A ray of hope for stage 4 appendix cancer patients at Fresno hospital

A 90-minute chemotherapy bath is giving Agustina Meza-Alfonso a new lease on life.

Last week Meza-Alfonso, 48, became the first patient to undergo hyperthermic intraperitoneal chemotherapy at Community Regional Medical Center in downtown Fresno.

Community is the only hospital in the central San Joaquin Valley to offer HIPEC and is among only a handful of hospitals in the state to provide it, including University of California medical centers at Irvine and San Diego.

Without the complicated, innovative procedure, the Visalia homemaker, diagnosed with stage 4 cancer of the appendix, had few options. She had a 10- to 12-inch tumor growing low in her pelvis and microscopic tumors growing on the walls of her abdomen.

Appendix cancer is rare, affecting an estimated 600 to 1,000 Americans a year. Often it goes undiagnosed until it’s found in scans looking for another suspected condition. The tumor inside Meza-Alfonso had been growing for about three years. Doctors in Visalia thought she had uterine cancer when they discovered the appendix tumor. Her symptoms: a swollen belly and abdominal pain.

On Thursday, Meza-Alfonso said through a Spanish interpreter: “I have no pain and my stomach is smaller.”

When she was referred to Community’s cancer doctors, they found her tumor had grown dangerously close to her kidneys.

“We had to do something. We couldn’t let it go any further,” said Dr. Babak “Bobby” Eghbalieh.

It would take about six months, however, for Eghbalieh and fellow cancer surgeon Amir H. Fathi to get insurance approval for the surgery and chemotherapy.

HIPEC is not without risks and is not recommended for everyone. Patients undergo an invasive surgery before the chemotherapy treatment, known as cytoreductive or “debulking” surgery. Ridding the abdomen of tumor nodules of any visible size is crucial to the procedure’s success.

“Patients are selected very carefully,” Eghbalieh said. In addition to Meza-Alfonso, Community has 10 other patients who have been identified as candidates for the surgery, he said.

HIPEC, which has been performed for about a decade in Europe, has become more common in the United States in the past five years, said Fathi, who with Eghbalieh operated on Meza-Alfonso. “If you choose the right patient at the right time, your survival rate is 60 percent at five years,” he said. HIPEC is also done for certain chest-lining tumors and gynecological cancers, but it is used only for abdominal cases at Community at this time.

In Meza-Alfonso’s case, her mucinous type of cancer – also called “jelly belly” – had spread inside her abdomen. Eghbalieh and Fathi removed parts of her rectum, colon, small bowel, gallbladder. They then scraped the entire lining of her abdominal cavity for tumors. The cytoreductive surgery took 10 hours.

Once the tiniest tumor nodules had been cut away, two tubes were inserted into Meza-Alfonso’s belly and a highly concentrated chemotherapy solution was heated to 108 degrees Fahrenheit, a temperature considered hot enough essentially to kill tumors.

Over the next 90 minutes, the heated solution circulated in and out of her belly and her abdomen was shaken to slosh the cancer-killing solution onto all sides of the abdominal cavity. At the end, the solution was suctioned out, her belly irrigated with water and the doctors began to reconstruct her intestines.

On Thursday, Meza-Alfonso said she was ready to go home. As an outpatient, she will have traditional intravenous chemotherapy once every two weeks for six months as a precaution. And Eghbalieh and Fathi will monitor her for far longer.

She said she gives thanks to God and the doctors. The procedure, she said, “is priceless.”

This story was originally published April 7, 2016 at 6:09 PM with the headline "A ray of hope for stage 4 appendix cancer patients at Fresno hospital."