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Ruben Borrero, 51, of Toms River is a cancer survivor. A family man with strong faith, he believes that everything happens for a reason – even his yearlong battle with cancer. He is using his experience as a way to reach out to other people – advocating for early detection, sharing his experience to ease the journey for those following in his footsteps, and letting others know what he believed helped to save his life.
In the summer of 2008, Ruben Borrero was the picture of health. He held down two jobs, enjoyed playing sports and at 5’6” and 170 lbs, could bench press 250 pounds. So when he experienced some digestive changes – bloating and pressure when he ate high fiber foods – he didn’t think too much of it. In September, when he notice a small amount of blood in his stool he still wasn’t overly concerned – but moved up his annual physical nonetheless.
After a seemingly healthy checkup, Ruben’s doctor sent him for a routine colonoscopy. The results of that test were shocking. Ruben had several polyps at the top of the colon that were removed during the procedure. He also had a large tumor in the lower portion of the colon; biopsy results revealed it was malignant. On December 18, 2008 Ruben was diagnosed with locally advanced stage III rectal cancer.
“It was like I was hit by a truck,” recounts Ruben on learning of his diagnosis. “I was a healthy man. I had an annual physical. I didn’t drink or smoke and I had no known history of colorectal cancer in my family.” So began, what his wife Denise describes as a yearlong roller coaster ride of doctors, tests and treatments to save Ruben’s life.
Of the 150,000 cases of colorectal cancer diagnosed each year in the United States, more than 40,000 people are diagnosed with rectal cancer. Ruben’s tumor was located in the rectum, the lower part of the colon that connects the large bowel to the anus, and tests revealed the probability of lymph node involvement. While the prognosis and treatment for this type of cancer depends on its spread into the rectal wall and lymph nodes, historically, locally advanced rectal cancer is known for its dismal prognosis.
Ruben saw a colorectal specialist the very next day. Because of the size and location of his tumor, the doctor recommended neoadjuvant therapy – consisting of radiation and chemotherapy treatments prior to surgery to shrink the size of the tumor. This would allow the surgeon to more completely remove the cancer and minimize the damage to Ruben’s colon, hopefully avoiding the need for a permanent colostomy. He also recommended another round of chemotherapy after the surgery to ensure the complete eradication of any leftover cancer cells.
The couple met with Girish Amin, M.D., a Toms River oncologist to discuss Ruben’s options. “Dr. Amin gave us a whole variety of different treatment options. It was a bit overwhelming, and there wasn’t a lot of time to think about it. It was very hard to know which one to choose, but fortunately, we chose the clinical research trial,” says Denise, “and that was the right choice for Ruben.”
Clinical trials are research studies in which patients gain access to promising new approaches to cancer treatments as doctors work to find ways to improve upon cancer care. While not always widely available, the J. Citta Regional Cancer Center at Community Medical Center offers patients access to these national and regional clinical research studies for cancer treatment, prevention, and supportive care.
“Participation in oncology trials is very important,” explains Rajesh Iyer, M.D., Chairman of the Radiation Oncology department at Community and a member of the J. Citta Cancer Center team that treated Borrero. “They are the best way we have of testing how well new treatment approaches work. Specifically, the randomized trial, in which the new treatment is compared head to head with the current standard of care, allows us to verify how effective and safe the new treatment is.”
Ruben and his wife were initially nervous about taking part in a study, but their fears were quickly laid to rest. “Once we met with the team at Community’s Cancer Center we felt very comfortable with our decision,” says Denise, “They explained the protocol to us, who they were and what they were all about. We felt like the care on the study would be more specialized and individualized,” she adds, a key factor in their decision. And in fact, they were right.
According to Dr. Iyer, a board certified Radiation Oncologist, oncology protocols are very detailed: they specify many requirements not only for the initial work-up and treatment delivery, but also for the patient's follow-up. As a result, the physician works with protocol nurses to ensure that all of the protocol specifications are met. Furthermore, the patient's treatment records are reviewed by the central protocol administrative office to ensure compliance. As a result, patients who participate in protocols do receive “extra-attention” and one-on-one involvement from the oncology team.
