When Lyn Alraimouny learned she had esophageal cancer in 2012, her primary doctor referred her to a surgeon at a New York City hospital, who laid out an intimidating plan to treat her stage 3 disease. At the urging of family members, Lyn got a second opinion from Memorial Sloan Kettering, where her doctor offered her a less-invasive surgical option.
Lyn Alraimouny took a moment to collect herself. Calling Memorial Sloan Kettering in the summer of 2012 to schedule a second opinion for her esophageal cancer diagnosis, Lyn’s throat caught when she learned she would be seeing thoracic (chest) surgeon Nabil Rizk.
Just hearing Dr. Rizk’s name felt like a sign that Lyn was coming to the right place: He had successfully treated Lyn’s elderly mother for lung cancer five years before.
“I’m not a religious person,” says the Queens, New York, resident, “but the fact that I was assigned to Dr. Rizk was like God telling me, ‘This is where you need to go.’”
Then 50 years old, Lyn had suddenly begun to have difficulty swallowing food. “I thought, I’ve got to eat more slowly. I must not be chewing well enough,” she recalls.
But she was unnerved enough to mention the problem to a friend at work. A 20-year survivor of Hodgkin’s lymphoma, Lyn’s fear was that her cancer — cured at age 29 — had returned. Lyn’s coworker suggested she might have gastroesophageal reflux disease (GERD), and Lyn’s doctor agreed before sending her to a specialist, just to make sure.
The specialist examined Lyn’s esophagus while she was under sedation. Shortly after awakening from the procedure, Lyn was shocked to hear the doctor tell her: “There’s something there. It’s not what I expected.”
Lyn didn’t fit the profile of the typical esophageal patient. Cancer of the esophagus disproportionately strikes men over age 65, and while GERD — a condition in which the stomach contents leak backward into the esophagus — is also a risk factor, Lyn hadn’t suffered from it. Nor was the new malignancy related to her previous bout with Hodgkin’s.
Lyn’s trusted primary doctor referred her to a surgeon at a large New York City hospital, who laid out an intimidating treatment plan: surgery involving a large vertical incision down her torso “that would cut me in half” and the removal of three-quarters of her esophagus. Lyn might also need chemotherapy and radiation treatments after the surgery, she was told.
Her husband and siblings urged her to get a second opinion at Memorial Sloan Kettering, so she called and received the appointment with Dr. Rizk the following day. Lyn says she liked him for his “straightforward and non-threatening” demeanor and was taken with the “aura of hope” he seemed to project.
Less Invasive Surgical Option
Dr. Rizk, whose primary research interest is in evaluating esophageal cancer treatment outcomes, examined Lyn’s biopsy results, scans, and other tests and confirmed her diagnosis. But he proposed an entirely different plan of attack, with chemotherapy and radiation taking place before minimally invasive robotic-assisted surgery to remove whatever tumor remained.
While Lyn wasn’t a typical esophageal cancer patient, her case was similar to about 70 percent of those with the disease. “Her cancer was stage 3, locally advanced, and became symptomatic only when the tumor grew enough to obstruct the esophagus,” Dr. Rizk says.
Two-thirds of her esophagus would need to be removed, but robotic surgery would mean less pain and bleeding and quicker healing, Dr. Rizk told Lyn. Nine smaller cuts would be made instead of one long incision in a seven-hour procedure that would also remove lymph nodes in the region along with the top portion of Lyn’s stomach.
About 35 to 40 percent of esophageal cancer patients at Memorial Sloan Kettering are operated on robotically, Dr. Rizk says, compared to only about 10 percent nationwide. This advance is possible because of Memorial Sloan Kettering’s research database of 1,700 esophageal cancer patient outcomes dating back to 1996 — and because of diligent efforts by Dr. Rizk and colleagues to adjust robotic techniques over time to improve those outcomes.
“We started doing this [surgery] about three years ago, and the results have been pretty remarkable,” he says. “There’s a distinct difference in how patients feel afterwards … and the data also suggest it’s a better esophageal cancer operation than open surgery. The surgical instruments are longer so we’re operating closer to the disease itself.”
“A Special Place”
After several months of chemotherapy and radiation treatments, Lyn’s robotic surgery took place in March 2013, after which she was hospitalized for ten days. She remained upbeat throughout the trio of treatments and their aftermath, drawing strength from a network of family members, friends, and colleagues who willingly dropped everything to help during the tougher moments.
Shortly after returning home from surgery, however, Lyn suffered a mental and physical blow when a surgical site infection — a common complication — landed her back in the hospital for a week. Clearing this hurdle was made easier with Memorial Sloan Kettering’s array of social offerings for inpatients, including concerts and arts and crafts classes.
“I took advantage of everything Memorial Sloan Kettering has to offer,” she says. “Plus, you have to walk the halls, so you meet people, and the nurses are great. It’s a special place.”
After a three-month recovery at home — part of which included the use of a feeding tube as her internal organs healed — Lyn returned to her job as a manager for New York City’s Human Resources Administration with renewed vigor. “It’s hectic and challenging, but I pride myself on keeping calm,” she says. “I’m a better manager because of what I’ve been through.”
“I Don’t Sweat the Small Stuff”
Lyn’s follow-up care includes imaging scans and check-ups with Dr. Rizk every six months. He notes that the risk of her esophageal cancer returning will continue to decline slowly until six years post-treatment, when it drops nearly to zero.
Because her stomach is smaller and sits higher than it did before surgery, Lyn deals with lingering digestive issues and needs to sleep propped up so food and beverages go down more efficiently. She will have lifelong reflux as a result of her surgery, Dr. Rizk says, and must eat smaller and more frequent meals to compensate.
“Dr. Rizk describes what’s left of my esophagus as a drain that gets clogged often,” she says matter-of-factly. “Sometimes water stays on top and I end up choking. It can be bothersome.”
Still, Lyn relies on her knack for seeing the bright spot in every situation. “I don’t sweat the small stuff anymore,” she says. “My head is screwed on better and I put things in perspective. I always find the positive.”