Sara Alvarenga is proud of her “very calm” personality. “That’s how I do it,” she says. “Even in traumatic situations, I am very cool, calm and collected.”
At 38 years old, she has endured far more traumatic situations than herself. Five years ago, Alvarenga was diagnosed with stage 4 colorectal cancer. Local doctors labeled her “terminal.” The fact that she’s still here and thriving is a testament to the many advances we’ve made in our understanding of this disease, and the fact that we’re working across disciplines to deliver breakthrough treatments one after the other. It is a testament to the unique collaborative atmosphere at City of Hope, where professionals come together again and again.
It’s also a tribute to Alvarenga’s powerful motivation to keep fighting.
“I put up with a lot for my kids,” she says. She and her husband Felix have a 12-year-old son, Ethan, and her 7-year-old daughter, Alana. “My greatest hope and dream is to see my children grow up.”
Alvarenga grew up quite a distance from his current home in Whittier, California. Although she was born in Mexico, her family moved to rural Kansas when she was one year old, and her mother worked at a nearby beef processing plant. Alvarenga came west when she was 18 to attend the University of Southern California. “I am a typical first-generation immigrant and the United States is my home,” she says.
By the end of 2018, Alvarenga was immersed in the American dream, married (Felix is a workplace safety consultant), mother of two children, and building a career as an operations manager at an investment firm.
However, she was concerned about her stomach.
A series of misdiagnoses
“One night at dinner, I realized something wasn’t right. I felt sore and bloated and just sitting there was hard.”
A series of emergency medicine and primary care visits resulted in repeated misdiagnoses. appendicitis. “Intestinal infection.” “Microperforated colon.” Her doctors gave her antibiotics. Her pain got worse. Alvarenga’s condition deteriorated to the point where she could barely move, so she was taken to the emergency room for surgery. “They removed the infected part of my colon,” she said. “And they said they saw something in my liver.”
A few days later, Alvarenga received a pathology report showing late-stage colorectal cancer that had spread to her liver. It was shocking and dark news.
“No one told me why I was thinking about cancer,” she recalls.
Unfortunately, this mindset persists in areas where colorectal cancer is still considered an “old man’s disease.” Until recently, colorectal cancer screening was not recommended for those under age 50. But the U.S. Preventive Services Task Force recognized a new reality, lowering that age to 45 in 2021.
“Colon cancer is on the rise among young people,” said Mustafa Raof, MD, assistant professor of surgical oncology at City of Hope. “And they tend to be more aggressive.”
In fact, colon cancer is the number one cause of cancer death in people under the age of 50. a study Young people have been shown to have twice the risk of developing colon cancer and are much more likely to be diagnosed with the terminal disease.
Alvarenga was only 33 years old. Still, she handled her diagnosis matter-of-factly in a “cool, calm and collected” style, thinking simply, “Okay, what do I do next?”
her family’s reaction
For other families it was a different story.
“My mother told me that she felt like her whole world had come crashing down on her,” Alvarenga recalled, fighting back tears. Then she was talking about her children and she burst into tears.
“Alana was too young to understand anything beyond ‘Mommy is sick.’ But seven-year-old Ethan asked me, ‘Are you going to die?’ Can you take me? Who can hug me? ”
Doctors wanted to start chemotherapy, but Alvarenga didn’t like their pessimism. Doctors flatly told him that he only had two to five years to live, and that chemotherapy would not make much of a difference.
Seeking a second opinion, Alvarenga contacted City of Hope. The first words I heard there knew I had found the right place. There are no statistics. There are no general predictions. Veteran oncologist Dean W. Lim, MD, said: “You are not terminal. You are treatable.”
“That’s all I wanted to hear,” Alvarenga said.
Leverage the latest research
Why is there such a noticeable difference?
“Colon cancer treatment has made great advances in recent years,” Dr. Raoff explained. “But it takes time for that knowledge to reach every oncologist in the region. At City of Hope, we are on the front lines, and the new knowledge we gain is immediately available to patients. It will be done.”
