Celebrating New Life After Cancer
Expert Team Helps Woman Beat Colorectal Cancer and Deliver a Healthy Baby Girl
Just a few weeks after Michelle Jahnke learned she was pregnant with her first child, joy turned to sadness and fear. The 30-year-old was diagnosed with stage 3 rectal cancer.
The standard of care for her disease included combined chemotherapy and radiation therapy, followed by surgery and then more chemotherapy. One physician after another told Jahnke she needed to terminate the pregnancy because her unborn child would not survive radiation or surgery. She quoted one oncologist as saying: "There is nothing I can do to help your baby."
But University of Chicago Medicine oncologist, Blase Polite, MD, told Jahnke and her husband, Mark, that a novel approach to therapy was possible -- one that could treat the cancer and save their baby. To achieve that goal, Polite assembled a care team that incorporated six more specialists. The physicians and surgeons, all recognized experts in their fields, worked closely together to plan and implement each step of Jahnke’s treatment and the delivery of her child. Today, Jahnke has a beautiful baby girl and shows no signs of cancer.
Jahnke recently visited her physician team and expressed gratitude for her care: "I want to thank you so much from the bottom of my heart, my husband’s heart and my daughter’s heart. We are so appreciative to have had each and every one of you along with us on this journey. My daughter and I are here today because of all of you.”
Meet Michelle Jahnke’s Physicians:
Blase Polite, MD, Gastrointestinal Oncology
"My job was to figure out a way, first and foremost to cure the cancer, but then also to come up with a way for Michelle to carry the baby to term,” Polite said. A nationally known expert in gastrointestinal cancer care, Polite works on a team of colorectal specialists that sees a high of volume of cases and regularly designs individualized treatment plans for their patients. "We know there are different ways to successfully treat colorectal cancer,” he said.
During his first meeting with Jahnke, Polite explained that a new treatment approach -- chemotherapy alone before surgery -- was on the horizon for her type of cancer. Based on studies of babies born to mothers who had chemotherapy for breast cancer during pregnancy, Polite believed giving the treatment to Jahnke during her pregnancy would be safe for her baby. Before moving forward, he conferred with pharmacists specially trained in how oncology drugs are handled in the body. He also sought input from many physician colleagues around the country. Polite concluded that surgery and, if needed, radiation could wait until after the birth.
Mahmoud Ismail, MD, High Risk Obstetrics/Gynecology
Mahmoud Ismail, MD, told Jahnke there was only a small chance that her chemotherapy would affect the development of her baby. Throughout the pregnancy, Ismail used frequent ultrasounds to regularly observe the growth of the developing fetus. He also collaborated with Polite and other members of the medical team to monitor Jahnke’s overall health.
Ismail delivered Jahnke’s healthy baby girl by cesarean section at 35 weeks gestation.
Stanley Liauw, MD, Radiation Oncology
After delivery of the baby, tests showed chemotherapy had successfully kept the cancer in check. However, radiation oncologist Stanley Liauw, MD, determined that radiation therapy was still a necessary component of comprehensive treatment for the tumor. Jahnke chose to have a specialized type of radiation called proton therapy at a center in suburban Chicago. Liauw stayed involved in Jahnke's care, consulting with the proton center to review and fine-tune her treatment plan.
David Cohen, MD, Reproductive Endocrinology
Reproductive endocrinologist, David Cohen, MD, joined Jahnke’s team early on to determine if anything could be done to save the function of her ovaries. "Fighting the cancer was the primary issue,” Cohen said. "Nonetheless, taking a holistic approach, we examined all possible options for preserving Michelle’s fertility.”
Cohen weighed every alternative and discussed them with Jahnke and her husband. The doctor and the couple agreed it was best not to pursue any treatment to maintain her fertility.
Sonia Kupfer, MD, Gastroenterology and Colorectal Cancer Genetics
Gastroenterologist Sonia Kupfer, MD, has a particular interest in diagnosing and treating patients with hereditary gastrointestinal cancer syndromes and other genetic disorders of the digestive system. She works with Cassandra Gulden, CGC, a genetic counselor with expertise in cancer risk assessment.
"When these cancers show up at younger ages, we try to determine if the cause is genetic,” Kupfer said. "Based on a patient’s personal and family cancer history, we may recommend genetic testing to identify if a there is a change in the patient’s DNA that increases the risk of developing cancer.”
Jahnke’s background -- her paternal grandmother may have had colon cancer -- and young age raised some suspicions. Genetic sequencing revealed a variant of a gene; however, the significance of the mutation is unknown at this point.
"Future advances in genetic testing may give us more information about this finding,” Kupfer explained. "This is still a new field and it is always changing. We asked Michelle to contact us on a regular basis. We may be able to tell her more later and also help future generations of her family understand their risk of cancer.”
Mukta Krane, MD, Colorectal Surgery
"All of the members of Michelle’s medical team wanted to help her achieve both of her goals: to treat the cancer and to deliver a healthy baby,” said Mukta Krane, MD, an expert in colorectal surgery. "Dr. Polite’s plan was unconventional, but it was safe and feasible. We knew we were not compromising her care.”
Krane performed Jahnke’s colorectal surgery on April 22, 2013, six weeks after Jahnke finished radiation treatment and a second round of chemotherapy. Krane removed the sigmoid colon (the area of the large intestine closest to the rectum) as well as the majority of the rectum that contained the tumor. "The surgery went well,” Krane said. "And Michelle has a good prognosis.” The pathology report after surgery showed no remaining tumor cells. Still, both Krane and Polite will continue to follow Jahnke for years to come.
Meaghan Tenney, MD, Gynecologic Oncology
A specialist in gynecologic cancers, Meaghan Tenney, MD, met with Jahnke to discuss a hysterectomy (removal of the uterus) and an oophorectomy (removal of the ovaries) as proactive measures to reducing the likelihood of her later developing ovarian or endometrial cancer.
"I recommended the surgery as a reasonable option for Michelle to consider based on the status of the mutation,” Tenney said. "She decided she didn’t want to take any chances with a recurrence or another cancer in the future.” Tenney worked in collaboration with Krane to perform the hysterectomy and oophorectomy at the same time as the colorectal procedure.
Meet Michelle and Mark’s Baby:
Elana Marie was born to Michelle and Mark Jahnke on November 30, 2012, weighing 6 pounds. Her Apgar score, based on a test given to every newborn minutes after birth, was a perfect 10.
Recently, the family celebrated the little girl’s first birthday. "Elana continues to thrive and is reaching all of her milestones,” Jahnke said. "She is walking, dancing, and loves all food. And she says ‘mom’ and ‘dada.’
"Elana is the light of my life,” Jahnke said. "I love being a mom.”
A version of this story ran in the Winter 2014 issue of Imagine, a magazine published three times a year by the University of Chicago Medicine.
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