Tuesday, June 19, 2012
SAN DIEGO James Vanderpool is in the surgical waiting area at UC San Diego’s Thornton Hospital. He’s minutes away from a procedure that could get rid of all of the cancer in his body.
A few months ago, Vanderpool was in the hospital to have his appendix taken out. When doctors opened him up, they found his appendix was cancerous. It had burst, spreading malignant debris throughout his abdomen.
Some cancer patients choose to undergo a particularly aggressive form of treatment. It's not for the faint-hearted.
Vanderpool was told he had only one viable option: surgeons would need to open him up, and take the cancer out.
“I’m approaching it, you know, in a positive manner," Vanderpool says from his hospital bed. "You know, I’m hoping for the best, and going in that way, you know. Uh, I don’t know.”
You want to talk about aggressive cancer therapy? Vanderpool’s going to get it…and then some.
It’s a unique type of surgery and chemotherapy offered to certain cancer patients. The operation is highly invasive, and there’s no clinical proof that it’s more effective than standard treatments. Still, some cancer patients are willing to take the chance.
Inside the operating room, Dr. Andrew Lowy and surgical resident Hanna Copeland cut Vanderpool’s abdomen wide open.
Then, they inspect each organ for signs of cancer. When they find it, they cut it out.
Each piece of tumor or suspicious-looking tissue is saved for the pathology lab. It doesn’t take long before the samples pile up.
Surgeons eventually collect tumors from Vanderpool’s small bowel, colon, liver, and stomach.
Even so, Dr. Lowy says things look pretty good.
“He has fairly minimal disease, in the spectrum of patients that we see, which is good for him," Lowy pointed out. "We’re not going to have to remove any of his normal organs or tissues. We did remove his gall bladder, ‘cause it was very stuck to his omentum, which we have to take out.”
Lowy explained the omentum is piece of fatty tissue attached to the stomach and colon. Tumor cells often get caught there.
“And so, even though we can’t see things there, we usually take that out; it’s a non-vital structure. And after that, we will recheck his abdomen again, we’ll go over it another time," added Lowy. "And after we’re comfortable that we’ve taken out all the disease there is to take out, we’ll set up and give him chemotherapy.”
Before that, surgeons got rid of excess blood and fluids, and temporarily sewed up Vanderpool’s skin.
Then it was time for a special type of chemotherapy called Hipec.
Here’s how it works: heated saline solution is circulated through Vanderpool’s abdomen. After a few minutes, heated chemotherapy is added to the mix.
The solution is hot enough to kill cancer cells, but not too hot to damage internal organs.
To make sure the chemotherapy is evenly distributed inside Vanderpool’s abdomen, Lowy does what’s called the shake and bake.
Over the next hour or so, Lowy and the surgical resident would take turn jiggling Vanderpool’s belly.
The cost of the operation and the heated chemotherapy can be more than $100,000. Insurance companies may cover the surgery, but not necessarily the chemotherapy. And there are some oncologists who say there’s no proof the therapy even works.
Dr. David Ryan is clinical director of the Mass General Cancer Center in Boston. He said there has been only one study ever done where people were randomly assigned to get the procedure or not.
"And that was an old study," Ryan explained. "It did show an improvement in survival, but it was so flawed, we can’t actually trust the results of that study.”
Dr. Ryan said the cytoreductive surgery exposes patients to a high risk of infection, and other serious complications.
“We don’t really accurately know how much benefit they’re getting from it. We know how much risk they’re putting themselves up to, but we actually don’t know how much benefit," Ryan argued. "How much longer are they going to live because they did this procedure, as opposed to doing the standard treatment? We can’t accurately tell them that.”
He admitted there aren’t any current studies that prove the method is effective.
But Dr. Barone said he’s done the treatments on plenty of patients with advanced colon cancer, who were told to go home and die.
“Patients who were in their 20s and 30s who had young children, 2 and 3 years old. And I’ve had a number of patients, who’ve seen those kids graduate from high school and college," Barrone said.
Jennifer Marrone, 31, was diagnosed with colon cancer last year and went through nine months of chemotherapy.
Then she found out the cancer had spread to her liver.
The Murrieta resident heard about Hipec, and decided to give it a shot.
“If I’m gonna fight this battle, if I’m gonna have surgery anyways, let’s do it all," Marrone said. "Let’s give it everything we have, and not regret later that I had this opportunity, and didn’t take it.”
Marrone had the surgery and Hipec at UC San Diego's Thornton Hospital last month.
She said her recovery has gone pretty well.
What’s next? Sometime soon, Marrone will begin six more months of chemo.
“I’m so young, and I’m healthy right now," she said smiling. "Let’s kill this beast, and hopefully it doesn’t come back.”
James Vanderpool, meanwhile, is recovering from his surgery and will also begin chemo treatments soon.
Each year, about 1,500 Americans have cytoreductive surgery and Hipec.