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Lewis Black was propped up on pillows in his room at Huntsman Cancer Institute, with his wife, Kara, and daughters, Miriam, 14, and Lily, 11, by his side. He was recovering from an 11-hour surgery to save his life. On the menu were some of Lily’s favorites from The Point restaurant. They would watch a favorite show together later—anything to distract them from the serious nature of Lewis’s cancer.
“Just being together as a family and trying to do the kinds of things that we would normally do during the evening was important,” says Lewis, an administrative law judge with the Utah Department of Health and Human Services. “We wanted that sense of normalcy for our girls.”
“Everybody wanted to help but didn't know how, and I didn't know what I needed, either.”
Lewis first worried something was wrong in February 2022 when he inexplicably gained 40 pounds. A CT scan revealed he had stage 4 appendiceal adenocarcinoma, a rare cancer in the lining of the appendix.
“It was a little frightening,” Lewis says. “But I just thought to myself, ‘Okay, well. Now what do we do? Where do I go from here?’”
The surgery he needed was hyperthermic intraperitoneal chemoperfusion (HIPEC). During a HIPEC procedure, surgeons put chemo medicine, heated to 109 °F, right into the abdomen. By heating the chemotherapy drug and applying it directly to the cancer cells, doctors believe it helps the chemo work better. For patients with certain advanced cancers that have spread to the lining of the abdomen, HIPEC provides hope.
“It’s not simple surgery,” says Laura Lambert, MD, director of the Peritoneal Malignancy Program at Huntsman Cancer Institute and professor of surgery at the University of Utah. “It is a complex technical surgery. You have to be dedicated to treating the disease and taking care of the people with it.”
“We tailor the treatment to the individual, their situation with the cancer, but also what their goals are.”
The success rate of the surgery is difficult to pinpoint, Lambert says, because cancers of the appendix fall on a spectrum of diseases, and the biology of the tumor determines how well a person will respond to the two-step procedure.
“It’s the combination of removing all the tumors you can see and then putting heated chemotherapy directly into the abdominal cavity to treat any remaining microscopic cancer cells,” Lambert says. “You can use a much higher concentration of the chemotherapy this way than you can if you’re giving it intravenously.”
HIPEC surgery is used to treat a variety of cancers that spread through the abdomen including colon cancer, ovarian cancer, peritoneal mesothelioma, and some gastric and small bowel cancers. The complete recovery time can be lengthy and difficult, about three months.
“It’s a pretty significant recovery, so that’s a huge part of the decision making around who to offer it to,” Lambert says. “We tailor the treatment to the individual, their situation with the cancer, but also what their goals are, and what their level of risk tolerance is.”
"This was the right thing to do, the right place to do it, and the right person to do it."
When facing the cancer and the HIPEC surgery, Lewis’ main concern wasn’t for himself, but for his family.
“It was very tough,” Lewis says. “It was hard seeing Kara and the girls react. I just had to deal with it. But they had to watch me deal with it. Everybody wanted to help but didn't know how, and I didn't know what I needed, either.”
Huntsman Cancer Institute is one of only a handful of hospitals in the United States offering HIPEC surgery. The procedure is not new. It’s been in practice since 1980, but only a handful of surgeons are qualified to do it the United States because it requires specialized training and equipment.
“I felt extremely fortunate that Huntsman Cancer Institute is right here and they had one of the only people in the state qualified to do it,” Lewis says. “Dr. Lambert was wonderful. From the first appointment, explaining what the procedure would entail and what the risks were, to subsequent ones. The more I spoke with her, the more comfortable I was that this was the right thing to do, the right place to do it, and the right person to do it.”
“I gave myself permission to feel sorry for myself for about 10 to 15 minutes every day. And then I just would go on and do what I had to do.”
During the procedure, Lambert had to remove Lewis’ appendix, spleen, and gallbladder before applying chemotherapy drugs.
The 11-hour surgery was a success. Lewis’s cancer is in remission. He is feeling so good that the family recently went on a vacation to San Francisco.
“I have a hard time keeping up with him,” Kara says. “He just has to have frequent checkups but other than that, cancer seems like a distant memory.”
Lewis says his family, friends, and faith kept him going throughout his treatment.
“During that whole process,” he adds. “I gave myself permission to feel sorry for myself for about 10 to 15 minutes every day. And then I just would go on and do what I had to do.”