Following a diagnosis of epithelial-myoepithelial carcinoma, MUSC College of Health Professions adjunct professor Brown-Nelson underwent surgery and 33 radiation sessions at MUSC Hollings Cancer Center.
Preliminary tissue testing indicated that the growth was a malignancy originating elsewhere in her body. With no doctor immediately available to put the report into context, Brown-Nelson’s thoughts raced ahead. How far has it spread? Where has it spread? I don’t want to die. I want to live,
she recalled. Hundreds and hundreds of thoughts ran through my mind at once.
Upon consulting an otolaryngologist, she was advised to pursue treatment at MUSC Hollings Cancer Center due to the complex nature of her disease. Brown-Nelson had already reached the same conclusion. There was no question about where I was going to go to seek treatment,
she said. Having previously obtained three degrees from the MUSC College of Health Professions—where she currently works as an adjunct professor—and having witnessed multiple relatives undergo treatment within the medical institution, Brown-Nelson shared a profound connection to MUSC.
Final Pathology Revealed at MUSC Hollings Cancer Center
At Hollings, further evaluation ultimately revealed that the initial picture was not quite right. Alexandra Kejner, M.D., a head and neck surgical oncologist at Hollings, initially treated Brown-Nelson’s condition under the presumption that a primary malignancy had metastasized to her neck. However, following the operation and subsequent tissue examinations, the definitive pathology report demonstrated that the malignancy actually began in her submandibular gland, which is one of the salivary glands located underneath the jaw.
The diagnosis was epithelial-myoepithelial carcinoma, an uncommon type of salivary gland cancer. The other lymph nodes removed during surgery were negative for cancer. Unlike certain other malignancies affecting the head and neck region, the specific triggers for salivary gland cancers such as the one Brown-Nelson experienced are unknown.
Salivary gland cancers are somewhat unusual – and there is not a clear reason why they develop, like genetics, smoking, drinking, etc.
Alexandra Kejner, M.D., head and neck surgical oncologist at Hollings
Kejner noted that many of these cancers arise de novo, meaning a unique mutation that occurs at the cellular level. Coping with that lack of clarity was challenging for Brown-Nelson, who found it hard to reconcile having contracted a malignancy in this anatomical region given that she had never used drugs, consumed alcohol or smoked. Kejner explained that sometimes there simply is not a clear explanation, stating that it is an area of continuing research, but we yet don’t have a definitive cause.
Surgery and 33 Radiation Sessions Shape Her Treatment
Brown-Nelson’s first surgery took place in August 2023. Because the tumor had features that caused concern about recurrence, she also underwent radiation. According to Kejner, the tissue analysis revealed malignant cells present in localized nerve regions as well as tiny lymphatic and blood vessels, which contributed to the medical team’s advice that Brown-Nelson undergo further treatment following her operation.
Brown-Nelson ultimately completed 33 radiation sessions. Finishing radiation did not mean the end of her medical care. A lump later appeared near her surgical incision, raising concern that the cancer might have returned. Subsequent examinations happily revealed that the mass was a post-radiation cyst rather than a malignancy, though it still required surgical excision.
