A bond of trust, a path to healing

Patti Lyons, 61, of Doylestown, PA, is the proud owner of Peace Valley Lavender Farm. She enjoys an active lifestyle, cultivating acres of lavender, greeting visitors, and overseeing the farm's retail gift shop. Lyons also practices and teaches Aikido, a martial art she and her husband have enjoyed for thirty years and counting.

Five years ago, she began to experience blood in her stools, mild constipation, and weight loss. She consulted with gastroenterologist Sandhya Salguti, MD, who then performed a colonoscopy. This procedure is still the gold standard for detecting colon polyps and colorectal cancer.

Doctors recommend colon cancer screening for everyone starting at age 45—even sooner for those with a family history of it. This is important because not everyone shows symptoms, or the symptoms are not obviously connected to colorectal health. Some patients are not aware of having blood in the stool, for example. However, with non-obvious bleeding, anemia can still develop which occasionally leads to fatigue.

Using a long, flexible scope while Lyons was asleep from the sedation, Salguti examined the lining of her intestines. She then discovered a mass in her rectum. Additional imaging studies showed that the cancer had spread to nearby lymph nodes, indicating a stage 3 rectal cancer.

Fighting rectal cancer together

Salguti arranged for Lyons to meet Robert Akbari, MD, a board-certified, fellowship-trained colorectal surgeon, to discuss treatment options.

“My first appointment with Dr. Akbari was powerful,” Lyons recalled. The reality of her diagnosis was sinking in, and she found his professionalism and warmth reassuring.

“He laid out a roadmap for a proven protocol to treat stage 3 rectal cancer that would take about a year to complete,” she said. “As he went over the steps of the treatment plan, I could imagine myself going through the process and coming out on the other side in good health.”

A team of experts

“We often use chemotherapy, radiation, and surgery together to treat rectal cancer effectively,” said Akbari. However, he noted that with newer protocols some patients nowadays even avoid surgery, depending on circumstances.

Lyons began her treatment with chemotherapy under the care of Mitch Alden, DO, a medical oncologist, and a course of radiation therapy under the care of Sonal Mayekar, MD, a radiation oncologist. The goal is to shrink the tumor and eliminate or reduce cancer in the lymph nodes ahead of surgery. “We call it downstaging,” Akbari explained. In some cases, a person can have a complete response, meaning that all evidence of the person's cancer may be eliminated.

“I had a team of rectal cancer experts working together to treat my medical condition,” Lyons said.

“We collaborate to ensure that every patient gets the appropriate care,” said Christopher Bruce, MD. Bruce is the medical director of Penn Medicine Doylestown Hospital's nationally accredited Rectal Cancer Program. “We follow the latest national guidelines to create personalized treatment plans,” he said.

“I am honored that Mrs. Lyons put her faith and trust in me, my colleagues, and Doylestown Hospital,” Akbari said. “Our rectal cancer team includes pathology, radiology, radiation oncology, medical oncology, genetic counseling, and wound/ostomy specialists. We also have a colorectal nurse navigator, Marianne Haig, RN, who can help expedite imaging and office appointments, provide access to support services, and offer guidance through diagnosis, treatment, and recovery.”

Nationally accredited for rectal cancer

Doylestown Hospital recently earned a three-year accreditation from the National Accreditation Program for Rectal Cancer (NAPRC), a quality program of the American College of Surgeons. Only four hospitals in Pennsylvania hold this prestigious distinction, and Doylestown Hospital is the only one in Bucks County.

“When you are dealing with cancer, you don't need extra stress,” Lyons said. She appreciated having access to high-level care so close to home.

“It took me 12 minutes to drive to Doylestown Hospital. I didn't have to go to Philly or anywhere else,” she said. She said getting to chemotherapy and daily radiation treatments was easy and that it was much less stressful for her husband to visit her in the hospital.

Highly personalized, connected, and advanced care

“You don't appreciate how important it is to have this level of expertise and service close by until you need it,” Lyons said. The compassionate care she received and the special connection she formed with Akbari played an equally important role in her decisions about her care.

