A cancer diagnosis can be daunting. But what if the cancer diagnosis involves an extremely rare form of cancer – and the diagnosis is made during a pandemic? One patient lived through this harrowing experience.

Over the past several years, Vince McRuiz of Brookfield, Connecticut, has experienced several health and personal challenges. The 68-year old was diagnosed with ulcerative colitis in 2013 and underwent major colon surgery in 2019, which required a three-week hospital stay. In 2018, McRuiz lost his wife, Cynthia, to complications from Parkinson’s disease.

Listen to an episode of The Onco’Zine Brief. Peter Hofland, Ph.D interviews Vince McRuiz and Margo Shoup, MD, FACS, a nationally recognized surgical oncologist who specializes in gastrointestinal cancers and sarcomas. Shoup is also the senior vice president, and system chair of the Nuvance Health Cancer Institute, where she provides strategic and clinical leadership for all aspects of Nuvance Health’s cancer services. For more information about The Onco’Zine Brief or how to sponsor or support this public radio broadcast and podcast, please visit our page at Patreon.

Then in March 2020, just as the COVID-19 pandemic was ramping up in the northeastern United States, a routine CT scan at Danbury Hospital, a part of Nuvance Health, to follow-up on his earlier colon surgery, showed a mass in McRuiz abdomen. The biopsy results confirmed that the mass was indeed malignant- and, with 20-inches, extraordinarily large.

McRuiz was diagnosed with a large, but rare, abdominal cancer called a retroperitoneal sarcoma, a type of cancer that develops in the lining of the abdominal wall and the soft tissues that surround the kidneys, pancreas, and blood vessels.* [1]

McRuiz needed surgery.

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As the father of three children and grandfather of four, McRuize’s family is the centerpiece of his life. He understood that despite the COVID-19 pandemic, he urgently needed treatment.  A treatment to remove the abdominal cancer as quickly as possible so he could get back to spending time with his family and other life’s priorities.

“I was stunned. I was frightened, and I didn’t really know anything about cancer,” said McRuiz.

“I lost my mother and two good friends to cancer, so as far as I knew, it meant a death sentence — that was foremost on my mind,” McRuiz said.

A complex surgery
To help provide care close to home, McRuiz’ medical oncologist/hematologist, Sharynn Hall, MD, arranged for him to meet Margo Shoup, MD, FACS, a nationally recognized surgical oncologist who specializes in gastrointestinal cancers and sarcomas and network chair of cancer services at Nuvance Health.

Photo: Margo Shoup, MD, FACS, a nationally recognized surgical oncologist with expertise in gastrointestinal cancers. Shoup, who joined Nuvance Health in April 2019, continues to build on the existing cancer programs so that people have access to top-notch community-based care without traveling far. It’s up to us to make this happen, and we can. She also manages the first-of-its-kind cancer care collaboration with Memorial Sloan Kettering Cancer Center (MSK) that successfully launched in 2017 to accelerate access to the newest cancer treatments for residents of the New Yorl Hudson Valley and Western Connecticut. Photo courtesy: © 2020 Nuvance Health. Used with permission.

Removing retroperitoneal sarcoma requires one of the most complex types of surgery. And while a diagnosis of cancer alone can indeed be daunting, making a decision about how to proceed when diagnosed with a rare type of cancer during a pandemic may create additional anxiety.

Fortunately, Shoup has expertise in this type of cancer surgery because she specializes in treating gastrointestinal cancers and sarcomas.

Although McRuiz initially intended to travel to New York City for his cancer care, with COVID-19 and his advanced-stage large cancer, causing him significant discomfort, this was not an ideal option. After meeting with Shoup, he decided to have surgery at Danbury Hospital.

Surgery with complete resection of the primary tumor is still the only curative option for the treatment of patients with retroperitoneal sarcoma and considered the standard of care.** [2]

As a result, and regardless of the increasing effects of the pandemic in her community, Shoup recommended McRuiz to have surgery as soon as possible.

Successful treatment
During a four-hour surgery, Shoup removed a large tumor that was over 20 inches in size, as well as two smaller tumors that were 8 inches and 5 inches. She also removed one of McRuiz’s kidneys and an adrenal gland, which had been displaced by the largest tumor.

“The COVID-19 dimension was a little scary, but honestly, it wasn’t great on my mind yet because I was so focused on the fact that I had cancer,” McRuiz noted

McRuiz said he felt secure during his hospital stay due to his private room and other safety precautions. He was also impressed by his care.

“Shoup was terrific,” he said. “I think the world of her. “And Victoria Grasso (a nurse and member of McRuiz’s care team) was also outstanding,” McRuiz observed.

