Appendiceal carcinoma, pseudomyxoma peritonei (PMP)* and other peritoneal surface malignancies are rare and, sadly, all too often misdiagnosed or poorly managed. Just ask Joseph Laureanno, a 53-year-old sales executive from Lowell.
“I’d been having some discomfort in my lower right abdomen,” he recalls. “So when I went for my regular wellness checkup with my PCP, he sent me for a CT, thinking I might have a gallstone.”
“Based on the CT, however, they thought I might need an appendectomy but were concerned about the fluid they saw in my abdomen,” he continues. “They suggested I go by ambulance to the ER at a Boston hospital. They found a small growth they called a mucocele on my appendix but commented that the fluid was not a concern because it didn’t appear to be infected. So after 10 hours, they sent me home with the recommendation to get back to my PCP for a referral to see a gastroenterologist. There was no great sense of urgency.”
His PCP referred Laureanno to Lauri Welch, BS, NP, a nurse practitioner who works in a gastroenterology practice affiliated with Lowell General. And then things took a dramatically different tack.
“She told me this potentially was a dangerous type of cancer, and she immediately referred me to Sajani Shah, MD at Tufts Medical Center.” Shah is a board-certified general surgeon, and she scheduled Laureanno for an appendectomy within two weeks of seeing him in August of 2010.
When Laureanno woke up from the procedure, however, he learned that he not only still had his appendix, but also that he had mucinous cystadenocarcinoma.
“Dr. Shah told me that she had stopped in the middle of the operation and called in Dr. Goodman to take a look,” he says, referring to Martin D. Goodman, MD, head of the Peritoneal Surface Malignancy Program in Tufts Medical Center’s Surgical Oncology Division. “My appendix was ‘leaking’ cancerous fluid into my abdomen, so a simple appendectomy wouldn’t have solved the problem. The good news was that my cancer was low- to middle-grade, according to Dr. Shah, and that Dr. Goodman specializes in treating this type of cancer.”
Goodman, in fact, is nationally recognized for his expertise and experience in treating peritoneal malignancies with hyperthermic intraperitoneal chemotherapy (HIPEC). He and his team perform 40 to 50 HIPEC procedures annually, making Tufts Medical Center one of the higher-volume centers in the country. HIPEC today is the gold standard for treating appendiceal carcinoma, and it also is used for treating PMP, peritoneal carcinomatosis, ovarian cancer, peritoneal mesothelioma and gastric cancers.
“I met with Dr. Goodman about two weeks later and he explained the procedure,” Laureanno says. “My anxiety level was pretty much off the charts, but he had an amazing way of calming me down, and helping me understand that this was my best treatment option. My prognosis without HIPEC was pretty dire.”
Laureanno underwent the six-and-a-half-hour HIPEC procedure in October 2010.
“They took out my appendix, gallbladder and the outside lining of my abdominal wall,” he says, then his peritoneal cavity was perfused with a heated fluid containing a high dose of chemotherapy. The incision required 46 staples to close. “It knocked the heck out of me,” he admits, but he was able to be discharged to home just seven days later (the typical length of stay for HIPEC patients ranges from 10 to 21 days). “I was determined,” he adds.
Laureanno’s follow-up regimen entails a CT scan every six months and blood work every three months. Nearly two years post-op, his latest tests reveal no signs of cancer cells.
“I’ve come to understand how easily this cancer can be overlooked, so I feel very lucky,” he says, crediting gastroenterologist Welch for realizing the urgency of the situation and referring him to Tufts Medical Center, and Shah for getting Goodman involved.
“They saved my life,” he adds.
*PMP is a rare condition characterized by the presence of mucin-producing tumors and the mucin – a gelatinous substance secreted by the tumor cells that enables them to move around the abdominal cavity. Appendiceal carcinoma is the most common source of the tumors that cause PMP.