Colorectal cancer, the second leading cause of U.S. cancer deaths, can be prevented if caught early. All too often, it isn’t discovered until the disease has progressed.
That was the case for James Kazak. He was diagnosed with colon cancer in June 2019 at age 61. Because it had spread to one of his lymph nodes, it was classified as stage IIIa. Chemotherapy knocked out the cancer and he continued on with his life.
About six months later, however, he began to experience intense stomach distress. He began eating less to avoid the pain. After multiple imaging scans found nothing, he was told to try fasting and to use an over-the-counter stomach acid reducer. Nothing helped.
In May 2021, the Laguna Niguel resident was admitted to a south Orange County hospital, unable to pass anything through his bowel. A youth baseball coach and lifelong athlete, Kazak had lost 50 pounds. Tests showed that his cancer had not only returned, it had spread into his abdomen. The 5-year survival rate for such stage IV colon cancers is only 14%.
Seeking a second opinion
His doctors started him on another round of chemotherapy. But one physician familiar with UCI Health surgical oncologist Dr. Maheswari Senthil, an expert in treating advanced gastrointestinal cancers, or peritoneal carcinomatosis, suggested that Kazak contact her for an evaluation.
Peritoneal carcinomatosis occurs when gastrointestinal and gynecological cancers spread widely throughout the abdomen and into the peritoneum, a thin lining that covers the abdominal organs and abdominal wall. Senthil, director of the Peritoneal Malignancy Program at the UCI Health Chao Comprehensive Cancer Center, has performed more than 500 cytoreductive surgeries, a procedure to remove all visible tumors. She told Kazak she could help.
Once he was transferred to UCI Medical Center for surgery in June 2021, she removed numerous tumors — some the size of grapefruits — along with his colon and part of his rectum in a procedure that lasted about nine hours. His abdomen was then bathed in a heated solution of chemotherapy for 90 minutes to kill any remaining microscopic cancer cells.
Kazak went home within five days of the surgery. On day one, he was back to his work as a tax advisor and the real estate business he runs with his wife, Grace.
“James had a very aggressive cancer, a complete bowel obstruction and a tumor type that was resistant to chemotherapy,” says Senthil. “Without this surgery, he might have only survived a couple of months.”
New lease on life
At first, the ileostomy bag Kazak now wears to collect his body’s waste gave him pause. “But then my ‘man ego’ kicked in,” he says. “I got to work on how to manage it and get my health back.”
A month after surgery, he and his wife flew to Tennessee with their 12-year-old son AJ for a week-long baseball tournament. In December, they all attended a national youth baseball tournament in Florida, where he coached AJ's team and boys he'd never met before to second place.
“I’m back to my normal weight of 245 pounds and I have all my energy back,” says Kazak, now 64, who works out regularly at a gym near his home.
At the moment, he is neck-deep in clients’ tax returns and doesn’t expect to come up for air until after April 15. But Senthil says his quality of life is excellent post-surgery, adding, “There is nothing he cannot do.”
“The prognosis for patients with this type of stage IV cancer is getting better and better,” she says. “Cytoreduction is an important component in the overall treatment of patients with advanced cancer.”
Cytoreduction improves survival
Research has demonstrated that patients live significantly longer after cytoreduction than those without it.
“Gastrointestinal cancer patients need to be aware of this operation,” says Senthil, a professor and chief of the UCI School of Medicine’s Division of Surgical Oncology. “They should be given this chance for extended survival and great quality of life.”
She also is determined to improve treatment for patients with advanced stomach cancer that also has spread to the peritoneal lining. Like colorectal cancer, the incidence of metastatic stomach cancer has been climbing in recent years, especially among adults in their 20s, 30s, 40s and 50s.
The current standard of care for these patients is intravenous (IV) chemotherapy. Studies have shown that chemotherapy (with platinum and fluoropyrimidine) slows the spread of cancer for about six months before it returns. Evidence suggests this regimen is insufficient because the peritoneal membrane reduces how much actual chemotherapy reaches the abdominal cavity.
Boosting chemotherapy's effectiveness
To combat this, Senthil has launched STOPGAP, a novel clinical trial to deliver the drugs directly to the peritoneum through a small device implanted into the abdominal fat tissue.
Participants then undergo cytoreduction surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), as Kazak did. STOPGAP, which seeks to enroll 35 patients, is the only U.S. clinical trial to combine all three modalities of treatment for advanced gastric cancers.
Cytoreduction surgery and HIPEC — whether for advanced gastric or colorectal cancers, as in Kazak’s case — isn’t for every patient. "But 50% of those evaluated turn out to be candidates," says Senthil, who performs about two cytoreduction procedures a week.
“Even stage IV cancers can have a very good outcome with this type of surgery when treated by the right team,” she adds, noting that the Chao Family Comprehensive Cancer Center, the only National Cancer Institute-designated comprehensive center in Orange County, is among the few cancer centers in Southern California with the necessary level of expertise.
“James is doing amazingly well — there is no evidence of disease and his treatment is complete,” Senthil says. “We’ll keep him under close surveillance for many years, but his chances of living an active, healthy life and seeing his son grow to manhood are very good.”