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Risky Operation Gives Cancer Patients Second Chance
Heated Chemotherapy Successful In Some Deadly Cancer Patients
POSTED: 3:20 pm MST March 11, 2010
UPDATED: 7:31 pm MST March 11, 2010
Cancer is never an easy diagnosis to accept, but when it spreads, the prognosis gets worse. Most patients whose cancer spreads throughout the stomach are given less than a year to live. There is a group of surgeons taking on what most consider impossible cases and performing a grueling surgery to save lives. The procedure gave two terminal patients the will to live.Allen Perritt has a need for speed. He turned his passion into a career as a commercial pilot. He was about to get in the cockpit for a 15-hour flight to China when he felt a pain in his side."We have an infirmary at the airport, and they examined me," said Allen Perritt.
It turned out to be cancer which spread from his appendix to the membrane that lines the abdomen or peritoneum. Doctors say when this happens, the cancer ends up smothering all of the organs around the stomach."They closed me up and sent me home: 'We can't fix you, sir. Have a good day,'" said Perritt.That's when he found Dr. Armando Sardi, the director at the Institute for Cancer Care at Mercy Medical Center in Baltimore. Sardi performs a risky 12-hour operation to try to save those sent home by others to die."This is an operation and a treatment that has the potential for anything you can imagine, but the alternative is death," said Sardi.Surgeons make a 15-inch incision from the chest to the pelvis and remove as much of the tumor as possible."We start cleaning, organ by organ," said Sardi.What they can't remove by hand, they use heated chemo to kill. It's circulated through the abdomen for 90 minutes then washed out."The heat alone kills cancer cells but also enhances the effect of chemotherapy," said Sardi.It's used to treat appendix, colon, gastric and ovarian cancers that have spread to the abdominal wall."To hear that I could be cured was like, 'I can do this. I'm only 43 years old. I do have the rest of my life,'" said cancer patient Tracy Kyle.Kyle and Perritt say recovery is brutal."I was alive. That's the main thing. I woke up," said Perritt.A year and a half later, Perritt's cancer-free and relishing his second chance.For colorectal cancer, Sardi says the invasive surgery has doubled the survival rate compared to chemotherapy alone. He's performed more than 100 surgeries and has had one patient die during the procedure.Background: The appendix is a pouch-like tube that's attached to the first section of the large intestine or colon. The organ is about 10 centimeters long and is considered part of the gastrointestinal tract. Doctors believe the appendix may play a role in the lymphatic and endocrine systems. Appendix cancer occurs when cells in the appendix become abnormal and multiply without control, forming a tumor. Some appendiceal cancers produce mucus until they burst and shed cells in the abdominal or peritoneal cavity. Pseudomyxoma peritonei is another name for such cancers that produce large amounts of mucus within the abdominal cavity. These cancers can come from the appendix, colon or ovaries.Symptoms: Patients may have stomach pains or side pains that many times are mistaken for cramping or appendicitis. If the tumor is small when discovered, a standard appendectomy may be the only treatment needed. However, if the cancer has spread to the peritoneum, the membrane that lines the abdomen, the condition is much more serious. In this case, the cancer can coat the other organs in the abdomen, eventually suffocating them.Treatment: In a few medical centers across the country, including Mercy Medical Center in Baltimore, and the University of California at San Diego Medical Center, surgeons perform a complicated two-part procedure to attempt to remove as much of the cancer as possible. The first part is called cytoreduction or debulking surgery, which removes the cancer in the abdomen. "We start cleaning organ by organ, trying to remove all the tumor while at the same time making sure with what we leave behind the patient will have a good quality of life," said Sardi. "As you can imagine, there's tumor everywhere, so it's impossible to believe that a surgeon is going to be able to remove every cell, but we do the best we can." After cytoreduction is complete, some patients may receive heated intraperitoneal chemotherapy, or hipec. Chemo drugs are heated to about 105 degrees and circulated over a 90-minute period through the abdominal cavity. Then the chemo is washed out. "Heat alone kills cancer cells, but also enhances the effect of the chemotherapy," said Sardi. "You obtain high concentrations of the chemotherapy in the area where the tumor is and very little gets outside."Recovery from this procedure can be brutal, including up to 12 days in the hospital and two months of recovery at home. "This is an operation and a treatment that has the potential for anything you can imagine, but the alternative is death," said Sardi.
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