Ampullary carcinoma: retiree beats lethal stomach cancer

At age 70, Jim Sandegren assumed the abdominal pains he felt every morning were just a normal part of growing older. “It usually happened after breakfast,” says the now 76-year-old resident of Keokuk, Iowa. “I kind of lived with it for a while.”

When the pains became severe–“like a punch in the stomach”–Jim knew it was time to visit his primary care physician, David Waddell, MD, of Keokuk. The initial diagnosis was an ulcer. When medication did not end the symptoms, Waddell ordered a CT scan. The end result: A spot on the pancreas that sounded like a death sentence.

“It was upsetting to say the least,” Jim says. “My wife was devastated.”

If Jim was to survive, a long and difficult road lay ahead. While his choices for follow-up care included the Mayo Clinic, Jim preferred to stay home in the Hawkeye State.

“We chose the Holden Comprehensive Cancer Center at the University of Iowa,” he says. “It was the right choice, there was never any doubt.”

Jim’s condition was a potentially fatal ampullary carcinoma. This type of cancer affects an area of the digestive system where the bile duct and pancreatic duct join and empty into the small intestine. Treatment typically involves extensive surgery (Whipple procedure) to remove the cancer and a large margin of healthy tissue.

“I was trying to put on a brave face,” Jim recalls. “In truth, I didn’t think I would live to see Christmas.”

After an extensive pre-surgical evaluation involving many hours with multiple specialists, Jim knew he was in good hands. Stress tests validated his fitness for the challenging surgery that lay ahead. Nurses offered reassuring advice. His new “best friend” became a special device he wore on his back to temporarily take over his bodily functions during the coming recovery.

The leader of Jim’s surgical team was Hisakazu Hoshi, MD, a specialist in oncologic and endocrine surgery who trained both in Japan and the U.S. Having spent a lot of time together before and after the surgery, the two men inevitably became friends. Indeed, as a Navy veteran who spent time in Yokosuka, Japan, Jim knows a little Japanese. Hoshi jokingly says that knowledge was enough to keep him on his toes should he accidentally mutter a frustration in his native tongue.

When the big day of surgery arrived, many of Jim’s friends and relatives kept vigil. Nine hours after entering the operating suite in July 2008, Jim woke up to find himself in a hospital bed that would be his home for the next two weeks. The procedure had gone well. Recovery had begun.

Once he was strong enough to return home, Jim received daily care from a home health nurse for three months. His recovery was remarkable. The cancer was gone. Quarterly doctor visits became semi-annual. Life, more precious than ever, returned to normal.

Today, six years later, Jim is happy and healthy and cancer-free. His only cancer clinic visits are annual, for routine blood tests.

Meanwhile, he continues to regularly visit his doctors and other medical caregivers—a 20-year routine that he believes assured timely interventions over the years and helped keep him healthy enough to survive an aggressive cancer attack. “I might add that the premature death of a sister was a real wake-up call for me, along with TV and radio ads,” he adds.

Jim adds that he and Suzanne try to follow a healthy diet. “We grow lots of vegetables in our garden and I’m a big fan,” he says. “I’m also a volunteer in a community garden project where we share the proceeds with a homeless shelter.”

Another volunteer activity involves flower gardening at Keokuk’s Rand Park, where a statue of Chief Keokuk overlooks the Mississippi River. Once in a while, Jim can’t help but think about his battle with cancer and the life-saving care he received at University of Iowa Hospitals & Clinics.

In that regard, he feels fortunate to be living in Iowa.

“We moved here from Dayton, Ohio, about a year before I got cancer,” Jim explains. “At the time we were exploring a little bit, looking to retire somewhere along the Mississippi. Keokuk seemed like a perfect place and it has been. We feel very fortunate to be here, with high-quality health care nearby at UI Hospitals & Clinics. I can’t imagine getting better care anywhere.”

Signs and symptoms:

• Anorexia
• Nausea
• Vomiting
• Jaundice
• Itching
• Weight loss
• Abdominal pain
• Diarrhea
• Courvoisier gallbladder (i.e., a distended, palpable gallbladder in a patient with jaundice)
• Fever, particularly when the biliary tract has been explored previously (e.g, after common duct exploration for stones)

–Winter 2014-15