An Army veteran thought he knew the cause of his knee pain. Doctors found a rare cancer
While U.S. Army Staff Sgt. Rayshaun Smith served a tour of duty in South Korea in 2018, he started feeling mild knee pain.
At first, he thought it was just from his rigorous military lifestyle or his intense workout regimen. He and his fellow soldiers were spending lots of time in mountainous areas, he said, and he thought that he might have done something to injure it.
"I thought it was just everyday pain," Smith, 32, told CBS News. "It wasn't like it never happened before."
For years, the pain persisted but remained treatable with over-the-counter painkillers. In 2020, while doing recruitment work stateside, he finally decided to see an Air Force doctor. The doctor prescribed medication and recommended physical therapy. But a few exercises with the physical therapist revealed the pain was coming from his hip, not his knee.
The physical therapist sent him to another specialist. Eventually, he ended up at the office of an orthopedic oncologist. A biopsy found that he had a rare grade 3 sarcoma in his pelvis. Smith was driving to work when he got the call.
"It was terrifying," Smith said. "I got to work and told my supervisor. He told me to just go home."
He was told his best option was to undergo an amputation of the cancerous part of his pelvis, which would leave Smith without a leg. Smith was then directed to the Cleveland Clinic because of how large that operation would be. There, he met Dr. Nathan Mesko, the leader of the Cleveland Clinic's orthopedic oncology team. Mesko had a different plan — one that would remove the deadly cancer, and let Smith keep his leg.
Treating a rare cancer with cutting-edge technology
Sarcomas are very rare, Mesko said, making up only about 1% of adult cancers. Sarcoma is most commonly found in children and young adults, according to the National Foundation for Cancer Research, though the exact age can vary depending on the type of sarcoma. Between 15,000 and 16,000 people a year are diagnosed with a form of sarcoma, Mesko said, compared with about 750,000 new diagnoses of prostate cancer a year.
The location of Smith's sarcoma meant treating it would be tricky. It was also very large, Mesko said, and had infiltrated the "entire left half of his pelvis," posing another problem.
"The bigger it gets, and depending on where in the pelvis it is, it can be very difficult to marry trying to save a limb and give somebody meaningful function with eradicating the cancer and getting it out cleanly," Mesko said.
Sarcomas can present at a number of stages, Mesko said, including as a tiny bump under the skin or a large lump in the muscle. Typically, pelvic sarcomas are very large when they're finally found, because it's hard to feel something in that part of the body. The reason Smith's knee had been hurting was because of something called referred pain, which Mesko compared to a person feeling pain in their arm during a heart attack: The pain may be coming from a different area than where the body registers feeling it.
During his first meeting with Smith, Mesko outlined his plan. Instead of removing the pelvis, replacing it with cadaver bone, and rebuilding Smith's hip joint so he might be able to use a prosthetic limb, he would 3D print an implant specifically fitted to the gap that would be left when the sarcoma was removed. It's a process that has been done before, Mesko said, but it's only become possible to do it regularly in the past decade. He estimated that about 500 to 1,000 such implants are used in a year in the U.S.
Mesko and his coworkers at the Cleveland Clinic "definitely do a lot of custom pelvis work with joint and tumor patients," he said, estimating his team created about 20 custom implants in 2023.
The prospect of the surgery was intimidating. The operation would take between six and 10 hours, exposing Smith to possible complications such as infections or blood clots. It would also have a long recovery period. Mesko said he walked Smith through the entire process, and that Smith had a surprisingly calm response.
"You see a lot of different emotions throughout your career, in terms of how people receive very difficult news," said Mesko. "Rayshaun didn't say a whole lot. His mom was with him. At the end, he looked at me, and he goes 'Alright, when are we going to get started?'"
"Just happy to be alive"
After about six weeks, the implant was ready, which meant it was time for Smith's surgery. He remembered the day as easy — until he woke up from the operation.
"Recovery was terrible," Smith said. He spent 10 days in the hospital, then went to an acute physical rehabilitation center. He said going from a physically active person to someone who needed help with many everyday activities was frustrating.
Now, he's "good physically," he said. While he still can't run like he used to, "basic life is back to the same."
He had a scare in 2022, when the sarcoma recurred, but doctors spotted it early during his regular scans. This time, the cancer was on the back of his femur, and removing it was much simpler, Mesko said. Smith spent just one night in the hospital.
"It was terrifying, but recovery wasn't bad," said Smith. "I was walking to stay after, even though I wasn't supposed to, but I didn't want to stay down about it."
For now, Smith and Mesko will continue to monitor the situation. Smith will have exams every three months to make sure the cancer hasn't grown back again, and Mesko said he and his team are prepared to handle any complications that may arise. Smith said that for now, he's just focusing on living in the moment.
"I'm just happy to be alive," he said.
