Pre-surgical Therapy Tested in Stomach Cancer

Like many people, Jackie Porter never thought she would be diagnosed with cancer. This Pearland, Texas, resident believed she suffered from a large stomach ulcer.

But when cancer cells were discovered beneath the ulcer, Porter became a pioneer of sorts, a position she also never thought she'd be in.

Porter participated in a test to determine whether chemotherapy and radiation before surgery (preoperative therapy) would produce a better outcome for stomach cancer patients than surgery first.

Patient initially diagnosed with an ulcer

The goal behind preoperative therapy is to increase the chance of a successful surgery by first reducing the size of the tumor using chemotherapy and radiation. M. D. Anderson researchers know that the response can benefit patients.

Porter thinks it worked for her.

Porter was 50, working at Southwestern Bell, married and with grown children when she started to lose weight because she just wasn't hungry. She would eat once a day at most, despite taking medications for what her doctors though were digestive problems.

Suspecting her condition was serious, Porter went to see a gastroenterologist who performed an endoscopy (a visual examination of the interior of her stomach) and found a large gastric ulcer that covered the duodenum, the tubular connection between the stomach and the small intestine. "That was why I didn't have an appetite. Food stayed in my stomach for a long time," she says.

Second biopsy reveals cancer beneath ulcer

Porter's gastroenterologist prescribed drugs to treat the ulcer. Six weeks later, the physician performed a second endoscopy to see if the therapy was working. It wasn't. Her doctor then performed a biopsy to examine it for cancer. None was found.

A second biopsy was ordered, and this one went deeper into the tissue around the ulcer. "They found cancer that had apparently been there for some time, but I never once suspected I might have it," Porter recalls.

For a second opinion, Porter's doctor referred her to Jaffer Ajani, M.D., a professor in the Department of Gastrointestinal Medical Oncology at M. D. Anderson. Ajani and a team of specialists in chemotherapy and radiation suggested Porter was a good candidate for their new preoperative protocol.

Chemotherapy and radiation work together to kill cells

"My family and I were in denial at first, but then I accepted that I had cancer and I trusted that these doctors would know the best treatment for me," Porter says.

"They told me chemotherapy can kill the cancer cells but that some may come back, so radiation can help shrink whatever tumor remains, and then I can have surgery."

Ajani also told Porter she would undergo three months of chemotherapy "24-7, through a tube into my collarbone," she says.

Treatment allows doctors to leave part of stomach

After a rest, she had radiation therapy every day for five weeks. "I was very weak, very sick, but very blessed because I didn't have to miss a treatment," she says.

After another period of rest, she had surgery in March 1999 that removed 75% of her stomach and a few surrounding lymph nodes. "With the help of the good Lord and M. D. Anderson, I still had a little stomach left," Porter says.

She has had few side effects, apart from the high blood pressure that resulted when one of her kidneys shut down, and from an appetite that comes and goes. Medicine helps her with both conditions, she says.

After several three-month check-ups, Porter graduated to six-month, then yearly check-ups. It has been seven years since her surgery, and she is looking forward to her annual visit to M. D. Anderson this August. The reason is simple, she says: "I like hearing that I have a clean bill of health."