Darío was astonished when he knew he had colorectal cancer.
In early 2015, Dario Cortes lost a considerable amount of weight. He chalked it up to healthy changes in his diet. But he was also experiencing rectal bleeding, which he knew was abnormal.
Dario, a retired higher education administrator, saw his primary care doctor. He was then referred to a cancer specialist at a New York City hospital. The specialist, however, didn’t seem as concerned as Dario was.
“He said it couldn’t be cancer because I had had a colonoscopy three years ago and it was clean,” recalls Dario, who is in his 60s.
The oncologist thought Dario had hemorrhoids. He recommended an injection of Botox® to relax the muscles around Dario’s rectum. This plan didn’t feel totally correct to Dario, but he decided to trust the doctor and move forward.
Two weeks before he was set to have Botox, Dario noticed a small protrusion out of his anus. It bothered him, so he asked the oncologist to remove it. When the sample was biopsied, Dario received unfortunate news: He had early-stage rectal cancer.
A New Connection
Rectal cancer is similar to colon cancer. Both are cancers of the large intestine, which is nearly six feet long. The colon is the first five and a half feet of the large intestine. The rectum is the last six inches.
Dario requested some advice from a family friend, Peter Scardino, a prostate cancer surgeon at Memorial Sloan Kettering. Dr. Scardino recommended that Dario see Julio Garcia-Aguilar, Chief of MSK’s Colorectal Service.
Dario made an appointment with Dr. Garcia-Aguilar through MSK’s Patient Access Service. He knew he was in good hands when they met in March 2015, and learned Dr. Garcia-Aguilar besides being a doctor, he was a scientific researcher. It signaled to Dario that they both like to do research and discover new frontiers.
“I trusted him since the beginning”, Dario says “I am also an investigator”. I have noticed that doctors who do a lot of research tend to be the most updated and on the cutting edge of the field,” They also had other things in common, too: They both speak Spanish and like to ride bikes.
Dr. Garcia-Aguilar ordered an MRI and a new biopsy to confirm the diagnosis and assess the extent of disease. Based on his findings, Dr. Garcia-Aguilar said that Dario would be a good candidate for chemotherapy and radiation to shrink the tumor. The hope was that Dario wouldn’t need surgery to remove his rectum and anus. Surgery would cure his cancer, but it would require Dario to wear an ostomy, an external pouch that collects stool.
Dario felt confident in that plan. He met with medical oncologist Rona Yaeger and radiation oncologist Karyn Goodman to discuss the next steps. Dario had four rounds of chemotherapy and was scheduled for 28 sessions of radiation. The radiation treatments were intense, though. Dario had to stop treatment after 23 sessions because his skin was getting burned, which is a side effect that sometimes happens with this type of therapy. But luckily, after 23 sessions, Dario had no evidence of disease
A Setback and Surgery
Six months after Dario finished treatment, the cancer returned. Dr. Garcia-Aguilar said that while chemotherapy and radiation were good first treatments, more often than not, the combination does not completely get rid of colorectal cancer.
“He was very up front from the beginning,” Dario says. “He said most of the time this cancer comes back. At that point, I didn’t have any other alternatives, so I went ahead with surgery.”
Surgery and outcomes for colorectal cancer have improved considerably in the past decades. There have been new advances, and more surgery options are available. Surgery can be done two ways. In open surgery, a doctor makes a nine-inch incision through the abdomen. In a minimally invasive procedure, small incisions are made, guided by a camera. At MSK, minimally invasive surgery (MIS) for colorectal cancer is standard. Compared with open surgery, people who have MIS have less pain and recover faster. They tend to have fewer complications and improved appearance.
Within the minimally invasive category, there are two approaches: laparoscopic and robotic. At MSK, robotic is the typical method. In fact, MSK has one of the largest programs in the world for robotic surgery for colorectal cancer.
“Regular laparoscopic surgery is like doing surgery with chopsticks. You have rigid instruments,” Dr. Garcia-Aguilar says. “With robotic surgery, the instruments have joints and a range of motion similar to the human hand. You can be much more precise.”
In August 2016, Dario had a three-hour robotic procedure at Memorial Hospital. Dr. Garcia-Aguilar removed a portion of Dario’s colon, plus his rectal and anal canal, and fitted him for an ostomy. Dario went home the very next day. People previously had to spend a week in the hospital recovering from colorectal cancer surgery.
“You Build an Ability to Adapt”
Dario adjusted well to the ostomy. He was intent on keeping up with his favorite activities, like cycling and going to the beach. One of his nurses, Kaci Costello, recommended an irrigation system so that he would only need to drain his pouch once a day, giving him much more flexibility in his day-to-day activities.
“I began to get creative with my new lifestyle,” Dario says. “You build an ability to adapt. It’s like if you have contact lenses, a hearing aid, or a hip replacement — everybody has something.”
After surgery, Dario had yearly follow-ups with Dr. Garcia-Aguilar. Now he is far enough past treatment that he no longer needs to see him. He still has an annual colonoscopy and sees Dr. Yaeger every six months for a check up, which includes a CT scan and blood work. Dario likes to check the MSK patient portal to see how his health has improved through the years.
“When I look at the portal on MyMSK, I can see my test results year-over-year,” he says. “I show people: This is how I knew I had cancer; this is how I’m doing today. I like looking at the numbers. It gives me a sense of confidence and comfort. It’s a way of using technology to take care of yourself.”
Thriving after Cancer
Since his treatment, Dario has reached many personal and professional milestones. He retired in November 2019 after a long career in education. In 2017, he walked his daughter Natalie down the aisle at her wedding; two years later Natalie gave birth to twins Lyla and Ford.
“Having grandchildren has been such an amazing experience,” he says. “It’s fascinating to start detecting their personality traits.” His other daughter, Sherry, is a successful university archivist.
He’s also traveled extensively. In addition to visiting his grandchildren in Texas, he’s been to Machu Picchu in Peru and Southeast Asia. He is currently planning a trip to eastern Europe.
“I would have never been able to do that if I just decided to let cancer have the final word,” he says.
“I would have missed my daughters, my grandchildren, working, retiring, and traveling. Time passes, and if you don’t act, you will say, ‘I wish I would have done that.’ You still can.”
Dario also volunteers at MSK as a sounding board for Spanish speakers who have been diagnosed with colorectal cancer.
“In Latino culture, you don’t discuss cancer,” Dario says. “We tend to be very private. A lot of men don’t want to do the surgery, so someone at MSK will say to them, ‘Would you like to speak with a patient who had surgery recently and someone who speaks Spanish?’ It feels very good to volunteer my time and knowledge.”
He often tells them to not delay getting the care that they need.
“I think it’s important to help others realize that you need to confront the illness head-on,” he says. “If I can make a difference in one person who changes their perspective, then it’s worth every minute.”
Dr. Garcia-Aguilar says that Dario is a model for how cancer can beget new beginnings and how fulfilling life can be after treatment.
“Dario’s acceptance and adaptability to his new situation, his determination to enjoy every day of his life, and his willingness to share his experience and help others have impressed me,” he says.