renovated kitchen baking — a pastime she enjoyed with her late grandmother. Taking Control T hings remained calm for the next few years and follow-up visits remained status quo until January 2016 when Schepisi experienced the uncomfortable sensation of food getting stuck in the top of her stomach. After calling her local oncologist, she was instructed to go to the emergency room where a cT scan was taken. it showed a blockage, but there was uncertainty as to whether a shadow that presented was the result of surgical scar tissue or was an indication of cancer. Her doctor immediately referred her to Timothy kennedy, mD, a surgical oncologist in the Gastrointestinal/Hepatobiliary Oncology Program at Rutgers cancer institute. Dr. kennedy came to see Schepisi in the eR and informed her that what they were seeing was indeed cancer. He also told her she needed a second HiPec surgery — a procedure kennedy was more than familiar with, having performed about 70 of the operations over the past five years. But he shared that she didn’t need to have the procedure right away, since the new malignancy appeared to be slow growing. Schepisi didn’t hesitate. “i wasn’t going to let my cancer be in control of me. i was going to be in control of it,” she recalls. it was a matter of whether going back to Baltimore since she was already familiar with the procedure and team there or working with a new doctor and having the benefit of being close to home. The Schepisis decided that proximity was important, plus, having been at Rutgers cancer institute in previous years, there was also a level of comfort and trust with the expertise there. Schepisi’s blockage resolved and she immediately arranged to have HiPec later that month with kennedy at Robert Wood Johnson University Hospital, the flagship hospital of Rutgers cancer institute. A second HiPec surgery is not unusual, notes kennedy, who quickly points out that the procedure — whether a first time or second time — is not for everyone. “Looking at the biology of the disease is most important. if it’s a slow growing cancer like low-grade appendiceal, there is more benefit in removing the disease and treating with HiPec, because it can take many years for the cancer to grow back. For more aggressive cancers like colorectal and gastric, we would treat with systemic chemotherapy first to assess response before considering patients for aggressive surgery. Those with slow growing cancers and disease that is responding to chemotherapy are good candidates for the procedure. Patients who are also young and healthy like Lisa tend to have better outcomes,” notes the doctor, who is also an associate professor of surgery at Rutgers Robert Wood Johnson medical School. “The risks outweigh the benefits in some cases, but it really needs to be taken on a case by case basis. There is a survival benefit for many patients,” he says. kennedy adds that unfortunately, study on cRS and HiPec has been extremely limited., but points out “those who have the procedure at a specialty center tend to have better outcomes,” adding that about 100 facilities across the country currently perform HiPec, with about 20 to 30 of those locations being some type of speP H OTO By : N i c k R O m A N e N kO “My quality of life is great. I really can’t complain,” says Lisa Schepisi, who is taking things “one day at a time.” 18 I Cancer Connection I Autumn 2016