{"id":4928,"date":"2016-01-20T00:00:00","date_gmt":"2016-01-20T07:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/01\/20\/team-approach-attitude-keep-rare-cancer-in-check\/"},"modified":"2022-08-18T10:08:12","modified_gmt":"2022-08-18T16:08:12","slug":"team-approach-attitude-keep-rare-cancer-in-check","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/team-approach-attitude-keep-rare-cancer-in-check\/","title":{"rendered":"Team approach, attitude keep rare cancer in check"},"content":{"rendered":"
<\/div>

It started with heartburn right around his 50th birthday, which he tamed with Tums and Zantac. Although his wife told him he should see a doctor, Doug Everett shrugged it off: Everyone has heartburn, right?<\/p>\n

It was eight years until Everett brought it up with his doctor \u2013 David Gaspar, MD, of University of Colorado Hospital\u2019s AF Williams Family Medicine Clinic at Stapleton. It wasn\u2019t the heartburn so much as a sense of just not feeling right, which Gaspar suspected might be a reaction to the Lipitor Everett was taking for a slight increase in cholesterol. Gaspar palpated Everett\u2019s liver and ordered an ultrasound, which Everett underwent on May 2, 2014.<\/p>\n

Within days, a team of UCH cancer specialists had diagnosed a primary pancreatic neuroendocrine tumor and assessed the treatment options in a multidisciplinary clinic. Less than a month later, on May 30, 2014, Richard Schulick, MD, MBA<\/a>, surgical oncologist and chairman of the University of Colorado School of Medicine\u2019s Department of Surgery, removed a cancerous mass larger than a softball and fed by no fewer than five arteries. Schulick then reconfigured Everett\u2019s digestive tract in a Whipple procedure<\/a>. In the ICU afterwards, Schulick told Everett, \u201cI don\u2019t know how you ate.\u201d<\/p>\n

Doug Everett in his office at National Jewish Health.<\/figcaption><\/figure>\n

Everett\u2019s story shows that a combination of ongoing care from a diverse team of specialists and a positive attitude can help someone stay healthy \u2013 despite having the same cancer that killed Steve Jobs.<\/p>\n

A rare cancer<\/strong><\/p>\n

Neuroendocrine cancers are rare, accounting for just 1 to 2 percent of pancreatic cancers. They\u2019re also slow-growing and tend to spin off metastatic tumors that end up larger than the parent tumor, says Tom Purcell, MD, MBA, executive director of Cancer Services for University of Colorado Hospital and the CU School of Medicine medical oncologist treating Everett.<\/p>\n

The cancers can manifest in many places \u2013 the pancreas, the small bowel, the lungs and elsewhere. The \u201cendocrine\u201d refers to hormone-secreting organs such as the hypothalamus, the pituitary, the thyroid, the adrenals, and the pancreas (which secretes hormones into the bloodstream as well as digestive fluids into the gut). The \u201cneuro\u201d alludes to these hormones\u2019 effect on the activity of nerves and vice-versa. The combination regulates everything from metabolism to mood.<\/p>\n

When Schulick first described the tumor to Everett and his wife, Char Sorensen, the surgeon called it a \u201cwell-behaved pancreatic cancer.\u201d<\/p>\n

Neither Everett nor Sorensen had ever heard of neuroendocrine cancer. Everett in particular is no health care neophyte. He is head of the Division of Biostatistics and Bioinformatics at National Jewish Health in Denver and has a PhD in cardiorespiratory physiology. The pancreatic cancers they knew were as nasty as they come: The typical pancreatic adenocarcinoma is the most fatal of cancers, with just 6 percent of patients surviving five years after diagnosis, according to American Cancer Society data<\/a>.<\/p>\n

Either way, the diagnosis was jarring, Sorensen said. A close friend\u2019s husband had recently succumbed to pancreatic cancer just 17 days after diagnosis.<\/p>\n

\u201cWhat I\u2019d heard as far as pancreatic tumors is that people get them and they die,\u201d she says.<\/p>\n

It takes a team<\/strong><\/p>\n

Everett sits at a table in his National Jewish corner office. Snow falls outside the windows. He is trim and looks a solid decade younger than his 59 years. Shelves of technical and medical-science volumes augment a slightly bookish appearance. But this is an athlete \u2013 a former competitive swimmer who later ran and now cycles \u2013 45 minutes well before dawn on the trainer this morning, he says. Nothing about him suggests that he\u2019s a cancer patient.<\/p>\n

\"Doug
Doug Everett and Char Sorensen walking near their home in Westminster last summer.<\/figcaption><\/figure>\n

And indeed, the surgery initially changed his life dramatically. The tumor had been blocking pancreatic secretions into his gut and had affected gastric emptying, too. The Tums had followed the tumor out the door, as did the Lipitor. The mild hypertension he had experienced prior to surgery also disappeared \u2013 Everett figures the tumor itself was secreting a hormone that triggered it.<\/p>\n