Photo: Vince McRuiz and his daughter, Elise, who temporarily moved in with her Samoyed dog, Brie, to help her father during the recovering process. McRuiz said his daughter’s care and assistance were invaluable, especially during the early recovery period. Photo courtesy: © 2020 Nuvance Health. Used with permission.

A focus on recovery
McRuiz was discharged from the hospital within four days after his surgery, a relatively short time following a major, invasive, surgery.

To help with the recovery process, his daughter, Elise, temporarily moved in with her Samoyed dog, Brie, to stay with him and was able to work from his house. McRuiz said his daughter’s care and assistance were invaluable during the early recovery period. And while McRuiz also briefly had in-home nursing care, he noted that he needed very little nursing assistance during his recovery.

“When I got out of the hospital, I was weak as a kitten, and walking was a big challenge. I was in significant pain for about a week afterward and had a lot of rebuilding to do,” McRuiz commented.

“For two weeks, the hardest part of my day was getting out of bed because I didn’t have abdominal strength,” he added.

During the early part of his recovery and guided by his care team, McRuiz said he focused on good nutrition to help with healing, and getting up and walking as much as he could. He also focused on deep breathing exercises to improve his lung function, build strength, improve overall health, and reduce the risk of pneumonia — which was especially crucial because of COVID-19.

“I started by walking around the house, and now I’m walking 1.5 miles a day,” said Vince, who has always enjoyed outdoor activities such as swimming, landscape gardening, hiking, and riding his motorcycle.

Today, a few months after his surgery and initial recovery, McRuiz is in good spirits. He still needs to have quarterly follow-up CT scans to make sure he is healing well and to determine if additional treatment is required. But for now, he is looking forward to regaining his strength and enjoying life as completely as possible.

“I look forward to doing fun things with my kids and grandchildren, like hiking trips,” McRuiz said.

“My grandkids are very active, and I want to spend a lot of time with them experiencing their growth. I also love to travel, and I can’t wait to get back to that,” he added.

McRuiz said he is also working on recovering after the loss of his wife.

“I look forward to getting physically healthier so I can put more energy toward my emotional health,” said Vince.

Encouraging others not to postpone treatment
With his experience behind him, one thing that McRuiz observed is that many people may decide to postpone their treatment. However, McRuiz wants to encourage others not to put off medical care due to COVID-19 concerns. His own experience demonstrates that healthcare professionals are capable of dealing with health concerns during a pandemic.

“Evidence indicates that some people are afraid to leave their homes in order to seek needed treatment, sometimes letting an illness get far worse,” McRuiz explained.

“But people should weigh the benefits and risks of possible COVID-19 exposure versus getting the care they need. Listen to science and not to fear when it comes to managing your health.”

* Note: A sarcoma is a rare type of cancer that starts in tissues like bone or muscle. Soft tissue sarcomas generally develop in soft tissues such as fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. While sarcomas can be found in any part of the body, they generally start in the arms or legs. They can, however, also be found in the trunk, head and neck area, the internal organs, and the area in the back of the abdominal cavity, known as the retroperitoneum.[3]

** The role of preoperative radiotherapy in the treatment of patients with retroperitoneal sarcoma is not clear and is currently being investigated clinical trial. Neo-adjuvant chemotherapy is also not considered a standard treatment option but can be considered occasionally when complete resection is uncertain.[2]

Clinical trials
Proton or Photon RT for Retroperitoneal Sarcomas – NCT01659203
Radical Resection and Heated Intraperitoneal Chemotherapy (HIPEC) for Recurrent Retroperitoneal Sarcoma – NCT03792867
Surgery With Our Without Neoadjuvant Chemotherapy in High-Risk RetroPeritoneal Sarcoma (STRASS2) – NCT04031677

[1] Porpiglia AS, Reddy SS, Farma JM. Retroperitoneal Sarcomas. Surg Clin North Am. 2016;96(5):993-1001. doi:10.1016/j.suc.2016.05.009
[2] Van Houdt WJ, Zaidi S, Messiou C, Thway K, Strauss DC, Jones RL. Treatment of retroperitoneal sarcoma: current standards and new developments. Curr Opin Oncol. 2017;29(4):260-267. doi:10.1097/CCO.0000000000000377
[3] American Cancer Society.Cancer Facts & Figures 2020. Atlanta, Ga: American CancerSociety; 2020. Online. Last accessed August 1, 2020.

Featured image: Vince McRuiz a few months after his surgery and recovery. Photo courtesy: © 2020 Nuvance Health. Used with permission.

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