsattar said. “We didn’t leave him with any residual (cancer) nor (did he have) any lack of function.”
After the operation, Pastuovic showed no signs of the disease. Although it has been two years since the operation without any signs of cancer returning, Abdelsattar said they will continue to monitor it with blood tests and scans for the next three years.
“He’s very good,” commented Abdelsattar. “He went to his daughter’s wedding. “All of that wouldn’t have been possible if we didn’t have the equipment and experience to do (this type of surgery).”
“I live differently”
Pastuovic’s dream of reaching the beach in February 2022 came true.
“Six weeks after the operation, I was in Florida, walking on the beach,” he said.
Doctors also had to remove a nerve that helps the diaphragm, meaning walking can sometimes be a challenge.
“Basically, only half my diaphragm works. So sometimes I have a hard time breathing,” he explained. “Over time, it has gotten better.”
His breathing improved so much that he was able to walk in Quito, Ecuador, which is more than 9,000 feet above sea levelwithout breathing heavily.
“I climbed a cathedral on foot, about 150 steps, to get to the top,” he said. “I made it at that point.”
He thought it was a positive thing to be able to walk freely above sea level on that trip, because Pastuovic was there to walk his daughter down the aisle this summer.
“Everything was great,” he declared.
Pastuovic says that before he was diagnosed with cancer, he often had a negative outlook on life. Being in the hospital for about 40 days, often alone, helped him change his mentality.
“No matter how bad things are, no matter how negative someone’s thinking is, you can find positive thoughts in yourself,” he said. “Now I live my life differently.”
He confessed that he goes out of his way to congratulate people for their good services or kind acts and stated that he wanted to share his story to thank the medical staff who “saved his life.”
“I try to live my life every day as if it were my last day,” he said, “and not think about the bad things.”
