A Complicated Case: Expertise and Emotional Support Combine for an Excellent Outcome
There was cause for concern when Mary Keogh came to the University of Chicago Medicine in late February 2007. She had been feeling healthy, traveling with her husband, going about her life as a 62-year-old retiree. But while exercising, Keogh had started feeling quick, sharp pains in her side.
A resident of Bloomington, Illinois, Keogh saw her physician, who ordered a sonogram. When it revealed a "spot," Keogh said, she was referred to Donald Jensen, MD, professor of medicine and director of the Center for Liver Diseases at the medical center.
In consultation with former hepatology fellow Rohit Satoskar, MD, Jensen ran a series of tests that not only revealed a large mass on Keogh’s liver, but showed fatty liver disease and cirrhosis of the liver. "To make matters more interesting, she also was discovered to have an incidental neoplasm, or mass of tissue, on her lung," Jensen said.
The prognosis was not good. According to Jensen, it is extremely rare for someone to have both a primary liver tumor and a different lung tumor (carcinoid). This combination arises in one or two people out of 100,000. The survival rate is almost nil. Keogh’s condition was especially dangerous given her underlying cirrhosis. "Mrs. Keogh likely would have been thought ‘incurable’ at most places," Jensen said.
Not at the medical center. "The beauty of Mrs. Keogh coming here is that we can handle almost anything. We were willing to risk operating on the liver tumor in spite of her cirrhosis; others would have avoided resecting the liver with the presence of cirrhosis, fearing that her body could not compensate for it," Jensen said.
"However," he continued, "we felt she otherwise was in good shape, that her cirrhosis wasn’t that advanced and that her tumor was in a good location to be removed without having to remove too much uninvolved liver."
Her physicians suspected the mass on Keogh’s liver was hepatocellular carcinoma (large liver cancer). Jensen consulted with oncologist Philip Hoffman, MD, professor of medicine. They partnered with liver surgeon Giuliano Testa, MD, former director of liver transplantation and hepatobiliary surgery, and lung surgeon Mark Ferguson, MD, University of Chicago professor of surgery.
The team decided that, despite the cirrhosis and the 4.57 cm tumor, Testa could perform a surgical resection, or removal, the approach with the best chance of success. On March 14, 2007, Keogh underwent what would become the first of three surgeries.
She knew there would be two operations: resection of the tumors on the liver and on the lung. But two weeks after the liver resection, Jensen, Testa and Satoskar told Keogh they needed to remove more of her liver to get all of the tumor. At that point, Jensen said, "We were worried she might not have a great outcome."
But, Keogh said, "I never panicked. I had every confidence in my doctors. If this is what we needed to do, we would do it."
Jensen said Keogh’s confidence in the medical center team is one reason she made it through her illness successfully. His goal is to instill calm. "We set up a system so that my nurse, Mary Tiberg, is the first person someone sees," he said. "She’s bright and she cares a lot about our patients."
According to Keogh, that system "started me off well. Mary told me how wonderful the doctors are, that I was in the best possible hands and not to worry. She set the tone. I love her."
Tiberg, RN, MSN, added, "Mrs. Keogh came through with flying colors. She never lost her ability to be optimistic, and to fight the cancer."
Nevertheless, after the second liver surgery in April, Keogh faced the lung resection in June, "the one I most feared," she said. "But that one wasn’t bad at all." Her recovery was normal, aside from the fact that her hair thinned out after the third surgery. "I’m not sure why she lost hair," Jensen said. "She received no chemotherapy. Likely it was from the stress of three surgeries."
Jensen also said he cannot explain why Keogh developed cancer. "Cirrhosis predisposes for the development of liver cancer," he said, "but not this type. Why did she develop cancer? We don’t know why. Bad luck. Bad genes. We don’t know."
Today, three years after her last surgery, Keogh’s hair is back and she remains cancer free. "I say to myself, ‘Serendipity brought you to the University of Chicago Medicine. Things could have gone many, many different ways.’ I have one thing after another to be grateful for."
Said Jensen, "Mrs. Keogh’s situation was pretty unusual. We see lots of cancer, but not two cancers and cirrhosis."
How does he face such complications? "Our physicians are top-notch, but I think the best thing we can do is deliver the best in personalized medicine that incorporates new technology where indicated," Jensen said. "This takes teamwork, wisdom and experience. It can’t be rushed or forced, and it involves skill in interpersonal relations and effective patient education."