It was apparent from the start that Marissa Antonio’s case was unique. She was just 39 and a new mother when an MRI revealed a 19cm tumor in her liver, and unlike with most cases, she did not have any complicating disease in the liver, such as cirrhosis. Marissa knew something was not right when she started having pain on her right side and was more tired than normal. At the time she was working nights as a nurse and assumed that was the cause of the fatigue. When she started noticing blood in her urine and couldn’t keep any food down, she knew it was time to visit her doctor.
At the visit, her doctor immediately sent her to the Emergency Department where doctors did a biopsy and the next day she received the news; she had hepatocellular carcinoma (HCC), or liver cancer. Marissa was not only devastated, but also shocked that this could happen to her. Her daughter was just 19 months old and knowing she had a long road ahead, she requested to be seen by doctors at Yale.
“My husband and I had been trying to conceive for almost five years, and our daughter finally was here and I was too sick to take care of her. It was two years before I felt well enough to do so. I am so thankful to my husband and my father for stepping up to care for her when I could not,” said Marissa.
For any patient with HCC it is important to be referred to a medical center that has a multidisciplinary program and is able to offer a range of treatment possibilities. Marissa first met with medical oncologist Dr. Stacey Stein and with hepatologist Dr. Tamar Taddei, and after discussing the case at the multidisciplinary tumor board, they explained her treatment plan. She started a treatment regimen known as chemoembolization to shrink her tumor before surgery could be scheduled to remove it. Despite suffering various side effects, Marissa was able to complete the treatment and her tumor decreased by over 90 percent.
Before her surgery was scheduled, an MRI was ordered to assess the location and involvement of the tumor. It revealed that there were major veins involved and the cancer was spreading towards her heart. Therefore, a surgery was deemed too risky. Marissa woke up every day just thankful she was alive. She planned a trip to the Philippines to reconnect with family and continued to be monitored. When she returned from her trip, another scan was done and this time her cancer was receding instead of growing as they had expected. It was still considered risky, but Drs. Sukru Emre and Ronald Salem decided to take advantage of the small window offered and attempt the surgery Marissa so desperately needed.
After eight and a half hours Marissa awoke to good news; her surgeons were able to remove all of the tumor with no complications, and she would not need a liver transplant.
The newly formed Liver Cancer Program at Smilow Cancer Hospital, led by Mario Strazzabosco, MD, PhD, Professor of Medicine, is dedicated to diagnosing liver cancer early, when treatment is optimal. “Marissa’s case illustrates the complexities around the management of HCC and how the application of a multidisciplinary approach to care can lead to success against any odds,” commented Dr. Strazzabosco. “The success of Marissa’s case is the result of a profound knowledge of the standard of care and the ability to think out of the box when needed.”
Marissa’s care team followed her closely and never stopped exploring new options for her. This continued, and a year after surgery a CAT scan of the chest revealed a growth on the left lower lobe of her lung; the HCC had returned. Thoracic surgeon, Dr. Frank Detterbeck, was able to remove the lesion, along with a benign lesion that had been discovered earlier, but a later scan showed two more small growths. These were also resected, but she experienced complications from the multiple surgeries, and suffered a lung collapse. When more growth was found in the lung, another surgery was not an option and a clinical trial had proved too toxic for her body to handle. That is when they turned to Dr. Kimberly Johung in the Department of Radiotherapy at Smilow.
Marissa continued to work while receiving radiation therapy and subsequent tests showed that her Alpha-fetoprotein (AFP), a tumor marker to help detect and diagnose cancers of the liver, had dropped to a safe level. Marissa herself works as a radiology nurse in the YNHH Health System. She shares her story and patients trust that she understands what they are going through. “I feel like God has put me here to be with these patients as they go through a similar journey,” said Marissa. “My faith played a crucial role in my recovery, and helped me through the dark times. I hope that I can be that support for someone else.” Marissa also attributes her recovery and renewed health to the healthy eating habits she implemented into her everyday life.
While visiting the Philippines, Marissa discussed the family’s history of liver disease, which she had always assumed was from alcohol use. However, due to the presentation of Marissa’s case, it is suspected that her mother was a carrier for Hepatitis B and unknowingly passed it to Marissa during pregnancy or childbirth. Hepatitis B is a known cause of liver cancer, as are metabolic syndromes and alcoholic liver disease.
Marissa will continue to be treated with antivirals and followed closely for any signs of recurrence by her hepatologists at Smilow. Her daughter is now seven years old. She grew up with her mother constantly going to doctor’s appointments and spending time in the hospital, but with the support of family, they have both made it through a difficult journey. Marissa commented that she feels as though her daughter knew when she was finally feeling better.
“She had never been one to ask me to carry her before, but one day she looked up at me and begged for me to pick her up. It was a very special moment. I show her pictures of when I was sick, mommy with no hair, and she knows what I have been through and that I plan to be here for her for a long time,” said Marissa. “This was a long journey for all of us, full of obstacles and setbacks. I always tell people that I was treated at the best hospital, with the best doctors. They never gave up on me, and I am so thankful that they kept believing my life was worth saving.”