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Second Opinion Opens the Door to Lifesaving Cancer Care

LeAnn Kuper couldn't have been more surprised when she was diagnosed with advanced colon cancer and told it was incurable. Despite that shocking news, the upbeat interior designer was undeterred. LeAnn took her case to Mayo Clinic and found a determined physician who offered her a promising alternative.

LeAnn Kuper couldn’t have been more surprised when she was diagnosed with advanced colon cancer and told it was incurable. Despite that shocking news, the upbeat interior designer was undeterred. LeAnn took her case to Mayo Clinic and found a determined physician who offered her a promising alternative.


All
her life, LeAnn Kuper had been the epitome of good health. Fit and active, the interior
designer walked and sometimes ran several times a week. The wife and mother of
three adult children never needed surgery, anesthesia or any sort of
hospitalization beyond birthing her babies decades ago.

So in October 2018, LeAnn was stunned when, after developing a persistent fever and fatigue, she learned that she had colon cancer. When surgery to remove the tumor revealed that the cancer had spread throughout her abdominal cavity and was deemed medically incurable, LeAnn and her husband, Jody, immediately decided to get a second opinion.

LeAnn, who lives in Milbank, South Dakota, knew she wanted to seek that opinion at Mayo Clinic, but she wasn’t sure how to go about it. So she picked up the phone and called her cousin, Roger Hofer, M.D., a Mayo Clinic anesthesiologist.

“Little
did we know that Roger worked with Dr. Grotz, and he was the doctor we needed
to see,” LeAnn says. “We are strong believers, and we believe the
Lord just paved the way for us.”

When Travis Grotz, M.D., a Mayo Clinic surgical oncologist, heard that that the only treatment LeAnn had been offered locally was palliative chemotherapy, he knew he could provide more than that.

A few days later, LeAnn and Jody drove to Mayo Clinic in Rochester and met with Dr. Grotz. He agreed that LeAnn needed chemotherapy, but he recommended an alternate treatment plan involving surgery and hyperthermic intraperitoneal chemotherapy, or HIPEC. The plan worked. Today, there is no evidence of cancer in LeAnn’s body.

“I
definitely feel that Dr. Grotz has given me a second chance at life,” LeAnn
says. “I know there’s a chance it can come back, but it doesn’t have to. I
feel that prayers of many, the phenomenal support of my husband and family, along
with great medical care have brought me this far.”

A multiphase plan

From
her first appointment with Dr. Grotz, it was clear to LeAnn that Mayo Clinic
was where she was supposed to be. “My husband and I both needed to hear
some hope in his voice,” LeAnn says. “He had a very kind and humble
confidence about him. We trusted him immediately and had confidence in his
abilities and experience. It wasn’t that he was painting a rose-colored picture
for us, but we needed hope at that point. We all need someone who will give us
a chance.”

Based
on LeAnn’s physical evaluation, lab reports and scans, it was evident that she had
cancer cells throughout her abdomen. Despite that, she was a good candidate for
surgery. “Her being a really healthy person, her mindset, her grit and her
strength are really what helped her get through a lot of the treatment,”
Dr. Grotz says.

“I’m not a worried sort of person, and I had total confidence in my medical team.”

LeAnn Kuper

Although
patients with colon cancer that has spread outside the colon traditionally have
been told it’s a terminal condition, research shows that targeted interventions
can improve outcomes dramatically. “In people who got only chemotherapy, research
shows they do poorly,” Dr. Grotz explains. “Life expectancy is 12
months, with 24 months being the highest. Treatment with surgery and then HIPEC
chemo in the most recent studies suggest that if we can remove all the cancer
cells, people on average survive 41 months, which equates to a 40% five-year
survival.”

For
LeAnn, there was no question she’d follow the path Dr. Grotz had prescribed.
“There wasn’t a lot of gray area. It just was what it was,” she says.
“I’m not a worried sort of person, and I had total confidence in my
medical team.”

The
first phase of LeAnn’s treatment took place in Milbank and Sioux Falls, South
Dakota, so she could be closer to home. Every other week from November to
April, LeAnn received a chemotherapy infusion. When LeAnn finished 12 rounds of
infusions, she returned to Mayo Clinic for imaging.

“She
had a great response to chemotherapy and all of her tumor markers came down,”
Dr. Grotz says. The day after scans were taken, LeAnn had a laparoscopic
procedure involving video monitoring to identify where cancer cells remained in
her body. Based on findings from that procedure, Dr. Grotz decided to proceed
with surgery to remove the areas affected by the cancer.

A precision operation, encouraging recovery

On
June 3, LeAnn underwent a 10-hour surgery, during which Dr. Grotz systematically
evaluated her entire abdomen. “We looked in every nook and every cranny
and at every organ to see if there was any disease,” he says.

While
having chemotherapy before surgery significantly reduced the amount of cancer
in her body, LeAnn still had a fair amount of disease. As a result, during the
surgery her abdominal lining, or peritoneum, was stripped; her uterus and
ovaries were removed; her gallbladder was removed; and parts of her colon were taken
out.

After
all of the obvious tumors were removed, Dr. Grotz administered intraperitoneal
chemotherapy, heated to approximately 108 degrees Fahrenheit, to target any
microscopic cancer cells that may have been left behind.

“The
heat seems to help the chemotherapy penetrate the cancer better,” Dr.
Grotz says. “We know cancer is more susceptible to heat, so the heat
upregulates the stress in the cancer cells and makes them more susceptible to
chemotherapy.”

“I called her a week after she was discharged, and she was outside gardening. It was pretty amazing.”

Travis Grotz, M.D.

The
chemotherapy was circulated in LeAnn’s abdomen for 90 minutes and then drained.
After her cavity was flushed, the surgical team reconstructed her colon.

People
who undergo a procedure like LeAnn’s remain in the hospital an average of seven
to eight days. LeAnn was discharged after four. “I called her a week after
she was discharged, and she was outside gardening,” Dr. Grotz says. “It
was pretty amazing.”

Due
to the extent of the surgery, it usually takes patients between three and six
months to fully recover from the procedure. “There’s a lot of fatigue and
gastrointestinal irritability because the bowels are bathed in chemotherapy for
an hour and a half,” Dr. Grotz explains.

In
LeeAnn’s case, recovery has gone well. Although it’s only been four months
since her surgery, LeAnn, who specializes in designing and installing window
treatments, feels better than she has in a year. “I’ve gotten back to my
normal walking pace, and I started installing my shades again. I came through
without any of the side effects for the most part and not any complications,
which is huge.”

LeAnn
says there was never a doubt in her mind after she met Dr. Grotz that
everything would work out. “Things could not have gone better for me,”
she says. “Once my diagnosis was given, our path was laid out for us. We
just felt like it was pretty obvious what we should do, and there weren’t a lot
of times we had to sit and scratch our heads and make a decision. I could just
be confident that everything that could be done was being done.”


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