Pain led John and Linda Cook on a fearful, frustrating journey that started in a hospital emergency room and ended in a 12-hour surgery at the University of Mississippi Medical Center.
Cook said he gave in to abdominal pain the third time it struck, seeking help in his Columbus hometown.
What doctors found confounded them. Multiple tumors and mucous filled his belly, obviously the cause of the pain.
“They told me 'We don't know what that is and don't know how to deal with it,'” Cook recalled.
His medical condition is rare, said Dr. Shannon Orr, assistant professor of surgical oncology in the UMMC Division of Transplant Surgery, who saw similar cases during his fellowship at M.D. Anderson Cancer Center.
The weight gain and pain came from tumors growing in his abdomen, attached to the peritoneum, a membrane that lines the abdominal cavity. Over months those tumors grew, secreting a thick mucous and filling his belly.
When he arrived at UMMC, Dr. Kirsten Gambrell, then chief resident for surgery and now a fellow in surgical critical care, realized he might be a candidate for a unique surgery.
On May 12, Cook became the first patient at UMMC to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy or HIPEC, a fancy name for a process in which Orr, Gambrell and a team of others remove the tumors and mucous, any other malignant tissue they find, then flood his abdominal cavity with a heated saline and chemotherapy solution to destroy any remaining cancer cells.
“We take out everything, give him the chemo, then put him back together again,” Orr said. “That way, there's no closings or sutures for tumor cells to hide behind.”
It probably started with appendix cancer, said Orr, who led the surgical team. “About nine months before he presented, he remembered having a lower right quadrant pain and fever. His appendix most likely ruptured because of the cancer.”
But Cook didn't go to the hospital then. When the pain subsided, he figured he'd had a virus or food poisoning. A few months later after eating out with his brother in law, he again experienced abdominal pain. Again, he blamed it on food poisoning.
Tumor cells spread, grew and secreted mucous.