{"id":32554,"date":"2020-06-17T08:30:05","date_gmt":"2020-06-17T14:30:05","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=32554"},"modified":"2023-02-20T08:35:04","modified_gmt":"2023-02-20T15:35:04","slug":"rectal-cancer-treatment-without-surgery","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/rectal-cancer-treatment-without-surgery\/","title":{"rendered":"Rectal cancer treatment without surgery"},"content":{"rendered":"
<\/div>

Jeff Armentrout is a first, a designation he never sought and in many ways he wishes he never had, but his cancer put him in that position.<\/p>\n

In August 2016 Armentrout, then 39, was in the midst of life as a law enforcement officer in northern Colorado when he began experiencing fatigue and saw blood in his stool. The tiredness was a puzzle to a guy who moved from high school sports in his native Omaha to a college career as an offensive lineman for the University of South Dakota\u2019s football team and a discus thrower with the school\u2019s track-and-field unit. The physician he saw attributed the bloody stools to hemorrhoids \u2013 perhaps the result of the mountain biking, running and lifting he did regularly.<\/p>\n

\"The
The summer after finishing his rectal cancer treatment without surgery, Jeff enjoyed a trip to the beach in California. Photo courtesy of Jeff Armentrout.<\/figcaption><\/figure>\n

The problems didn\u2019t clear up, so in December 2016 Armentrout got a colonoscopy, a key screen for precancerous and cancerous polyps in the intestinal tract. The procedure revealed suspicious lesions, and the news worsened when a biopsy confirmed that Armentrout had rectal cancer: tumors in the lowest section of the large intestine. Some 43,000 new cases of the disease are diagnosed each year<\/a> in the United States, about a third of the 130,000 colorectal cancer cases annually diagnosed in the country.<\/p>\n

Armentrout\u2019s gastroenterologist told him that he needed surgery to remove the tumors and handed him a list of general surgeons with the advice to have the procedure done before Christmas, a couple of weeks away.<\/p>\n

The situation was urgent. Armentrout\u2019s cancer was Stage III B<\/a>, meaning it had spread to nearby lymph nodes, though not yet to other organs. Shortly after his tests, he passed a large amount of blood and had to go to the emergency department. Still, after doing his own research, he decided to seek a second opinion about the best course of treatment. That led him to UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a> and put him on the road to becoming a first in UCHealth\u2019s innovative treatment of colorectal cancer.<\/p>\n

A new consideration: rectal cancer treatment without surgery<\/strong><\/h2>\n
\"Jeff
Jeff Armentrout (left) with his younger brother Jeremy. Jeff credits his family, as well as friends and faith, for helping him through his battle with rectal cancer, which included treatment without surgery. Photo courtesy of Jeff Armentrout.<\/figcaption><\/figure>\n

At UCH, Armentrout met with a multidisciplinary team<\/a>, including a medical and a radiation oncologist and a surgeon, who considered his possible paths forward. After reviewing his case, the care team offered a treatment approach called neoadjuvant therapy<\/a> that involves doing complete regimens of chemotherapy and radiation in the hopes of shrinking tumors as much as possible before surgery, rather than adding rounds of chemo after surgery, said Dr. Christopher Lieu<\/a>, associate professor of Medicine-Medical Oncology<\/a> and director of the Gastrointestinal Medical Oncology Program at the University of Colorado School of Medicine<\/a>. Lieu was among those who met with Armentrout.<\/p>\n

The approach also offers a new measure of hope for a small group of patients who achieve a \u201ccomplete clinical response\u201d \u2013 eradication of the cancer cells from the rectum \u2013 after chemo and radiation, Lieu said. These patients might even be able to recover without surgery, an idea pioneered by a group of surgeons in S\u00e3o Paulo, Brazil in the early 2000s<\/a>. Memorial Sloan Kettering Cancer Center in New York successfully tested the nonsurgical strategy, dubbed \u201cselective nonoperative management,\u201d with studies that began in 2014<\/a>, he added.<\/p>\n

For this select group (about 30% of patients), the chances of remaining cancer-free for the rest of their lives are about 70%, said Dr. Jon Vogel<\/a>, professor of Surgery-GI, Endocrine and Tumor Surgery<\/a> and head of the Colorectal Surgery Section<\/a> at the CU School of Medicine, who also met with Armentrout. In addition, selective nonoperative management allows some patients to avoid a permanent colostomy \u2013 an opening in the abdomen attached to the top of the colon to allow waste to leave the body for capture in a bag, he added.<\/p>\n

Surgical challenges for rectal cancer<\/strong><\/h2>\n

Rectal cancer surgery presents a number of difficulties, Vogel explained. He noted that the rectum is confined to a narrow space, surrounded by blood vessels, muscles and nerves.<\/p>\n

\u201cIt\u2019s a particularly challenging environment to work in because of the anatomical restrictions,\u201d he said. Even a surgery that goes well can weaken nerves and muscles in the bowel already injured by chemo, radiation and the cancer itself, he added. In most cases, patients can recover with a temporary opening (ostomy) for waste to evacuate, but that means waiting for the bowel to heal and then a second surgery to close the opening.<\/p>\n

There are other surgical risks, Vogel said, including nerve damage that may lead to sexual and\/or urinary dysfunction, Vogel said. \u201cThere is just a lot of baggage that comes with rectal surgery.\u201d<\/p>\n

\"Jeff
Jeff during one of his chemotherapy treatments in Fort Collins in 2017. Photo courtesy of Jeff Armentrout<\/figcaption><\/figure>\n

