Hiyama was able to remove all of Tsuruoka’s visible tumor
and 28 lymph nodes. After surgery, to try to further reduce
his risk of recurrence, Tsuruoka received three months of
chemotherapy with FOLFOX, a combination of folinic acid,
fluorouracil and oxaliplatin, followed by five weeks of radiation
therapy. Tsuruoka also learned after surgery that his tumor had
elevated levels of the protein HER2.
The targeted therapy Herceptin (trastuzumab) was approved
in 2010 for treatment of certain patients with metastatic stomach
cancer who have elevated HER2. Tsuruoka’s cancer was not
metastatic, but Wainberg recommended that he take Herceptin,
which he did for a year. Herceptin is currently being studied for
use in patients with stage III stomach cancer.
After surgery, Tsuruoka says, he did not feel too bad. About
a week after the gastrectomy, while still in the hospital, he
ordered his first meal of solid food—pancakes, sausage and eggs.
On March 29, 2014, after one cycle of chemotherapy, Tsuruoka
celebrated his 72nd birthday, which had been on March 4, by
accompanying his family and friends to watch the horses race
in the Tokyo City Cup at Santa Anita Park in nearby Arcadia,
California. Going to the track has been a favorite pastime for
Tsuruoka since he was a young man in Japan. “He ate a lot,”
Smith says. Around that time, he also went out with his camera
to do nature photography.
But soon after that, Tsuruoka’s condition began to deteriorate.
He developed dental problems, including teeth that broke in two.
Because he was immunocompromised from chemotherapy, he
was instructed not to get dental work. He had trouble chewing
because of the discomfort, and food smelled different than usual
to him because of the chemotherapy. Before he started treatment, he weighed 151 pounds. At his lowest point, he weighed
97 pounds, underweight for his height of 5 feet 7 inches.
As Tsuruoka got sicker, Smith began to question her role in
helping him pursue such aggressive treatment. “My dad was the
ultimate decision maker, but a lot of times he’d look to me for
guidance,” she says.
Tsuruoka got dental work after finishing chemotherapy and
before starting radiation. But he continued to struggle to eat
and spent much of his time in bed. “He didn’t have the energy to
do photography or the strength to pick up a camera, because his
camera is like 5 pounds,” Smith says. “It was really a bad time
for us. For me, it felt like, ‘Why did we do all this if he’s not able
to enjoy his life?’”
Back to Life
As Tsuruoka’s treatment wound down, he and Smith embarked
on their next challenge: developing a plan for survivorship care.
As soon as Medicare open enrollment began, Smith’s first step
was to adjust her father’s plan so that Hiyama and Wainberg
were part of his assigned medical group.
Smith and Tsuruoka, with the help of Tsuruoka’s new
primary care doctor, found him a series of specialists to help
manage the long-term side effects of his treatment. Physical
therapy helped Tsuruoka to rebuild muscle he had lost during
his rapid weight loss. At the UCLA Center for East-West
Medicine, Tsuruoka received acupuncture. He also started
seeing a digestive health dietitian at UCLA, Nancee Jaffe, to
help him better adjust to life without a stomach.
Tsuruoka had muscle wasting, Jaffe says, and he needed to
find a way to add more protein to his diet. At first, Jaffe recom-
mended protein shakes, but Tsuruoka did not like them. Once
she learned that he often ate rice for breakfast, she recom-
mended that he add soybean paste and fish on top for added
protein. “If it’s not pleasurable and it doesn’t fit his current
lifestyle, it’s not going to work,” says Jaffe.
Tsuruoka continues to see Jaffe. At one point, his weight
reached 122 pounds, within the normal weight range, although
in late 2017 he started to lose weight again, for reasons he and
his medical team are investigating.
Tsuruoka receives periodic CT scans and endoscopies to
monitor for recurrence and continues to visit Wainberg and
Hiyama. “He’s a lucky man in some ways,” says Wainberg. “He’s
got a good attitude, and his family has been obviously very
interested and engaged in helping gastric cancer patients.”
Stomach cancer survivor Shigeo Tsuruoka takes photos at one of his
favorite spots, Friendship Park in San Pedro, California.