Cancer-free After Stage 4 Colon, Liver and Lung Cancers

The words “colon cancer” were frightening enough for Efrain Hernández Pérez. But when doctors discovered the disease had spread to his liver, the uncertainty became overwhelming.

“At that moment, you have no idea what’s going to happen,” says Hernández. “You hear ‘cancer’ and ‘metastasis,’ and it feels like a death sentence. The original treatment plan was supposed to be much simpler.”

Doctors at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System, took action quickly, implementing an aggressive treatment program and putting the latest technology into practice. Hernández became one of the first patients at Sylvester to receive a hepatic artery infusion (HAI) pump, which delivers chemotherapy directly into the liver.

Where it started

In May 2019, Hernández was diagnosed with stage 4 colon cancer following a colonoscopy. He was referred to the Colon and Rectal Surgery Fellowship at the University of Miami Miller School of Medicine. Further testing revealed hepatic metastasis and eight lesions on his liver. A genetic exam of the tumor helped identify the most effective treatment for that specific type, Hernández recalled.

Agustin Pimentel, M.D., Sylvester gastrointestinal medical oncologist, assistant professor of clinical medicine in the Department of Medicine, Division of Medical Oncology at the Miller School, developed the treatment plan.

“It was a complicated case, and we began a treatment of systemic chemotherapy,” says Dr. Pimentel. “We knew it would be a long process, and it included oncologic surgery, colorectal surgeons and interventional radiologists.”

The treatment phase – a coordinated team approach

The treatment originally called for 16 rounds of chemotherapy; however, Hernández completed 12. During follow-up visits, Dr. Pimentel recalls seeing on CT scans that the tumors were shrinking quickly.

“Instead of finishing the last four rounds, he presented my case to the tumor board, and they decided it was a good time to move forward with surgery,” Hernández says. “That was in August, and I went into surgery at the end of October 2019. It was six months – almost to the day – after my diagnosis.”

Sylvester’s tumor board is a meeting where an entire team of physicians discusses patient cases to determine the best course of care across the entire continuum of care.

The surgery lasted nine hours. One surgeon removed the colon tumor; another removed seven of the eight liver lesions. The HAI pump was implanted to deliver and control chemotherapy directly to the liver, allowing the powerful drugs to avoid circulating throughout the entire body and reducing toxicity and side effects.

Still amazed by the technology and how it helped him, Hernández says he was one of the first five patients at Sylvester to receive the HAI pump. He wore it for several years while fighting liver cancer as doctors determined the next steps, and the side effects were manageable. In April 2020, an interventional radiology team performed a liver tumor ablation to eliminate the remaining lesion.

“Part of the success of the outcome was that the doctors didn’t just stick with the standard treatments,” Hernández says. “They looked at what other options they could use — like the pump and other types of therapy.”

Four years later, remission continues.

Nearly four years in remission, Hernández recalls that the doctor who found the colon tumor told him he would refer him to the best place to save his life: Sylvester.

“I was not expecting that kind of technology; I was just expecting to be well cared for by the doctors,” he says. “At the beginning, I didn’t know what to expect, how bad it was going to be. But when I started learning about the plan — how detailed, how specific it was — I thought maybe I do have a chance. Early on, I wasn’t expecting much.”

In July 2021, one of Hernández’s routine CT scans revealed two small shadows in one of his lungs. Dr. Pimentel determined surgery would be the best course of action and referred him to a thoracic surgeon.

Technology and Sylvester’s physicians’ knowledge, quick action and team approach again played a central role.

Using the da Vinci robotic system, doctors performed a minimally invasive operation and removed one of the lung tumors. The second was successfully removed in October 2022, and Hernández has been cancer-free since.

He believes the ability to make these kinds of advances and continue investing in research is giving cancer patients far more hope than they had 20 or 30 years ago. Aside from knowledgeable physicians and an integrated cancer center with a team approach, the tools are now in place, he adds, and they are meant to be used for the patient’s benefit.

“Technology has progressed so dramatically that the chances of success today are much greater than they once were. The breakthroughs are truly remarkable,” says Hernández. “Unfortunately, I have seen others who didn’t have access to this type of technology and didn’t survive.”

Today, Hernández says the experience reshaped not only his health but also his outlook on life and the time he spends with those closest to him.

“It was a really difficult time. Nobody wants to go through something like that,” says Hernández. “Today I’m more focused, I appreciate what I have.”

Written by Cynthia Corzo.

Tags: Colorectal cancer survival rates, Dr. Augustin Pimentel, Liver-directed cancer therapy, Metastatic colorectal cancer treatment options, Sylvester Comprehensive Cancer Center