One Year, Two Cancers

It started with a simple stomachache. But over several days in August 2020, Teresa Bermudez’s discomfort grew to what she calls “howling pain,” until, finally, she went to the emergency department at Mather Hospital. There, a computed tomography (CT) scan revealed a bowel obstruction something was blocking food and liquid from passing through her intestines. A medical emergency, a bowel obstruction can cut off the blood supply to the colon and lead to lifeOne year, two cancers Blindsided by a diagnosis of colon cancer and then a finding of breast cancer, Teresa Bermudez has become a believer in the power of screenings I threatening complications, such as tissue death and infection. Bermudez was quickly admitted, and her doctors immediately summoned surgeon Mohamad Abouzeid, MD who took a look at the results of her workup and knew the situation was even more dire than first understood. “A tumor was blocking her intestine,” he says. “It was obvious she had colon cancer.” Bermudez, then 62, needed surgery, and she needed it fast. The secretary and mom to two grown sons was shocked at the news and shattered at the thought of what she might leave behind if the worst happened. “I had just become a grandmother for the first time,” says Bermudez, who lives in Yaphank with her husband, Claudio. “I was terrified.” But Dr. Abouzeid helped ease her fears. “He was incredible,” says Bermudez. “You hear this booming voice coming down the hall and you’re like, ‘Oh, thank God.’ Dr. Abouzeid explained everything so plainly, and never made us feel rushed he’d just sit in the chair and say, ‘OK, what’s going on?’ I was never afraid to ask dumb questions.” A DOUBLE-BARRELED TREATMENT

Less than a week after Bermudez’s trip to the ED, Dr. Abouzeid performed surgery to remove the portion of Bermudez’s colon that contained the cancer. Then, in a procedure called a colostomy, he routed the top end of her colon outside her body through an opening (called a stoma) made in the abdominal wall, with a bag attached to collect the body’s waste. To make an appointment with Dr. Abouzeid, call Mather Surgical Associates, a practice of Harbor View Medical Services, at 631-714-2968. 14 NORTHWELL CONNECTIONS VOLUME 2, 2022 The colostomy was temporary but necessary to allow her body to heal. Eventually, it would be reversed to allow for normal bowel function. The operation revealed that Bermudez had stage IIA colon cancer her cancer had grown through the muscle layer of the colon but had not spread to her lymph nodes. She was lucky. When colon cancer is caught at this stage, the prognosis is excellent, with a five-year survival rate of 91%. Most patients with stage II colon cancer don’t require further treatment after surgery. But when the cancer obstructs the colon, as in Bermudez’s case, there is a higher risk for recurrence, so after surgery, she underwent six months of chemo treatments. A few months later, in the spring of 2021, Dr. Abouzeid performed her colostomy reversal. A “SCREENING EVANGELIST”

Bermudez felt blindsided by her diagnosis. Sure, her primary care physician had been suggesting for years that she get a colonoscopy to screen for colon cancer. But no one in her family had ever had the disease, so she assumed her risk was low and put off making an appointment. As she now knows, that assumption was wrong. Colorectal cancer is the second most common cause of cancer deaths for men and women combined, and most cases occur in people without a family history. Regular screenings not only help catch colon cancer when it’s small and easier to treat, says Dr. Abouzeid; colonoscopy can even prevent the cancer from developing in the first place. That’s because in this screening test, a doctor views the entire length of the rectum and colon with a special scope, and can remove any suspicious polyps, or growths. Since polyps can develop into cancer, the exam is detection and treatment, all in one. (For the latest colon cancer screening recommendations, see “An ounce of prevention,” page 8.) “Now I tell people, go when your doctor tells you to go,” says Bermudez. She heeded her own advice when it came time for her mammogram last year, even though she was undergoing treatment for her colon cancer at the time. And she was lucky she did: The test revealed ductal carcinoma in situ, or DCIS. Considered the earliest form of breast cancer, DCIS is a collection of abnormal cells inside a milk duct. DCIS is preinvasive, meaning it hasn’t spread out of the ducts and into nearby breast tissue. Roughly one in five new cases of breast cancer are DCIS, and nearly all can be cured. In April 2021, Bermudez underwent a successful lumpectomy a focused surgery in which just the affected duct was removed. A BRIGHT FUTURE

Two separate cancers occurring one right after the other can suggest that a person has an inherited genetic vulnerability to developing the disease. But Bermudez’s tests did not reveal any known cancer-causing genes. Instead, doctors believe her cancers were just an unfortunate coincidence after all, getting older is the most important risk factor for cancer overall and for many individual cancer types. Each year, almost 80% of new colon cancer cases and 70% of new breast cancer cases are in people over 55 years old. Today Bermudez is cancer-free. Her doctors will continue to monitor her with follow-up screenings for the next five years, but she remains optimistic. Retired now, she has plenty of time to enjoy her life. The granddaughter who was born shortly before it all started is now 2 years old and has a baby sister. “I’m going to see my grandchildren and do some gardening,” said Bermudez on a recent fall afternoon. “It’s beautiful out today. It’s beautiful every day I open my eyes.”

 

Reprinted from Northwell Connections, Volume 2