colon cancer hero

Young mother perseveres despite ‘terminal’ colorectal cancer diagnosis

Thanks to her uniquely collaborative care team at City of Hope and her resolute nature, Sara Alvarenga has lived five years since her Stage 4 cancer was discovered at age 33

Sara Alvarenga takes pride in her “remarkably calm” personality. “That’s how I operate,” she says. “I’m pretty cool, calm and collected under traumatic circumstances.”

At 38, she has endured more than her share of traumatic circumstances. Five years ago, Alvarenga was diagnosed with Stage 4 colorectal cancer. Her local doctors labeled her “terminal.” That she’s still here and thriving is a testament to the many advances in the understanding of this disease, plus the uniquely collaborative atmosphere at City of Hope, where experts across disciplines have come together — multiple times — to provide one breakthrough treatment after another.

It is also a tribute to Alvarenga’s powerful motivation to keep fighting.

Sara Alvarenga
Sara Alvarenga

“I will put up with a lot to be there for my kids,” she says. She and husband Felix have a son, Ethan, 12, and a daughter, Alana, 7. “My greatest hope, my dream, is to see my kids grow up.”

Alvarenga grew up quite far from her current home in Whittier, California. She was born in Mexico, but when she was a year old the family migrated to rural Kansas, where her mother took a job in the nearby beef-processing plant. Alvarenga came west at age 18 to attend the University of Southern California. “I’m a typical first-generation immigrant,” she says, “and the U.S. is my home.”

By late 2018, Alvarenga was fully immersed in the American Dream, married (Felix is a workplace safety consultant), mom of two, building a career as an operations manager for an investment company.

But her stomach was bothering her.

A String of Misdiagnoses

“One night at dinner,” she recalled, “I knew something wasn’t right. I felt pain, bloating — it was hard just to sit there.”

A string of urgent care and primary care visits produced repeated misdiagnoses. Appendicitis. A “gut infection.” A “micro-perforated colon.” Doctors gave her antibiotics. The pain got worse. When it became so bad that she could barely move, Alvarenga was rushed to the emergency room for surgery. “They removed the infected part of my colon,” she said. “And they said they saw something on my liver.”

Days later, Alvarenga got the pathology report indicating late-stage colorectal cancer that had spread to the liver. It was shocking, grim news.

“Nobody had given me a reason to think cancer,” she recalled.

Mustafa Raoof
Mustafa Raoof, M.D.

Unfortunately, this mentality persists in places where colorectal cancer is still considered an “old person’s disease.” Until recently, screening for colorectal cancer wasn’t recommended before age 50. But in 2021, the U.S. Preventive Services Task Force lowered that age to 45, acknowledging a new reality.

“Colon cancer is on the rise in young people,” said Mustafa Raoof, M.D., M.S., assistant professor in the Division of Surgical Oncology, Department of Surgery at City of Hope. “And it tends to be more aggressive.”

 In fact, colon cancer is the No. 1 cause of cancer death in people under 50. One study showed that younger people have twice the risk of developing colon cancer and are much likelier to be diagnosed with late-stage disease.

Alvarenga was only 33. Still, she handled the diagnosis matter-of-factly in her “cool, calm, collected” style, thinking simply, “OK, what do we do next?”

Her Family Reacts

It was a different story for other family members.

“My mother told me that she felt like her entire world had crashed down on her,” recalled Alvarenga, trying not to cry. Then, talking about her kids, the tears poured out.

“Alana was too little to understand anything more than ‘Mommy is sick.’ But Ethan, who was 7, asked me, ‘Are you going to die? Who will take me to school? Who will give me hugs?’”

Her doctors wanted to begin chemotherapy, but Alvarenga didn’t like their pessimistic attitude, how they flatly told her she had at best only two to five years to live, and that chemotherapy would not make much difference.

In search of a second opinion, Alvarenga contacted City of Hope, where the very first thing she heard convinced her she’d found the right place. No statistics. No generic prognostications. Veteran oncologist Dean W. Lim, M.D., simply said, “You’re not terminal. You’re treatable.”

“That’s all I needed to hear,” Alvarenga said.

Leveraging the Latest Research

Why such a stark difference?

