October 28, 2019
Laura Perez, 20, is a gentle soul with a special connection to animals. This spring, she found an injured fawn on the side of the road near her home in Kansas City, Kansas. She nursed it back to health, and now the young doe, named Petunia, frolics with Laura’s goats, sheep, ducks, cats and horses.
Two years earlier, it was Laura who needed rescuing. In late summer 2017, she made 2 trips to the Children’s Mercy emergency department with abdominal pain. When Laura’s pain grew worse, she was admitted to the hospital for extensive tests. At just 18, she was diagnosed with colon cancer and referred to The University of Kansas Cancer Center.
A frightening colon cancer diagnosis
Research data show colorectal cancer increasing among adults under 50. “We rarely see a patient as young as Laura, but colon cancer is definitely becoming more common among 20- and 30-year-olds,” said surgical oncologist Mazin Al-kasspooles, MD.
Young people often ignore abdominal symptoms because they don’t suspect colorectal cancer. Physicians often assume the cause is appendicitis or constipation. For that reason, young people with colorectal cancer are often diagnosed late.
Medical oncologist Raed Al-Rajabi, MD, examined Laura and ran new tests. Then, he met with a multidisciplinary team of colleagues, called a tumor board, to discuss her case.
“At first, the mass on her colon appeared to be the only problem,” says Dr. Al-Rajabi. “Then we did a laparoscopic exam using a small camera and found her cancer was far more advanced than we originally thought.”
The primary tumor had penetrated the colon wall and metastasized (spread) throughout her abdominal cavity. Tiny cancer cells, invisible on CT scans, coated her reproductive organs and other tissues. Laura’s diagnosis changed to stage 4 metastatic colon cancer.
“It was really, really scary,” Laura says.
Innovative approach to colon cancer
Dr. Al-Rajabi started Laura on a powerful chemotherapy regimen to suppress the growth of her tumors. After 4 months, she was admitted to The University of Kansas Hospital for cytoreductive surgery followed by hypothermic intraoperative intraperitoneal chemotherapy.
CRS-HIPEC is a cancer-fighting technique available at the most advanced cancer centers in the country. Dr. Al-kasspooles has completed the procedure hundreds of times since the early 2000s. In the surgical oncology field, his expertise is widely known and respected.
Dr. Al-kasspooles partnered with gynecologic oncologist Julia Chapman, MD, to perform Laura’s surgery. He removed the cancerous section of her colon, plus tumors as small as grains of sand throughout her abdomen. Dr. Chapman removed the ovaries, fallopian tubes, cervix, uterus and part of the vagina.
In the final step, Dr. Al-kasspooles bathed Laura’s organs and tissues in a heated chemotherapy solution to destroy any hidden cancer cells.
Laura remained in the hospital 5 days after surgery. She remembers some nausea and vomiting the first 2 days, and then she began to feel better. “Laura took this with extreme bravery, even though she knew the odds were against her,” says Dr. Al-Rajabi.
Aggressive colon cancer treatment pays off
Laura’s operation was successful. There was no evidence of cancer after surgery. As an added precaution, Dr. Al-Rajabi prescribed 2 more months of IV chemotherapy.
“I had to take it easy until I healed. Then I went back for scans every few months. I’ve been clear every time,” says Laura.
Patients with complex cancers benefit from the multidisciplinary approach at The University of Kansas Cancer Center. When physicians from different specialties work together, patient outcomes are better. In fact, patients treated at NCI-designated centers such as ours have a 25% greater chance of survival than those at other cancer centers.
“Laura sees a medical oncologist, a surgeon and a gynecologic oncologist on the same day, in the same clinic,” explains Dr. Chapman. “We’re all watching her very closely and communicating with each other about all aspects of her care.”
An aggressive treatment plan dramatically improved Laura’s chance for survival. Yet the possibility for cancer recurrence exists. “If it ever returns, we would be just as aggressive in our treatment,” says Dr. Al-Rajabi.
“My care was amazing. Everybody was so nice. If I ever get sick again, I plan on going back,” Laura says.
Lifesaving, life-changing care
Courtney Marsh, MD, MPH, is a reproductive endocrinologist who often assists with cancer patients like Laura. Initially, Dr. Marsh planned an experimental fertility preservation technique available only in the Kansas City area. During surgery to remove Laura’s ovary for preservation, it was discovered she had a tumor on the ovary. As a result, Dr. Marsh could not proceed with the ovarian tissue cryopreservation.
“I was pretty upset to learn that I won’t have the opportunity to have kids. Every once in a while, I wake up and feel sad about what happened,” says Laura.
Besides the loss of fertility, Laura will experience lifelong repercussions from the hysterectomy. “Premature menopause puts young women at greater risk for heart disease and a host of other health issues,” says Dr. Chapman.
The value of hormone replacement therapy for menopausal women over 50 may be up for debate. But there is no question of its importance for someone as young as Laura.
“Without estrogen, women run the risk of significant problems with their skin, hair, bones, urinary system, brain and heart,” says Dr. Chapman. “Laura needs hormones for the protective benefits now and in the future.”
Laura has been cancer-free for 18 months. During that time, she completed the certified nursing assistant program at Donnelly College. Now, she’s studying to become a licensed practical nurse.
“I would like to become a doctor and work with cancer patients,” says Laura. “I’m a better listener now and can give good advice based on what’s happened to me.”
Dr. Al-kasspooles and the cancer team wish Laura the very best. “We are amazed by how well she’s done. Her positive outlook has helped quite a bit. We’ve all been inspired by her,” he says.
Laura credits a phrase from “The Lion King” for her optimism. “I really like the meaning of ‘hakuna matata.’ You know, no worries,” she says. “Those words helped me get through the tough times.”
Those words, and a small, furry creature named Rusty, eased Laura’s difficult journey. Shortly after her diagnosis, she added the Chihuahua to her menagerie. “He’s been with me ever since. I don’t think I would have made it without him,” she says.