In fact, the progress has been amazing.
“Back in the 1970s,” he continued, “we were doing one round of chemotherapy, it was only 20 to 30 percent effective, and it didn’t last very long, and the only surgical option was It wasn’t very safe.
“By the 1990s, liver resection, which removes tumors that had spread from the colon, had become standardized and less risky. We also developed drug pump therapies to control the disease more effectively.
“In the 2000s, two new drugs, oxaliplatin and irinotecan, achieved up to 70% tumor reduction, making surgery a viable option for more people. And in the 2010s, targeted therapies emerged. There were also treatments that could cure stage 4 disease without surgery.
Alvarenga would benefit from all of these advances and more during his time at City of Hope.
First, I started chemotherapy in February 2019. Every two weeks, Alvarenga received IV infusions of FOLFOX, a triple-drug therapy that includes oxaliplatin, and Avastin, a drug approved for colon cancer that cuts off a tumor’s blood supply. In 2004.
Chemotherapy alone rarely removes stage 4 colon cancer. Some kind of surgery is required. Six months after starting treatment, surgical oncologist Dr. Lareh Maelstrom removed 13 tumors from Alvarenga’s liver.
However, cancer can be a stubborn enemy, and soon new “rogue” spots appeared. “Isolated recurrences are common when you have this many tumors,” Maelstrom says. Interventional radiologist Dr. Jonathan Kessler performed an ablation procedure to eradicate the new malignancy. Alvarenga was also equipped with City of Hope’s signature hepatic artery infusion (HAI) pump.
“We are the third-largest user of HAI pumps,” Maelstrom said. “The goal is to deliver higher concentrations of chemotherapy that target the liver.”
Stay positive and patient
With each relapse and treatment, Alvarenga battled feelings of frustration and hopelessness, always thinking about her children.
“I knew this was going to take a long time and I had to process everything,” she said. “I’m inspired by my kids. I’m not praying for a cure. All I need is to get through one more day.”
Maelstrom was deeply moved by the patient’s courage.
“As a mother, I really empathized with her will to live for her family,” she said. “I admired her courage through all of this and the strength she showed every time I saw her.”
It would take more courage.
A new tumor appeared in Alvarenga’s peritoneum, the membrane that lines the abdominal cavity. This required more surgeries. Raoff and Maelström performed a “cytoreductive” surgery, a type of “search and destroy” surgery, to determine where cancer cells were believed to be hiding, including in multiple lymph nodes and the omentum (the fatty layer that wraps around the abdominal organs). Every part of the body that could be removed was removed. At the same time, gynecological oncologist Dr. Mihae Song performed a hysterectomy and removed Ms. Alvarenga’s uterus and ovaries, which unfortunately ended Ms. Alvarenga’s chances of having more children.
“We discussed whether to remove only the ovaries or the uterus as well,” Song said. (In so-called uterus-conserving surgery, there is still the possibility of pregnancy through in vitro fertilization.) Surgery. “
And she continues to move forward, dealing with new challenges as they arise. Her treatment, modified after her peritoneal discovery, now includes irinotecan and the monoclonal antibody panitumumab, a combination that has been shown to be an effective “third-line” treatment. . She required yet another surgery to remove cancerous lymph nodes in her chest. She then underwent radiation therapy to treat the malignant areas in her lungs.
Her doctor is practical, but I also admire her patience.
“Sarah beat the odds for cancer patients at multiple institutions,” Raoff said. “And her case is a great example of the expertise we can provide at City of Hope.”
Despite all this, Sarah and Felix remain positive. They recently bought a house, traveled to Cancun and Europe, and have plans to do more. “We are a normal, busy young family,” Alvarenga says. “Life doesn’t end because of cancer. Children grow up. Laundry piles up. Life goes on. I’m building my cancer treatment into my schedule.
“I’m a mother. I don’t have time for self-pity.”