But Vogel stressed that the nonsurgical option, even for those who qualify, is not a slam dunk. \u201cOur concern is that we could be undertreating the cancer,\u201d he said. He noted that there is a roughly 20% chance that the cancer will regrow in the rectum and require potentially more difficult surgery than the one the patient sought to avoid. If the cancer regrows, it may also spread to other areas of the body, Vogel said.<\/p>\n

Groundbreaking choice of neoadjuvant therapy<\/strong><\/h2>\n

When Armentrout met with Lieu and his colleagues in December 2016, UCH had not tested the nonsurgical approach on a patient with colorectal cancer, though the hospital had adopted the neoadjuvant therapy strategy in 2015 with the arrival of radiation oncologist Dr. Karyn Goodman, who brought it with her from Memorial Sloan Kettering, Lieu said.<\/p>\n

With no guarantees other than the promise of constant support from his providers, Armentrout chose neoadjuvant therapy and began his chemotherapy on Jan. 2, 2017. He traveled only a few blocks from his home to get it, at UCHealth Cancer Care and Hematology Clinic \u2013 Harmony Campus<\/a> in Fort Collins, under the care of oncologist Dr. Lynn Mathew<\/a>.<\/p>\n

The trip was short, but the chemo road was rocky. During the second treatment, Armentrout said his heart rate \u201cwent through the roof,\u201d to about 180 beats per minute. Lieu told him if that happened again, they\u2019d have to stop the treatment and go to surgery. Mathew referred him for acupuncture treatments, which helped to ease his anxiety. His mother and younger brother, Jeremy, came in from Nebraska to ease him through the ordeal with companionship and home-cooked meals. His faith also helped to carry him through the disease and beyond.<\/p>\n

\"Dr.
Dr. Christopher Lieu<\/figcaption><\/figure>\n

\u201cThe cancer was a wake-up call for me spiritually to rebuild my relationship with Jesus and God,\u201d Armentrout said. The reawakening \u201cre-centered\u201d him and helped him to focus on taking care of himself and doing the things that were in his power to fight the disease. Meanwhile, he worked light- and part-time duty at his job, which offered a welcome distraction from the challenges of treatment.<\/p>\n

Passing the first test for rectal cancer treatment without surgery<\/strong><\/h2>\n

Armentrout completed eight rounds of chemotherapy and 28 radiation treatments, also at the Harmony Campus clinic, in June 2017. He was still scheduled for surgery that August, but he learned through a support group that Memorial Sloan Kettering had successfully treated rectal cancer patients without surgery. Vogel did not rule out surgery, but he considered that Memorial Sloan Kettering\u2019s support of the option \u201cthe Good Housekeeping Seal of Approval,\u201d if tests there verified that Armentrout had achieved the coveted complete clinical response to his treatments.<\/p>\n

At Memorial Sloan Kettering, Armentrout got an MRI and a flexible sigmoidoscopy \u2013 a thin tube fitted with a camera that allows providers to see inside the lower intestine. The images showed only a thin white scar. The faint image indicated Armentrout was free from cancer, and he became UCH\u2019s first selective nonoperative management colorectal cancer patient. But the emphasis was on \u201cmanagement.\u201d Armentrout and the patients who have followed him require close scrutiny by providers.<\/p>\n

Treatment for rectal cancer without surgery required strict surveillance<\/strong><\/h2>\n

Returning to Colorado, Armentrout began a \u201cvery strict surveillance period,\u201d as Lieu put it. That meant meeting with all his providers every three months for physical exams, blood work, imaging tests and, if necessary, additional scopes of his intestines.<\/p>\n

\u201cWe keep a close eye on all these patients to make sure the cancer has not come back,\u201d Lieu said. \u201cIf it does, we can pounce on it.\u201d<\/p>\n

That\u2019s not a theoretical fear, he added. \u201cIn a study of patients receiving non-operative management, the data from UCHealth is similar to other institutions in that about 20 percent of patients saw their cancer return locally,\u201d he said.<\/p>\n

\"Dr.
Dr. Jon Vogel<\/figcaption><\/figure>\n

Happily, Armentrout is not in that group. In December 2019, he met with Vogel, who smilingly introduced him to colleagues as \u201cPatient Number One,\u201d a pioneer of a new strategy for treating selected rectal cancer patients. As of this June, Armentrout has been cancer-free for three years, a key milestone because in a majority of cases, cancer recurs within that period, Vogel said. He now makes surveillance visits every six months.<\/p>\n

Armentrout\u2019s battle continues, however. His rectal cancer treatment without surgery left him with bladder and nerve pain, occasional incontinence and sexual dysfunction. He prefers, though, to focus on the things he values most, which he sums up as \u201cfamily, faith and friends.\u201d A return to full-time work is also on the horizon, along with many more days of hiking, biking and fishing.<\/p>\n

At the dawn of 2017, Jeff Armentrout thought his days might be numbered. Three-and-a-half years later, he thinks about the possibilities that lie ahead. \u201cHopefully someday I\u2019ll settle down again and have a family,\u201d he said.<\/p>\n

As for the multidisciplinary team at UCHealth, Armentrout is also plainspoken. \u201cThey saved my life,\u201d he said. \u201cComing to them was a blessing.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Jeff Armentrout is a first, a designation he never sought and in many ways he wishes he never had, but his cancer put him in that position. In August 2016 Armentrout, then 39, was in the midst of life as a law enforcement officer in northern Colorado when he began experiencing fatigue and saw blood […]<\/p>\n","protected":false},"author":2143,"featured_media":32556,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,6936,743,702],"class_list":["post-32554","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-digestive-gastrointestinal-cancer-treatment","tag-digestive-health-liver-and-pancreas-gastroenterology","tag-surgical-care"],"acf":[],"yoast_head":"\nRectal cancer treatment without surgery - 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