for a new job. She consulted with Monica Bertagnolli,
a surgical oncologist with experience removing
tumors like hers. Bertagnolli clearly described her
surgical approach and the associated risks. Trusting
a surgeon, says Sail, can feel strange. “As a patient,
you want them to care because this is your body. But
on the table, you need them to emotionally separate,
you need them to do that job,” she says. Sail notes that
Bertagnolli was confident in her ability to remove
the mass and provided a clear plan of what to expect
before, during and after surgery.
After undergoing two additional surgeries, Sail
is currently taking hormone therapy, which has
controlled the tumor’s growth. She recommends
that patients ask a lot of questions before undergoing surgery. “The fear of the unknown is hard for the
average person, but for someone going through this,
it’s even worse,” she says. Patients can ask what their
scars will look like, what to expect during recovery,
and what kind of professional help is available in the
hospital and during recovery at home, Sail adds.
A Broader Approach
For Sail, surgery was the obvious choice. But for those
with metastatic disease, like Martin, the decision isn’t
always clear. Surgery is often not considered an option
for metastatic patients because it may not extend
survival or improve quality of life. However, advances
in surgical techniques have made an operation a more
viable choice for some patients with metastatic cancer.
For example, surgeons once were reluctant to operate
on liver metastases because the organ tears easily and
contains many blood vessels. In recent years, thanks
to more precise imaging and surgical techniques, a
surgeon can better identify and remove cancerous
cells without damaging the rest of the organ. Nearly 60
percent of colorectal cancer patients whose metasta-
ses are isolated to the liver and who undergo surgery
to remove them live five years or longer, according to
some recent studies.
Martin’s case fell into a gray area. She had tumors
on her liver. Scans also showed small spots on her
lungs that doctors felt were likely benign and not a
concern. In early May 2013, she saw medical oncologist Wells Messersmith, director of the University of
Colorado Cancer Center’s Gastrointestinal Medical
Oncology Program in Denver, who gave Martin her
first glimmer of hope.
Messersmith recommended Martin undergo
chemotherapy over the summer. If, in the fall,
computerized tomography scans showed that the
tumors in her liver had become smaller, one of the
cancer center’s surgeons would operate. Martin
started on FOLFOX, a chemotherapy regimen that
combines 5-fluorouracil, leucovorin and oxaliplatin.
The tumors responded to the treatment, and in
August 2013, Martin underwent open surgery to
remove her gallbladder and more than half of her
liver, where the cancer cells had spread.
Recovery was rough: After surgery, she gained
40 pounds in water weight and was admitted to the
intensive care unit. She had a blood clot. To eliminate
any traces of cancer in her body, she needed to undergo
more chemotherapy. But two days after Christmas 2013,
Martin was told she had no evidence of disease. “That
was fantastic for me,” she says.
The years since have been a rollercoaster ride
for Martin. Scans in February 2014 showed new
lesions growing on her liver. Instead of more
surgery, she underwent an intense targeted
Patients should look for a surgeon with
experience doing the type of procedure
recommended to treat their cancer.