But that\u2019s not the end of the story. Neuroendocrine tumors may grow slowly, but they do grow, and they spread to other organs. So patients like Everett undergo scans and blood tests every couple of months for the rest of their lives. In Everett\u2019s case, the imaging two months after surgery was clean, as was another round two months after that. But in November 2014, a scan showed tumors in his liver\u2019s right lobe.<\/p>\n

Purcell took Everett\u2019s case to a session of the University of Colorado Cancer Center\u2019s neuroendocrine multidisciplinary clinic (MDC) at UCH. The group, which includes specialists in medical oncology, surgical oncology, radiation oncology, gastroenterology, interventional radiology, pathology, radiology and nuclear medicine, meets weekly to discuss complex cases like Everett\u2019s.<\/p>\n

\u201cNo one physician can take care of neuroendocrine cancer patients,\u201d Purcell says. \u201cIt requires a diverse team of specialists that approach the patient together, each bringing treatment tools to the table.\u201d<\/p>\n

Rad onc<\/strong><\/p>\n

The goal is not only to extend a patient\u2019s survival but also to improve quality of life. \u201cWith the right tool at the right time, you can stretch out the need for interventions and keep the patient as well as possible \u2013 even those we don\u2019t cure \u2013 for 5, 10, 15 years,\u201d Schulick says.<\/p>\n

For Everett and Sorensen, access to the MDC saved time and stress, but was also reassuring, Sorensen says.<\/p>\n

\u201cI know we\u2019re going to get the opinion of the whole group and not just one person,\u201d she says. \u201cIt\u2019s such a relief that we have had this whole team behind us.\u201d<\/p>\n

The MDC\u2019s consensus was to start Everett on oral chemotherapy in December 2014. The tumors shrank, but so did Everett\u2019s blood-cell count. The MDC team changed the care plan to radiation therapy, which Tracey Schefter, MD, a CU School of Medicine radiation oncologist, performed in March 2015. There\u2019s still a tumor visible in the liver, but it hasn\u2019t changed in appearance since, Everett says. Schulick tells him that \u00a0removing part of the liver is a possibility, but they\u2019ll continue to watch and wait.<\/p>\n

Attitude matters<\/strong><\/p>\n

This sort of uncertainty, inherent in neuroendocrine tumor treatment, can take a psychological toll, Purcell says.<\/p>\n

\u201cThe good thing about neuroendocrine tumors is that patients live a long time with metastatic disease,\u201d he says. \u201cThe flip side is that we have to continue surveillance, and that can be very stressful for the patient.\u201d<\/p>\n

This is where Everett\u2019s attitude has been important. He is, as Sorensen puts it, \u201cone of these relentlessly optimistic people. I really believe that goes a long way toward why he\u2019s doing so well \u2013 because he believes he\u2019ll be fine.\u201d<\/p>\n

The competitor in Everett also plays a role. He\u2019s been through so many surgeries \u2013 shoulders, an ankle, a 2012 prostatectomy \u2013 that he considers them to be inconveniences as opposed to life-altering events. He prefers the word \u201cdiscomfort\u201d to \u201cpain\u201d because \u201cpain is scary, and discomfort is something you manage.\u201d He views his cancer as a tough adversary, but one against whom he can hold his own.<\/p>\n

\"Tom
Tom Purcell during a weekly neuroendocrine multidisciplinary clinic at UCH.<\/figcaption><\/figure>\n

\u201cI\u2019m not afraid, and I have every expectation that I\u2019ll succeed,\u201d Everett says. \u201cIf you go into a competition thinking you might not win, you\u2019ve already lost.\u201d<\/p>\n

He\u2019s not the only player in this game, he adds.<\/p>\n

\u201cWithout my contribution, what Schulick, Purcell and Schefter do goes for naught,\u201d he says.<\/p>\n

For those who find themselves facing a cancer diagnosis like his, he says to \u201ckeep asking questions until you get answers.\u201d Keep living life and make sure you feel good about the health care professionals you\u2019re seeing \u2013 not only about their abilities as practitioners, but also their personal demeanor, because cancer treatment is a collaboration, he says.<\/p>\n

That applies to how doctors interact with family, too. Sorensen says she\u2019s asked both Purcell and Schulick \u201cthe same inane questions probably 15 times, and they both look at me and say, \u2018You know, that\u2019s a really good question.\u2019\u201d<\/p>\n

\u201cShe knows that they listen to her and respect her,\u201d Everett says. \u201cI think that\u2019s fabulous.\u201d<\/p>\n

Doug Everett, Char Sorensen and UCH medical oncologist Tom Purcell, MD,<\/em> talk about<\/em> Everett\u2019s case and the unique challenges of neuroendocrine cancer.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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