Joshua Do clearly remembers the moment nine years ago when doctors delivered the diagnosis.
How could he forget—he had cussed darkly in front of his mom, the first time he’d done so. Not many high school seniors can say that.
He knew, as soon as the anesthesia lifted.
“The first person I saw was my mom,” he recalled. “She was crying.”
Then 17, he had yet to learn about this type of cancer’s sometimes grim survival rate for someone his age.
Fit and competitive, he had earned a spot as a swimmer and co-captain at East Kentwood High, one of the largest high schools in Michigan. He specialized in the breast stroke and the butterfly, the latter considered the sport’s most difficult style.
He had first noticed the bump on his collarbone in April 2009.
“You could see it,” he said. “It looked like a bone was broken, or like a knuckle.”
The bump got larger.
A biopsy at a Detroit hospital confirmed Ewing sarcoma.
Do, now 26, could only watch as his diagnosis morphed into a crisis for him and his family, as is common in such moments.
Ewing sarcoma is named after James Ewing, who in the early 1900s earned a reputation as the father of oncology. In 1932, Time magazine featured him on the cover, “Cancer Man Ewing.” He founded what is now the American Cancer Society.
Among his early work, Ewing studied a rare cancer that affected mostly adolescents, commonly in the lower leg, forearm, pelvis, skull and—as in Do’s case—the right clavicle.
Anywhere from 25 percent to 75 percent of patients will survive the disease beyond five years, according to Do’s doctor, depending on the tumor’s location, size and presence of metastasis. Survival is better for those with localized small tumors.
Of course, even a 3-in-4 survival rate sounds worrisome if you’re among the four. For someone Do’s age, with his condition, the odds were worse.
“I always try to keep a positive attitude,” he said. “I didn’t find out until about two years ago that the survival rate for someone my age and with my disease recurrence is 10-15 percent. I think my parents hid it from me.”
Three months after his diagnosis, Do underwent an autologous stem cell transplant at Spectrum Health Helen DeVos Children’s Hospital. He would be one of five patients to undergo the procedure at the hospital that year.
In this approach, doctors first collect a patient’s blood-forming stem cells. They then use chemotherapy and radiation for treatment, then return the collected stem cells into the patient.
Chemotherapy and radiation serve to kill the cancer cells, but they also kill the blood-producing cells left in the bone marrow. The restored stem cells serve to recharge the blood.
“Following the graft infusion, the patients are housed in specialized clean rooms until the infused cells start to function appropriately to return blood counts and function back to normal,” said Aly Abdel-Mageed, MD, section chief for the Pediatric Blood and Bone Marrow Transplant Program at Helen DeVos Children’s Hospital.
“This could take one to three weeks to start getting enough white blood cells to show in the blood, and allow the patient to get out of these specialized rooms.”
Doctors performed 29 autologous transplants at Helen DeVos Children’s Hospital from 2011 to 2016. The procedure differs from allogenic transplants, where stem cells are collected from a matching donor.
Work and play
Follow-up exams have shown no recurrence for Do. The major five-year survival mark has come and gone, although uncertainties still haunt him.
“There are days that it worries me, even now,” he said.
After his high school days, Do enjoyed a stint as a bartender before becoming a pharmacy technician at a chain drugstore.
He now works for Spectrum Health, where his mom and dad also work. His father, Tuan Do, is a clinical pharmacist, and his mother, Aimee Do, is a nurse at the adult oncology department.
As a pharmacy technician, Do helps prepare IV bags with various medications for patients. He works in what’s known as a laminar flow clean room, which uses high-pressured air filtration to create a sterile environment. His two sisters are also studying pharmacy.
In the meantime, Do is working toward a biochemistry degree at Grand Valley State University.
He estimates he has the equivalent of about a year’s worth of classes left to complete, but he knows it will be longer as he balances his studies against part-time work.
He likes to play guitar, golf and listen to reggae.
“It makes me feel like I’m always in summer,” he said. “Always at the beach.”