Despite urgings from my primary care physician to get a colonoscopy screening after I turned 50, I resisted. As a health-care provider, and someone who is tuned into changes in my body, I thought I would instinctively know if I had a serious illness. I was wrong. Even after finally relenting to at least take an at-home stool-based colon cancer test, in early January 2019, which found a positive result, I still believed I was in excellent health and the result was a false-positive. I had no symptoms of colon cancer and no warning signs that I would soon be facing the greatest health challenge of my life.
After undergoing a colonoscopy, the gastroenterologist told me he found a large malignant tumor in my sigmoid colon. The tumor was so big, said the doctor, it was almost completely blocking the colon, and I would need immediate surgery. From there, events moved very quickly.
Brian Beck, NP
Going Into Survival Mode
The diagnosis was shocking, not just because I had had no telltale signs of the disease, and no preparation for what I was now dealing with, but because I had been fortunate to have good health all my life. I was completely caught off guard by the diagnosis, which was about to get much worse.
In addition to the mass in my colon, imaging scans of my chest and abdomen found tumors in both the right and left lobes of my liver. I was now diagnosed with stage IV colorectal cancer. Just 2 weeks after the diagnosis, I underwent six rounds of neoadjuvant FOLFOX (fluorouracil and oxaliplatin) chemotherapy to shrink the tumors, followed by my first colon resection, plus ablation therapy to remove the tumors in my liver. I then received six rounds of adjuvant FOLFOX.
Even with this heavy treatment bombardment, follow-up imaging scans revealed new tumors in my liver. There was no doubt now this cancer was relentless, and I had to change treatment tactics if I was going to survive.
Helping Others
I sought a second opinion with a clinician/researcher at a major cancer center who recommended a combination chemotherapy regimen of FOLFIRI (leucovorin, fluorouracil, irinotecan), bevacizumab, and cisplatin. The treatment was difficult and caused numerous troubling side effects. Still, I was able to continue working throughout the course of treatment, which was therapeutic for me. If I had stayed home during this time, I would have obsessed over having cancer. Continuing to work and seeing patients gave me purpose. Getting up every morning to help others helped me, and I believe improved my outcome.
The combination treatment was successful in beating back the cancer for 9 months, but then the cancer recurred in my colon and liver, necessitating additional surgery on both organs. I also had yttrium-90 radioembolization on my liver.
Halting Disease Progression
My oncologist offered me a clinical trial investigating a combination of two immunotherapies, ipilimumab and nivolumab, plus a molecularly targeted therapy, panitumumab, for metastatic colorectal cancer to try to halt disease progression. But the response was the same as with my previous treatments: initial success followed by cancer recurrence.
I continued to progress through multiple different treatments with limited effectiveness, until genomic testing of the tumor found it was HER2-positive, RAS wild-type, which changed the trajectory of the disease. In early 2023, based on the results of the MOUNTAINEER phase II trial (ClinicalTrials.gov identifier NCT03043313), I received a combination of two targeted drugs, tucatinib and trastuzumab, for patients with chemotherapy-refractory, HER2-positive, RAS wild-type metastatic colorectal cancer.
Over the past year, imaging scans have found no evidence of disease. I’m currently receiving trastuzumab monotherapy, and it’s possible I may have to remain on this drug or another maintenance treatment for the rest of my life.
(Editor’s Note: On January 19, 2023, the U.S Food and Drug Administration granted accelerated approval to the combination of tucatinib and trastuzumab for patients with RAS wild-type, HER2-positive unresectable or metastatic colorectal cancer that has progressed on fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy.)
Selling the Benefits of Screening
Five years after my diagnosis, I’m continuing to live the best life I can. I’m still working as an advanced nurse practitioner and making medical mission pilgrimages to impoverished countries. Earlier this year, I helped provide free health-care services to communities in Honduras, and later this year, I’m planning a medical mission to El Salvador. I’ve always been motivated to provide care for others, but I’m even more motivated now.
I feel very lucky to be alive and able to maintain a high-quality life and give back to others. Cancer has taught me many lessons. Most important are to never skip a day to tell the people in my life how much I love them and to live life to the fullest.
I also now have a greater recognition—and appreciation—of the importance of maintaining regular cancer screenings. If I had gotten a colonoscopy screening when my physician advised me to, I may have been able to prevent cancer or at least catch it at an early, more curable stage. But instead of self-recrimination, I’m using my experience to encourage my patients who are resistant to getting cancer screenings not to put them off.
All of us, including me, need to do a better job of selling the benefits of cancer screenings to our patients and to the public at large. Catching cancer early—or preferably preventing it—should be the goal for us all.
Mr. Beck lives in Ethridge, Tennessee.
Editor’s Note: Columns in the Patient’s Corner are based solely on information The ASCO Post received from patients and should be considered anecdotal.
