Stuart Scott’s Cancer and the ‘Mother of all Surgeries’

“You beat cancer by how you live, why you live and the manner in which you live”, said ESPN sportscaster Stuart Scott on receiving the Jim Valvano Award for Perseverance in July 2014. Mr. Scott suffers from appendicular cancer, a rare cancer seen among one in a million. Pseudomyxoma peritonei (PMP) is a variant of appendicular cancer which rarely occurs in one in five million people globally.

On the 6th of September 2014, Mr. Scott tweeted saying he missed his daughter's first soccer game. He face timed the game with a friend, so as to not miss it. Scott has been fighting this cancer for the past seven years. He follows Jimmy V's motto to never give up. He is determined to fight cancer. He will not let it take away his life and he will fight it until the last day. Cancer affected people around the globe are inspired by his strength to fight the battle.

Mr. Scott was initially diagnosed with cancer in the abdomen in 2007. His appendix was removed and he was given chemotherapy and radiation when the cancer went into remission. It has returned twice since the time he was diagnosed, the last recurrence was in January 2013. Prior to receiving the award, Scott underwent four surgeries in a span of seven days.

Here is yet another example of the same in Pam Pope. On the 15th of December, Pam Pope, 65 years, underwent a 13-hour long cytoreductive surgery, nicknamed 'Mother of all Surgeries' to remove cancer from her body. She was suffering from appendix cancer, in other words, pseudomyxoma peritonei (PMP).

This surgery is called ‘Mother of all Surgeries’ because of the extent of spread, the number of organs that are to be removed during the surgery, the time and the surgical expertise required to perform the same.

The cause of appendicular cancer is unknown. Appendicular cancer is usually diagnosed late in the course, when the disease has spread to the whole of the abdomen. It is also known to re-occur.

How can appendicular cancer present itself?
The symptoms are often vague and last for a long duration. They could be:

• Abdominal pain
• Bloating
• Nausea
• Changing bowel habits
• Increased abdominal girth
• Symptoms of hernia

The vague, long-standing course of the illness makes it difficult to diagnose the same and is often misdiagnosed and treated as Irritable Bowel Syndrome. The same happened with Pam Pope. She was initially diagnosed to be suffering from Irritable Bowel Syndrome. When she sought a second opinion about the same, it was concluded to be PMP.

Diagnosis of Appendicular Cancer:
Usually an exploratory laparotomy shows the cancer seedlings on the appendicular surface. It is sometimes fortuitously noticed while performing abdominal surgeries for other reasons. A CT scan of the abdomen can locate the origin and extent of the tumor.

Treatment Options for Appendicular Cancer:
Surgery and chemotherapy are the two options currently available as treatment for appendicular cancer. These include cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC) and debulking surgery.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC):
In this kind of a surgery, the lining of the abdomen or organs like the omentum, gallbladder and bowel may be removed. In women, the uterus, ovaries and the fallopian tubes may be removed additionally. This surgery is also called Sugarbaker Operation. The surgery is usually followed by a Chemo bath, where a warm chemotherapy liquid is filled into the abdominal cavity and left there for 90 minutes to kill the reminder of the cancer cells without systemic effects. This is a difficult surgery done only by a few skilled surgical oncologists in today's world.

Debulking surgery:
This surgery involves removing the omentum (fatty tissue in the stomach) and a part of the bowel. In women, the womb (uterus) and ovaries may also be removed. Unfortunately, this surgery will not take away all the tumor cells and PMP is likely to grow back. This requires less surgical skills when compared to the cytoreductive surgery.

Sadly, there are only a few support groups available for appendicular cancer where one can get help. One such online group is pseudomyxomasurvivor.org

“Fight like hell. And when you get too tired to fight, then lay down and rest and let somebody else fight for you…” – Stuart Scott