Fall 2007

Case Dismissed

Patient Reaches 5-Year Mark for Rare Cancer

Charlotte Manning (right) receives a clean bill of health from her radiation oncologist, Angel Torano, M.D., after treatment for a rare form of cancer five years ago.

Last April, Charlotte Manning heard the words from her radiation oncologist she had been waiting to hear for five years: “This is your last visit, Charlotte!”

Angel Torano,M.D., was at least as happy as his patient, who five years earlier at age 69 had been diagnosed with a rare and aggressive cancer at the bottom of the bile duct system, the ampulla of Vater. “She had a clinical stage III tumor, with metastases to the lymph nodes, which put her at a high risk of recurrence,” he said. “But at her recent checkup, she showed no evidence of disease. It’s the best possible news.”

Nearly six years ago, Mrs. Manning, a housekeeper from Arnold, was “bending over, cleaning the tub” at a client’s house when she felt “something like heartburn. Maybe I’m drinking too much coffee,” she recalls thinking. “I’ll try to stop that.”

During the Thanksgiving and Christmas holidays of 2001, Mrs. Manning suffered all of the symptoms of this cancer: pain, fever, jaundice, and itchy skin. The itching ? caused by the jaundice, caused by a backup of bile ? made it almost unbearable to wear clothes, she said.

Evaluation by her primary care physician, Dr. Donna Chambers, led to a referral to gastroenterologist Dr. Michael Peters, who performed an endoscopic retrograde cholangiopancreatography, known as ERCP. A biopsy indicated an aggressive cancerous tumor in the ampulla of Vater, which is where the bile duct and the pancreatic duct come together. Only 1,000 people in the United States are diagnosed with this form of bile duct cancer annually.

“Mrs. Manning was referred to Johns Hopkins for a complex procedure called the Whipple,” said Dr. Torano. “It’s a huge surgery that involves removing part of the pancreas, small bowel, and some lymph nodes. AAMC wasn’t offering the Whipple procedure until DR. GLEN GIBSON came to AAMC a few years ago and began performing the procedure.” (See box at end of article.)

When her Baltimore surgeons recommended chemotherapy and radiation, she said, “I asked God to tell me what to do. I was feeling good after surgery. My choice was to go with it and have the treatment.” Mrs. Manning had combined chemotherapy and radiation, followed by an additional four months of chemotherapy. She chose Dr. Torano, director of Radiation Oncology at AAMC, for her radiation treatments, and Annapolis Oncology Center for chemotherapy.

“This cancer is notoriously difficult to diagnose, and there is no good screening for it,” said Dr. Torano. “At the first signs of any symptoms, see your doctor for evaluation. We have excellent physicians in this area who can help.”

Now 74, Mrs. Manning still works every day cleaning houses, and she is proud that she never misses work. “I’m really going to miss seeing Dr. Torano,” she said. “I’ll have to stop by once in a while to say hello!”

Back to this issue's table of contents

Back to the complete AAMC Magazine index