“I especially feel particularly connected to patients with a cancer diagnosis. It’s a long challenging road and part of my job, I think, is doing my best to explain things, offer support, and to help folks like Patti see the light at the end of the tunnel,” Akbari said.

In a robotic surgical procedure, Akbari removed the affected part of Lyons’ large intestine and the affected lymph nodes through tiny incisions. His medical partner, Bruce, assisted.

Like traditional laparoscopic surgery, robotic surgery is minimally invasive, using small incisions and a miniature camera. However, the robotic platform offers an enhanced 3-D view, and the instruments are more flexible. This enables the surgeon to gently manipulate tissue and place sutures in tight areas such as the pelvis. The surgical robot is particularly useful in a narrow area such as the pelvis. This area is crowded with significant nerves, organs, and blood vessels, which need to be navigated according to Akbari.

As part of Lyons' procedure, Akbari temporarily bypassed her large intestine by bringing the side of her small intestine through her abdominal wall outside her body. This opening is called a stoma, or more specifically an ileostomy. A special bag attaches to the opening, collecting waste outside the body.

“This part of the treatment for rectal cancer, if needed, can be daunting for patients,” Akbari said. He noted that with modern techniques and treatments, most ileostomies are temporary.

One of the hospital's wound care nurses, Jeanette Delaney, RN, taught Lyons and her husband about ostomy care and how to attach the bag. “My kind, loving husband helped to change my ostomy a few times a week,” Lyons said, noting that it was a little awkward when she attached the bag herself.

Facing a challenge

Home again after her surgery and hospital stay, Lyons was outside having a bowl of soup when she began to vomit. She went to Doylestown Hospital's Emergency Department and returned to the hospital. Her intestines were not waking up as they should, so food and digestive juices were backing up in her stomach.

“This is not typical or expected, but can happen after any abdominal surgery,” Akbari said. “We treat this condition by providing nutritional support until the bowels wake up again.” Since Lyons was not able to take in nutrition by mouth, she received a nasogastric (NG) tube, a thin tube that went through her nose to her stomach.

“Dr. Akbari or Dr. Bruce checked on me daily,” Lyons said. After more than a week with the NG tube, Lyons was finding it extremely uncomfortable, and she wanted it removed. “Dr. Bruce came to see me one day, and I asked him to take it out,” she said. He did, and fortunately, her intestines began working the next day.

Completing her treatment

At the time Lyons received treatment, best practices for rectal cancer care typically called for chemotherapy and radiation (6 weeks), followed by surgery, followed by more chemotherapy (4-6 months). In Lyons’ case, she had a complete response to her cancer treatment. After recovering from surgery, the last phase of chemo was optional.

Lyons decided to go ahead with her final round of chemotherapy. “It felt like an insurance policy,” she said.

“Management of rectal cancer is always progressing,” Akbari said. “In fact even more recently, patients often undergo all of their chemotherapy and radiation together upfront. If they have a complete response, with no evidence of any cancer left, these patients may opt for what is called 'watch and wait.' This means holding off on surgery and monitoring over time, sometimes avoiding surgery all together.”

In January 2020, Akbari reversed Patti's ileostomy surgery. She would no longer need to wear a bag. He reconnected her intestines so she could resume regular bowel movements. After three days in the hospital, she was able to return home.

An enduring connection

“Patti and her husband are very pleasant and likable,” Akbari said. “I get to know my cancer patients particularly well because there are a lot of steps to the treatment.” Akbari is a fan of lavender. He likes the scent so much that he visited Lyons' farm before meeting her as a patient. So, Lyons brings him lavender items from her shop occasionally when visiting his office.

“Dr. Alden follows her progress too,” Akbari said. Surveillance after surgery includes blood work, an annual CT scan, and colonoscopies. “I still see Patti every so often,” Akbari added. “She's doing great and approaching five years being cancer-free, a major milestone.”