Innovative Surgery Treats Adrenocortical Cancer

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, Staff Writer
While routine visits to the doctor sometimes may seen unnecessary, they may reveal life-saving information. For Angela Hawkins, a 2004 check-up changed the course of her life.

AngelaHawkins.jpgFor about six months, Hawkins had struggled with pain in her side, thinking it was an injured rib. But a yearly well-woman exam revealed she had an enlarged liver.

The gynecologist's concern prompted Hawkins to see a gastroenterologist, who performed a CT (computed tomography) scan and several biopsies, only to reveal inconclusive results. He referred her to M. D. Anderson, where Hawkins discovered her adrenal gland, not her liver, was the problem. She was diagnosed with stage IV adrenocortical carcinoma.

"As soon as you're diagnosed, you want something you can be working toward," Hawkins says. "The doctors at M. D. Anderson laid out a strategy plan, listing ways we could try to fight this."

Rare cancer requires intense treatment

Adrenocortical carcinoma is a malignant tumor that occurs in the outer layer of the adrenal gland. It is a rare cancer, affecting only about 300 to 500 people annually in the United States. Age is believed to be the biggest risk factor. Most cases occur in adults between the ages of 40 and 50, although it is known to strike children under 5 years old. Symptoms of adrenocortical carcinoma vary widely, depending on the hormones produced by the tumor.

Hawkins' doctor, Jean-Nicolas Vauthey, M.D., a professor in the Department of Surgical Oncology at M. D. Anderson, told her the cancer was inoperable as it was, so she received eight months of chemotherapy to shrink the tumor.

Workplace provides strength

During chemotherapy, Hawkins lost her hair and 35 pounds, but she says she was lucky to have a supportive work environment. Co-workers even helped raise money to offset her medical expenses. They never made her feel guilty for missing work, she says, even when she had to take a month off after surgery.

"They were very supportive the whole time, and I did everything I could to work," she says. "You can't take advantage of a situation like that."

New procedure removes tumor

After chemotherapy, Hawkins went back to Vauthey for surgery. He removed the tumor, one kidney and half of her liver using a procedure that placed the liver in a type of "sling."

The sling procedure ensures a more accurate surgery, dramatically reduces the chance of damaging the vena cava, a major vein that runs through the liver, and also reduces the likelihood of rupturing the tumor.

The technique can be used to remove large tumors in the right upper abdomen area and has been used in patients with adrenal, liver or colorectal cancer, stromal tumors and renal cell carcinoma.

The journey is the adventure

Nearly four years later, the lessons Hawkins learned remain fresh in her mind. She says family and time are too precious to lose track of.

"I think cancer helps you realize there are certain things in your life that you better enjoy," she says. "You can't get caught up in the day-to-day struggle. You have to enjoy the journey."

Family bond grows stronger

Science may have cured Hawkins, but it was the support from her extended family, which includes parents, a brother, a son and daughter, 11 aunts and uncles, and countless cousins, that carried her through.

"My family is huge and was very supportive. They are what got me through this," Hawkins says. "I think it was critical to my survival."

A brush with cancer also has brought her family closer together. Instead of putting off time together until "some day," a time that may never come, her family marks the small milestones like birthdays and anniversaries. They also recently took a trip to Italy and can't stop talking about it, she says.

During a period of uncertainty, Hawkins also found comfort in the dedication of her medical team.

"The doctors gave me some hope to hold on to," she says. "That's all we really have every day anyway."

Read more Feature Stories from Cancerwise

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