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, an administrator at Manhattan’s Berkeley College, 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 Cancer Doctor’s Advice — and 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 didn’t know what to do, but he knew someone he should ask for advice: a family friend, Peter Scardino. Dr. Scardino is a specialist in prostate cancer surgery and was Chair of the Department of Surgery at Memorial Sloan Kettering for ten years. He 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.
“I trusted him from day one,” Dario says. “I’m a researcher in my own field, and I saw that Dr. Garcia-Aguilar was also a researcher. I always find that the doctors who do a lot of research tend to be the most updated and on the cutting edge of the field. Plus, we both speak Spanish, and that was reassuring.”
Dr. Garcia-Aguilar ordered an MRI and a new biopsy to confirm the diagnosis and assess the extent of the 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 after 23 sessions because his skin was getting burned, which is a side effect that sometimes happens with this type of therapy. But luckily, when he ended radiation, 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 last few 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 for colorectal cancer is standard. Compared with open surgery, people who have minimally invasive surgery have less pain and recover faster. They have fewer complications and a better appearance.
Within minimally invasive procedures, there are two approaches: laparoscopic and robotic. At MSK, robotic surgery is typical. 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.”
Dario has yearly follow-ups with Dr. Garcia-Aguilar and visits with Dr. Yaeger every six months. He’s grateful to MSK for the care he received, and that he has been able to get back to thriving. Just recently, he walked his daughter down the aisle at her wedding.
Dario is also finding ways to give back. He volunteers with MSK to talk with people, especially Spanish speakers, who have been diagnosed with colorectal cancer.
“In Latino culture, anything dealing with cancer, you don’t discuss,” 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?’ I spoke with a few men, and they felt comfortable and went through with the surgery. It feels very good to volunteer my time and knowledge.
“I’m so fortunate,” he adds. “I’m alive. I can do the things I want to do. I can spend time with my family, my daughter, and my significant other. I can enjoy life to the fullest.”