Joseph Smith calculated he had about 18 months to live when he received the call that he had a rare form of cancer. And it was Stage 4.
However, Smith, a 74-year-old retired ironworker from rural Cantrall, was the first person in central Illinois to receive a surgical treatment that rinsed his abdominal cavity with heated chemotherapy.
“I didn’t think I’d be here,” Smith said. “I already prepared myself in case I didn’t get off the table.”
The life-saving procedure is known as hyperthermic intraperitoneal chemotherapy, or HIPEC. Because of it, Smith has more time with his wife of 54 years, Linda, as they raise the four girls – sisters from 4 to 8 years old – they adopted last year after their mother was diagnosed with cancer, which later claimed her life. The alternative would have been to watch the girls split up into different homes, said Smith, who has five great-grandchildren, four grandchildren and three children.
And Smith can continue to travel to Jacksonville on weekends to work on a 1935 Chevy Master town car that he and his son, Jason, are rebuilding, along with some help from his other son, Jeff.
“I didn’t think I’d be able to finish it,” Smith said.
Southern Illinois University School of Medicine and Memorial Medical Center worked together to bring the procedure to the region. Dr. Sabha Ganai, an assistant professor in the department of surgery at SIU School of Medicine, performed Smith’s eight-hour procedure on Oct. 8 at the hospital.
Smith was diagnosed in January 2014 with peritoneal mesothelioma, a cancer that attacks the lining of the abdomen. The peritoneum is a membrane that lines the abdominal cavity and the organs within it and produces a fluid that lubricates those organs.
Only a few hundred people are diagnosed with peritoneal mesothelioma each year. They have few treatment options and typically survive less than a year, Ganai said.
The HIPEC procedure, which has increasingly become the standard of care for these patients, has changed that, Ganai said.
Patients first undergo traditional surgery during which the surgeon removes all the visible tumor deposits in the abdominal cavity. For Smith, that included the removal of his spleen, appendix and lining of his diaphragm.
Once all visible tumors have been removed, a chemotherapy drug heated to nearly 108 degrees Fahrenheit is pumped into the abdominal cavity, and a special pump circulates and heats the fluid. The heat increases the effectiveness of the chemotherapy drug, mitomycin, which destroys the microscopic cancer cells that remain.
“A lot of pre-planning took place prior to the day of surgery,” Ganai said, and involved a multidisciplinary team of more than 20 people from Memorial working with her, including the operating room staff, cardiac perfusionists and pharmacy personnel.
The hospital leased a new FDA-approved pump, which heated and filtered the mitomycin that circulated through Smith’s abdominal cavity for about 90 minutes, said Drew Snyder, director of oncology services at the nonprofit hospital.
After the procedure, Smith was in the hospital for about a week.
Ganai, who is also director of gastrointestinal oncology at Simmons Cancer Institute, trained on the HIPEC procedure at the University of Chicago during her fellowship in complex general surgery oncology. She also trained in a rotation with Dr. Paul Sugarbaker, a leading proponent of the procedure, with Washington Hospital Center.
Smith is back at home with his four adopted daughters. He and his wife get up every weekday morning to make breakfast for them and send them off to school. He enjoys working outside and hopes to resume that when he’s back up to full strength, which doctors told him could be about a year. He says he’s feeling good but is usually fatigued by the day’s end. He’s grateful for the doctor who gave him more time to be with his family.
“Dr. Ganai is just great. If she hadn’t of been here, I wouldn’t be here either,” Smith said. “She is our family hero.”