“Colon cancer care has seen so much progress in recent years,” explained Raoof, “but it takes a while for that knowledge to reach all the community oncologists. At City of Hope, we are at the forefront, and any new knowledge we acquire is instantaneously offered to our patients.”

In fact, the progress has been stunning.

“Back in the 1970s,” he continued, “All we had was one chemo treatment, just 20-30% effective — and not for very long — and the only surgical options were not very safe.

“By the 1990s, the techniques for liver resection to remove tumors that had spread from the colon became standardized and less risky. We also developed drug-pump therapy to control disease more effectively.

“In the 2000s, two new drugs — oxaliplatin and irinotecan — achieved tumor shrinkage of up to 70%, making surgery a viable option for more people. And in the 2010s targeted therapies arrived, some even capable of curing Stage 4 disease without surgery.”

During her time at City of Hope, Alvarenga would benefit from all those advances, and more.

Laleh Melstrom M.D.
Laleh Melstrom,  M.D. 

First, chemo, which she began in February 2019. Every two weeks, Alvarenga received an IV infusion of FOLFOX (a three-drug combo treatment that includes oxaliplatin) plus Avastin, a drug that cuts off the tumor’s blood supply, approved for colon cancer in 2004.

Chemotherapy alone rarely eliminates Stage 4 colon cancer; some surgery is needed. Six months into treatment, surgical oncologist Laleh Melstrom, M.D., removed 13 tumors from Alvarenga’s liver.

But cancer can be a stubborn foe, and before long new “rogue” spots appeared. “With that many tumors, isolated recurrences are common,” said Melstrom. Interventional radiologist Jonathan Kessler, M.D., performed an ablation procedure to eradicate the new malignancies. Alvarenga was also fitted with a hepatic artery infusion (HAI) pump, a City of Hope specialty.

“We are the third highest volume institution with the use of HAI pumps,” said Melstrom. “The purpose is to deliver chemotherapy that is targeted to the liver at much higher concentrations.”

Staying Positive and Persevering

With each recurrence and successive treatment, Alvarenga fought the tendency toward frustration and despair, always thinking about her children.

“We knew this would take a long time and we’d have to handle all of it,” she said. “I’m motivated by my kids. I don’t pray for a cure. All I need is to make it through one more day.”

Melstrom was deeply moved by her patient’s courage.

“As a mother I absolutely empathized with her will to live for the benefit of her family,” she said. “I admired her bravery through all of this and the strength she shows every time I see her.”

More bravery would be needed.

Mihae Song, MD
Mihae Song, M.D.

New tumors appeared in Alvarenga’s peritoneum — a membrane that lines the abdominal cavity. This required still more surgery. Raoof and Melstrom performed a “cyto-reductive” procedure, a kind of “search and destroy” operation, excising every possible location thought to be harboring cancer cells, including multiple lymph nodes and the omentum (a fat layer wrapped around abdominal organs). Simultaneously, gynecologic oncologist Mihae Song, M.D., performed a hysterectomy, removing Alvarenga’s uterus and ovaries, sadly eliminating the possibility of Alvarenga having more children.

“We talked about removing the ovaries only versus the uterus as well,” said Song. (So-called uterus-sparing surgery leaves open the chance of carrying a pregnancy created using in-vitro fertilization.) “Sara wanted to maximize her chances for survival and, although she understood the loss of fertility, she wanted to move forward with the surgery.”

And she continues to move forward, dealing with new challenges as they arise. Her treatment, modified after the peritoneum discovery, now includes irinotecan and the monoclonal antibody panitumumab, a combination shown to be an effective “third line” treatment. She needed yet another surgery to remove cancerous lymph nodes in her chest. And she’s had radiation to handle malignant areas in her lungs.

Her doctors are realistic, but also astounded at how she’s persevered.

“Sara has beaten the odds for patients with cancer in multiple sites,” said Raoof. “And her case is an awesome example of the expertise we can offer at City of Hope.”

Through it all, Sara and Felix remain positive. They recently bought a house, they’ve traveled to Cancun and Europe, and they’re making plans to do more. “We are a normal, busy young family,” Alvarenga says. “Life doesn’t stop because of cancer. Kids grow. Laundry piles up. Life continues. We fit my cancer treatment into our schedule.

“I’m a mother. There’s no time to feel sorry for myself.”

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