Most patients whose cancer spreads through the stomach are given less than a year to live. But for those who are unwilling to accept that prognosis, there may be an alternative - a very complicated 12-hour surgery.
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.
Perritt had appendix cancer. "We have an infirmary at the airport and they examined me."
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,'" he said.
That's when he found Dr. Armando Sardi. He performs a risky 12-hour operation 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," Sardi said.
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," Sardi said.
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," explained Sardi.
It's used to treat appendix, colon, gastric and ovarian cancers that have spread to the abdominal wall.
Tracy Kyle is a cancer patient. "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."
Tracy and Allen say recovery is brutal.
"I was alive. That's the main thing. I woke up," Perritt said.
A year and a half later, Allen is cancer free and relishing his second chance.
For colorectal cancer, Dr. 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.
RISKY SURGERY FOR DEADLY CANCERS
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, Md., and the University of California at San Diego Medical Center in San Diego, Calif., 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," Armando Sardi, M.D., of Mercy Medical Center, told Ivanhoe. "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," Dr. Sardi said. "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 Dr. Sardi.
FOR MORE INFORMATION:
Dan CollinsPublic Relations
Mercy Medical Center
(410) 332-9714
