Rectal cancer survivor rides wave of good health

Charles Scalice loves to surf the cool, frothy waves of the Pacific off Sunset Beach. So when the Seal Beach resident was diagnosed with rectal cancer in February 2012, he was worried not only about surviving the disease but also about whether surgery might force him to give up his pastime or require a colostomy.

Scalice then surfed the Internet to find a surgeon with expertise in minimally invasive robot-assisted surgery for rectal cancer. That led him to UCI Health and to Joseph C. Carmichael, MD, who performed the surgery in March 2012.

Scalice, who completed about six months of oral chemotherapy, is now cancer-free and back to riding the waves. His scars are so small, they're not even visible in board shorts.  

"I believe in robotic surgery. It was a big factor in my decision to go to UCI Health," Scalice says. "I've had surgery before and I know what it's like to be cut open. Everything went great with the robotic surgery. Dr. Carmichael and his staff really care about what they're doing."

At the forefront

The physicians of UCI Health and its H.H. Chao Comprehensive Digestive Disease Center (CDDC) are at the forefront of both prevention and treatment of colorectal cancer — the nation's second-leading cause of cancer deaths. This year, about 96,830 new cases of colon cancer and about 40,000 new cases of rectal cancer will be diagnosed nationwide.

These rates, however, are lower than they were two decades ago, thanks to better treatments and the growing use of colonoscopy to screen for and remove precancerous polyps before they become malignant. 

UCI Health is home to the Chao Family Comprehensive Cancer Center, one of only 41 in the nation — and the only one in Orange County —- to receive the highest mark of excellence by the National Cancer Institute. UCI Health doctors believe more can be done to prevent colorectal cancers and improve survival.

"Only 50 to 60 percent of the people who should be screened for colorectal cancer are being screened," says Jason A. Zell, DO, MPH, a hematologist-oncologist who specializes in colon cancer. "We feel survival rates should be much better."

Patients who choose the CDDC at UCI Health for their colonoscopies will find a state-of-the-art approach to the potentially lifesaving test, explains William E. Karnes, MD, a UCI Health gastroenterologist. In addition, CDDC physicians have devised protocols to detect and remove flat polyps, which are more challenging to address than round polyps.

"We use chromoendoscopy, a special wavelength of light, to see flat polyps," Karnes says. "We spray on dyes to help see the polyps. UCI Health has also helped pioneer methods for how these flat polyps are removed.”

Working to improve survival

UCI Health is also promoting a new paradigm in surviving colorectal cancer. Typically, colorectal cancer survivors receive little additional treatment other than follow-up screenings. Zell is the principal investigator of a nationwide study examining whether a combination of two medications reduces colorectal cancer recurrence and the growth of new precancerous lesions, called adenomas.

"Colon cancer patients have a 40 percent increased risk of a second new colon cancer when compared to the general population," he explains. "There are 1.2 million colon cancer survivors, and they are looking for things they can do to decrease their risk."

The study, called Preventing Adenomas of the Colon with Eflornithine and Sulindac (PACES), will enroll 1,488 patients at 300 sites. Study participants will take either a combination of the drugs eflornithine and sulindac, or eflornithine alone, or sulindac alone, or a placebo daily for three years. Both medications inhibit polyamines, substances that, in excess, promote the abnormal growth of cells.

"It's believed that the medications cause the cells to stop growing, particularly at early stages of cancer formation," Zell says.

Providing advanced therapies

Scalice has enrolled in another NCI-funded clinical trial, also directed by Zell, to test whether reducing consumption of arginine-rich foods can lower polyamine levels in colorectal tissue. Polyamines are derived from the amino acid arginine, which is found mostly in meat. The study also tests whether taking a daily aspirin can lower polyamine levels.

"You just can't put a value on having this medical technology," Scalice says. "When you go to UCI Health, you feel like you have a whole staff there for you. It's phenomenal. I ask a lot of technical questions and they always have the answers."

Adds Zell: "At any one time, we have six to eight clinical colorectal cancer trials. Our goal is to make sure we have a clinical trial for every patient subset and to give our patients a chance to receive tomorrow's medicine today."

— UCI Health Marketing & Communications