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Yttrium 90 Microspheres Education and Support
When The Improbable
Is Possible
John Peterson
Sir-Spheres: Success Is Sweet
My cancer story started in 2001. I had been ill one day at work and went home early. I developed a fever that made me shake. For the next 2 days, the fever wouldn’t completely break. I also had pain in my groin area. My Mom is a nurse and said "You're going to the emergency room." I did. A CT was performed and it was found that I had a perforated colon from diverticulitis, which I wasn’t even aware I had although I had a family history. I had experienced intermittent bloody stools for a few years but I was only 41 so didn't think it could be too serious. I was told I had to have a colon-resection. "Just for a perforated colon," I asked? I didn't know much then. I had the surgery on June 1st, 2001 and a month later in my follow-up appointment with my surgeon I mentioned that I was still experiencing bloody stools. My surgeon ordered a flexible sigmoidoscopy and found a large, aggressive polyp. Although my GI doctor didn't think it was cancerous, it came back as such. I was told over the telephone on a Tuesday morning in August of 2001. My mom and I shed many tears but were assured that it was extremely early and still confined to the polyp and had not yet invaded the colon wall. I had another colon resection on August 23rd, 2001; just 5 days after my father died from a long battle with a dementia illness. No chemotherapy was advised. I had CEA tests and routine colonoscopies. Everything was fine for 6 years. However, in the winter of 2006-2007 I was sleeping a lot and didn't really know why. My eating and exercising habits hadn't really changed so I didn't think much of it. I was scheduled to have a CEA test and was actually a couple of months late as I had missed the December 2006 appointment. When I went for my appointment in April, my CEA was elevated to 7.8. It was now May and my GI doctor wanted the test repeated right away. It had risen to 11. Things immediately became chaotic. I had a CT scan and then a PET scan and then a needle biopsy of the determined area, 3 small lymph nodes behind my original resection from 6 years earlier. The needle biopsy results came back on my mother’s birthday, May 26th.
They were positive for adenocarcinoma in the lymph nodes. Some birthday present! On June 5th, 2007 I had a consultation. My mother and brother accompanied me. The doctor told me that if I was lucky, I would live about 5 years and would have chemotherapy the entire time, switching back and forth from 12 rounds of one type to 12 rounds of another with a month off between each cycle of 12 rounds. If I was very lucky I'd make it 5 years with possible periods of remission or until the cancer found a way around the chemotherapy. "And it always does," he didn't hesitate to say. I was mad, my Mom was sickened, and my brother was crying. I asked about surgery and he said that 95% of the surgeons in the country would not operate on me. It appeared the cancer had possibly spread to my liver as well. An MRI was ordered and showed a possible area on my thyroid. I was scheduled to have a Groshong catheter inserted in my chest on June 11th and scheduled my first chemotherapy appointment for June 19th. It was to be Folfox-Avastin. We wanted 2nd and 3rd and 4th opinions. I was to see a medical oncologist and surgeon, but they weren’t quick to set up. We were also pushing for surgery right away and wasn't told until the Avastin was coursing through my veins that I had to wait 6 weeks after having the Avastin to undergo surgery. We also thought to check out the Goshen, Indiana Center for Cancer Care on the recommendation of a friend of myMom's who teaches nursing at Goshen College, Joyce Hoffman. We did so and went to Goshen as they were able to get me in to see them in just 2 days. The medical oncologist put us at ease right away stating that he thought I could be cured here and that this shouldn't have happened to me. We told him we were scheduled to go to Mayo and IU and he encouraged us to do just that. He said that if either of them sounded too fatalistic, please come back to Goshen. A friend of mine accompanied me to Mayo, which was about 8 hours away. We made a fun trip of it and saw the great Mayo Clinic; so large and extremely efficient. Mayo wanted to do a new CT and I was afraid my insurance wouldn't pay for it so they went on the records I had brought with me and the scans from Elkhart. I had a new CEA test done at Mayo on July 11th, 2007 and it was 4.7. That was very encouraging I had only received one treatment. The medical oncologist I saw at Mayo wasn't convinced that the cancer hadn't spread to my liver. He didn't know and wouldn't know without new scans. I tried to peg him down to possible treatment regimes like radiation and surgery and just couldn't be sure. I asked him about the Goshen, Indiana Center for Cancer Care. He was extremely familiar with it and said that they are doing different techniques that are not being offered at Mayo. He advised me to return home and think for a day or two and if I was still unsettled, they could get me in right away again to see a great surgeon. We went back to Goshen.
