‘TNT’ procedure eradicates cancer pre-surgery
(Ad) When we think of TNT, we think of dynamite. And while total neoadjuvant therapy is not explosive, it does pack a powerful punch when it comes to cancer. Just ask Anna Capasso.
The 55-year-old corrections officer started feeling lower abdominal pain and bleeding during bowel movements. Originally diagnosed with hemorrhoids, she was eventually scheduled for a banding procedure to alleviate the problem. When she got there they found the tumor through a colonoscopy. Capasso had stage 3 colorectal cancer.
“I was devastated. I didn’t know what to do,” she said. “It took me a while once I heard the word ‘cancer.’ It took me a while to swallow it. That’s when they set me up with St. Vincent’s.”
St. Vincent’s Medical Center is part of Hartford HealthCare’s Fairfield Region, where clinicians create an individualized care plan for each patient with a team of doctors and experts.
“Patients with rectal cancer require a multidisciplinary approach, including a surgical oncologist, a medical oncologist, and a radiation oncologist. You need all three modalities to offer the best outcome,” Dr. Christopher Iannuzzi, the director of radiation oncology at St. Vincent’s, said. “This culminates in a multidisciplinary tumor conference, where pathology, radiology, genetics, clinical trial assistants, physician assistants, and navigators all come together to review the imaging studies, the pathology,
and current guidelines. From there they develop a personalized plan.”
TNT represents a different path to eradicating cancer in the body. Instead of removing as much of the tumor first, radiating the area, and using chemotherapy to shrink or eliminate any leftover cancerous cells, research has shown that starting with radiation and chemotherapy before surgery can lead to better outcomes in rectal cancer patients.
“Surgery is still the crux of oncology, but the question these days is ‘how you play your cards?’” Dr. Sandhya Dhanjal, who practices medical oncology and hematology for Hartford HealthCare, posed. “In the past we did surgery first then followed up with other modalities; however, with many kinds of cancer now, including rectal cancer, we are seeing better outcomes by shrinking the tumors beforehand.”
Dhanjal was responsible for the
chemotherapy piece of the regimen.
“When we give the radiation with chemo, the chemo is like the salt and pepper for the radiation,” she said. “It helps the radiation work better; it’s a sensitizer.”
Iannuzzi was in charge of the radiation.
“Her treatment was radiation to the pelvic region every day for five-and-a-half weeks. That was combined with a chemotherapy pill that sensitizes the radiation, then a two-week break, then a multiagent chemotherapy, then another break, then a repeat image to see the response, then surgery,” he explained.
Capasso was going through all that, and still going to work every day.
“I work a lot of hours, so when they told me I had to do chemo for six weeks every single day it was tough,” Capasso said. “Through the radiation and chemo I worked, then I had straight chemo. They put a port in and I did that for 16 weeks,
and I worked through the whole thing. I thought if I worked it would be easier to keep my mind off things a little.”
After the surgery, Capasso did take time off to rest and heal. And because the radiation and chemotherapy were given first, her body was able to concentrate on healing itself.
“Doing the radiation and chemotherapy before the surgery sterilizes the area around the tumor, and it makes the tumor smaller so you don’t need to give anything after,” Iannuzzi said. “One thing that prompted this was that patients who were having wound complications or post-op issues couldn’t get the chemo they needed at the right time, and they had a higher recurrence rate.”
Now Capasso is back in action, going for
check-ins every couple of months. The TNT method shrank the tumor from a stage 3 to a stage 1, and the surgery completed the task, currently leaving her cancer-free.
Even though St. Vincent’s is about an hour away, she says she would go to them over any other facility.
“I can’t say enough good things about the nurses that took care of me. I felt I wasn’t a number, but I was family. It was almost bittersweet to end that phase because I miss them. Everyone treats you with the utmost respect and decency,” Capasso said. “This is my first experience with St. Vincent’s, and I would go to St. Vincent’s again even though other hospitals are closer to me. They were that wonderful.”
New guidelines state that people should start
getting colonoscopies at 45 because the screening saves lives.
“Colorectal cancer starts as a polyp. It slowly transitions to a cancer, and that takes time,” Iannuzzi said. “If you are vigilant about screenings you will find the polyps, and you will avoid them becoming cancer.”
This is just one example of Hartford HealthCare St. Vincent’s Medical Center bringing more specialists and providers to the community. Tune into Hartford HealthCare St. Vincent’s Medical Center’s Facebook Live discussion, where you can ask your questions, on Thursday, March 28, at noon. For more information, start here: hartfordhealthcare.org/ digestive.
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