According to Dr. Iyer, treating rectal cancer requires intense combinations of chemotherapy and radiation, known as chemoradiotherapy, which often results in a greater incidence of side effects. “Many times the side effects of chemoradiotherapy can be so severe that the patient has to take unplanned treatment breaks, reduce chemotherapy dosages or discontinue therapy altogether. Any of which can compromise the effectiveness of the cancer treatment,” he adds.
“Mr. Borrero took part in a clinical trial, Radiation Therapy Oncology group (RTOG) 0822, that evaluated utilizing Intensity Modulated Radiation Therapy (IMRT) in lieu of standard radiation treatments, in combination with two strong chemotherapy medications – capacetabine and oxaliplatin,” explains Dr. Iyer. “IMRT is a more sophisticated radiation planning and delivery technique that is available at Community Medical Center. IMRT uses multiple computer-controlled radiation beams, optimized through computer planning to pinpoint the targeted tumor while reducing the amount of radiation to normal surrounding tissues – thereby reducing the incidence of side effects and allowing the patient to complete their full course of treatment.”
There were approximately 75 participants in the national study, which closed in November 2009. All of the participants will be followed for the next ten years. For Ruben, choosing to take part in the clinical trial available at the Center, offered access to some of the most advanced technology and treatment regimes for rectal cancer currently available – a choice that he firmly believes was instrumental in his recovery.
“Mr. Borrero did have a good experience with minimal side effects,” says Dr. Iyer, “this may have been due to the IMRT form of treatment delivery – and there is published evidence that patients with somewhat similar anal-canal cancer do have less side effects when treated with IMRT – but we will need to see the final results of the study, which will compare the experiences of all the patients on the study to historical controls to see if the group as a whole had less side effects.”
While the immediate results are still being analyzed, in Ruben’s case, the clinical trial and its innovative treatment were a success. The therapy shrunk the tumor a half inch – just enough for the surgeon to completely remove the cancer and reattach his colon, avoiding a permanent colostomy. Ruben admits the intense therapy before and after his surgery was grueling. However, the support of his family, friends, and the help of the staff at Community Medical Center’s J. Citta Cancer Center and Outpatient Infusion Department, were key in his ability to manage.
Ruben would receive his chemotherapy and then hit the streets – walking miles in an effort to get his heart pumping and the medicine throughout his bloodstream. “I always tried to live in the present moment,” he says “and to stay positive. There were days that the pain was bad, but I kept on moving. I refused to let the therapy take control of me.” While he did suffer side effects from treatment, including neuropathy in his hands and feet that lingers today, he found the staff at the J. Citta Cancer Center was always available and ready to help.
“The staff was helpful and reassuring. They made sure that he remained as healthy as could be so that he could get the treatment he needed,” says Denise, who notes their diligence with nutritional supplements, medicine to help keep side effects at bay and medication to bolster his immune system helped to ensure he was always able to receive his chemotherapy treatments on schedule. “Thanks to the individual treatment and compassion of the staff they even arranged my neupogen shot schedule to allow me to travel to North Carolina to see my son serving in the United States Army arrive home from Iraq. Something I’m not sure would have been possible with the more traditional treatment. They were always just a phone call away with their support and assistance,” Ruben adds about the Cancer Center staff. The couple believes the staff went “above and beyond,” to help Ruben through his ordeal.
Today Ruben is healthy, fit and cancer free – and he’s determined to turn his experience with cancer into something positive. Grateful for his health and the advanced treatment protocol that enabled him to regain it, he’s intent on becoming an advocate for people with cancer; sharing his story, promoting early detection and helping other people learn about the advanced treatments that are available right in his hometown.
“I can’t say enough positive things about the J. Citta Cancer Center and the Oncology department at Community Medical Center,” says Ruben. “They were exceptional. I would recommend the clinical research protocols as a treatment option for everyone.”
“We are proud at the J. Phillip Citta Regional Cancer Center to be able to offer patients entry on to protocols such as the one Mr. Borrero participated in,” says Dr. Iyer. These protocols allow patients access to innovative and cutting-edge future treatments right now, and in the comfort of their local community, without having to travel long distances to major cities for similar opportunities. The patients' participation also contributes to the medical profession's understanding regarding how effective these new treatments are, and protocols are the best way for medicine to advance to our goal of eliminating cancer altogether in the future.”
For more information on the J. Phillip Citta Regional Cancer Center at Community Medical Center, call (732) 557-8148 or visit www.barnabashealthradonc.org.
June 18, 2010
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