At Goshen, I was introduced to Dr. Seza Gulec, a surgical oncologist. He met with my Mom and me within days and presented a power-point presentation of the radiomicrosphere procedure he was suggesting I have. The first step was to have a PET/CT combined scan. We did so and that was more revealing and devastating than we had expected. The liver had indeed been involved and showed some spots of metabolic activity. He asked if I would consider being in a clinical trial involving the microspheres and chemotherapy at the same time. I said sure. I was introduced to to the research nurse, Sue Garl, and she
took some blood and did some tests to see if I qualified for the trial. I did and she was thrilled. I was, too. I was to eventually be patient number 17 out of 20 that Dr. Gulec was using in his chemo-SIRT clinical trial. It was the only trial like it in the country and only 12 miles from my house! I was scheduled to have the mapping done by interventional radiologist Dr. Michael Hall on August 14th, 2007. He said that my anatomy was such that he had to use an alternate route, but that in all actuality, that was better because the alternate route to the cancer lesions in my liver required no coiling. The conscious sedation they gave
me was such that they had to keep me awake enough to respond to some commands and I was cracking jokes and singing to them and was having a hard time being still. August 19th, 2007 was the second chemotherapy treatment only this time without Avastin as they were really hoping to schedule me for surgery. On August 21st, 2007, I had my chemo-fanny pack going on one side of the table with the radiomicrosphere insertion being done on the other. They told to lie extremely still and not laugh and sing. I told them not to give me so much sedation and I'd be fine. They didn't and I was still. There were many people in the room on that day. I could hear my chemo being administered ever so often and the doctors talking. I had some cramping in my stomach that I was told I would feel and that it would go away. It did right away. I was observed for a few hours and spent the night in the hospital for observation. I was unhooked from my chemotherapy the next day, got dressed and went home. I had another PET/CT in 3 weeks and it showed that the small cancer lesions in my liver were completely gone. Dr. Gulec had been so excited that he had wanted to telephone me at 1:00AM on the Friday when he viewed my scans! I was then scheduled for 3 more chemotherapy treatments during September of 2007 and the last one concluded on October 2nd, 2007, all without Avastin. They gave me 3 weeks to rest and my surgery was scheduled for October 25th, 2007. The entire time my CEA was being tracked and it stayed in the 4 to 5 range. Dr. Gulec had told my Mom and me that I would be having the PET-directed surgery, which Dr. Gulec basically pioneered. I would be prepped for a PET scan right before surgery and then whisked off to surgery and the PET scan and PET probe would find things not shown to the naked eye. He said that it was going to be partially exploratory and that the surgery could last anywhere from ½ hour to 5 hours. The surgery took 5 hours and when I awoke I was in ICU with tubes everywhere. Apparently the cancer from the lymph nodes had attached itself to a lower part of my colon and also to one of my ureters. This was not clearly evident from the scans taken before the surgery. It would have been easy for Dr. Gulec to perform a ureterostomy and a colostomy on me but he is a physician first and got to know me as a person as well as a patient. In fact, he told me to think of him as his big brother. He resected my colon with the cancerous lymph nodes and relieved the pressure on my ureter. He obtained two biopsies to assure he got clean margins. He resected my liver and checked the two long-time suspicious hemangiomas in the larger lobe. My lesions were in the small lobe of my liver. Everything was being biopsied there in the room at the time and it was all coming back with clean margins. The pathology report on the ureter came back in a couple of days. Dr. Gulec was ecstatic and we could all tell! I nursed back to health at home in November and healed quite well. My CEA was checked in early December and it was 1.0! I started back on chemotherapy on December 12th, 2007 and was hit with the full Folfox-Avastin treatment for 8 more treatments. I was unhooked from my last treatment on March 19th, 2008; Good Friday. A new beginning for me I was certain; just as that Easter weekend symbolized a new beginning as well. I am in remission. I still can’t believe it I was asked by Dr. Gulec to attend the 4th Annual International Radiomicrosphere Symposium on May 1st and 2nd of 2008 in Chicago, llinois. I talked with the surgeons, biologists, chemists, oncologists and interventional radiologists. I met some wonderful people and had a great time and ate like a hog! I never lost my hair through my chemotherapy and didn't ever have too much nausea. I was fortunate. Blessed, actually. I met the wonderful people from SIRTEX and also Suzanne Lindley who has such an incredible story. I am now involved in a patient advocacy program through the Cancer Center and Goshen Hospital and I was able to listen to my first fellow cancer survivor through the advocacy program. I am happy to be able to listen and to share my experience, strength and hope with any person affected by cancer. We can all learn through each other. I thank God above all and give Him all the praise for SIR-spheres treatment and SIRTEX. Thank Him for bringing so many talented and caring people all together in one place in Goshen, Indiana at the Center for Cancer Care.