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Lewis Black was propped up on pillows in his room at Huntsman Cancer Institute, with his wife, Kara, and daughters, Miriam, 14, and Lily, 11, by his side. He was recovering from an 11-hour surgery to save his life. On the menu were some of Lily鈥檚 favorites from The Point restaurant. They would watch a favorite show together later鈥攁nything to distract them from the serious nature of Lewis鈥檚 cancer.
鈥淛ust being together as a family and trying to do the kinds of things that we would normally do during the evening was important,鈥 says Lewis, an administrative law judge with the Utah Department of Health and Human Services. 鈥淲e wanted that sense of normalcy for our girls.鈥
鈥淓verybody wanted to help but didn't know how, and I didn't know what I needed, either.鈥
鈥擫ewis Black
Lewis first worried something was wrong in February 2022 when he inexplicably gained 40 pounds. A CT scan revealed he had stage 4 appendiceal adenocarcinoma, a rare cancer in the lining of the appendix.
鈥淚t was a little frightening,鈥 Lewis says. 鈥淏ut I just thought to myself, 鈥極kay, well. Now what do we do? Where do I go from here?鈥欌
The surgery he needed was hyperthermic intraperitoneal chemoperfusion (HIPEC). During a HIPEC procedure, surgeons put chemo medicine, heated to 109 掳F, right into the abdomen. By heating the chemotherapy drug and applying it directly to the cancer cells, doctors believe it helps the chemo work better. For patients with certain advanced cancers that have spread to the lining of the abdomen, HIPEC provides hope.
鈥淚t鈥檚 not simple surgery,鈥 says Laura Lambert, MD, director of the Peritoneal Malignancy Program at Huntsman Cancer Institute and professor of surgery at the University of Utah. 鈥淚t is a complex technical surgery. You have to be dedicated to treating the disease and taking care of the people with it.鈥
鈥淲e tailor the treatment to the individual, their situation with the cancer, but also what their goals are.鈥
鈥擫aura Lambert, MD
The success rate of the surgery is difficult to pinpoint, Lambert says, because cancers of the appendix fall on a spectrum of diseases, and the biology of the tumor determines how well a person will respond to the two-step procedure.
鈥淚t鈥檚 the combination of removing all the tumors you can see and then putting heated chemotherapy directly into the abdominal cavity to treat any remaining microscopic cancer cells,鈥 Lambert says. 鈥淵ou can use a much higher concentration of the chemotherapy this way than you can if you鈥檙e giving it intravenously.鈥
HIPEC surgery is used to treat a variety of cancers that spread through the abdomen including colon cancer, ovarian cancer, peritoneal mesothelioma, and some gastric and small bowel cancers. The complete recovery time can be lengthy and difficult, about three months.
鈥淚t鈥檚 a pretty significant recovery, so that鈥檚 a huge part of the decision making around who to offer it to,鈥 Lambert says. 鈥淲e tailor the treatment to the individual, their situation with the cancer, but also what their goals are, and what their level of risk tolerance is.鈥
"This was the right thing to do, the right place to do it, and the right person to do it."
鈥擫ewis Black
When facing the cancer and the HIPEC surgery, Lewis鈥 main concern wasn鈥檛 for himself, but for his family.
鈥淚t was very tough,鈥 Lewis says. 鈥淚t was hard seeing Kara and the girls react. I just had to deal with it. But they had to watch me deal with it. Everybody wanted to help but didn't know how, and I didn't know what I needed, either.鈥
Huntsman Cancer Institute is one of only a handful of hospitals in the United States offering HIPEC surgery. The procedure is not new. It鈥檚 been in practice since 1980, but only a handful of surgeons are qualified to do it the United States because it requires specialized training and equipment.
鈥淚 felt extremely fortunate that Huntsman Cancer Institute is right here and they had one of the only people in the state qualified to do it,鈥 Lewis says. 鈥淒r. Lambert was wonderful. From the first appointment, explaining what the procedure would entail and what the risks were, to subsequent ones. The more I spoke with her, the more comfortable I was that this was the right thing to do, the right place to do it, and the right person to do it.鈥
鈥淚 gave myself permission to feel sorry for myself for about 10 to 15 minutes every day. And then I just would go on and do what I had to do.鈥
鈥擫ewis Black
During the procedure, Lambert had to remove Lewis鈥 appendix, spleen, and gallbladder before applying chemotherapy drugs.
The 11-hour surgery was a success. Lewis鈥檚 cancer is in remission. He is feeling so good that the family recently went on a vacation to San Francisco.
鈥淚 have a hard time keeping up with him,鈥 Kara says. 鈥淗e just has to have frequent checkups but other than that, cancer seems like a distant memory.鈥
Lewis says his family, friends, and faith kept him going throughout his treatment.
鈥淒uring that whole process,鈥 he adds. 鈥淚 gave myself permission to feel sorry for myself for about 10 to 15 minutes every day. And then I just would go on and do what I had to do.鈥