At 34 years old, Alexiss Uchytil, of Menomonee Falls, did not expect she would need a colonoscopy for years to come, and she was not prepared for a cancer diagnosis. But after several months of blood in her stool, nausea, weight loss and abdominal pain, Alexiss saw Syed Mehdi, MD, a gastroenterologist with the Froedtert & the Medical College of Wisconsin health network. A colonoscopy and EGD (a diagnostic exam) showed Alexiss had a large malignant tumor in her pelvis and that the cancer had spread to her lymph nodes.

Alexiss was diagnosed with stage III rectal cancer in October 2018. She had to decide if she wanted to delay treatment to freeze her eggs. The radiation therapy she would need induces ovarian failure and sends the body into early menopause.

“We are having to address fertility more often,” said Monica Shukla, MD, radiation oncologist and MCW faculty member. “The average age for a rectal cancer diagnosis is 63. However, nationally, we are seeing a rise in colorectal cancer rates in younger people. For this reason, some national cancer organizations have recommended people at average risk begin screening colonoscopies at age 45 instead of 50.”

Alexiss chose to start her treatment as soon as possible and not freeze her eggs. “I am an aunt to two boys,” she said. “That is enough for me. I wanted the chance to live longer for them.”

Novel Treatment

It was difficult to make out the margins of Alexiss’ tumor on imaging to see if it involved the pelvic floor or sphincter — muscles that control the bowels. There was a chance she would need a permanent colostomy. To avoid this, her doctors opted for treatment called total neoadjuvant therapy, or TNT, which shrinks the tumor before surgery.

The standard treatment for locally advanced rectal cancer is chemotherapy and radiation therapy, followed by surgery and a second round of chemotherapy. TNT shifts the second round of chemotherapy to the beginning.

“With this treatment sequence, studies have shown the tumor shrinks more, there is a higher chance of sphincter-sparing surgery and patients tolerate the chemotherapy better,” said Carrie Peterson, MD, MS, colorectal surgeon and MCW faculty member.

Alexiss had chemotherapy and radiation therapy at Froedtert Menomonee Falls Hospital. Her surgery, in July 2019, took place at Froedtert Hospital. Dr. Peterson resected the tumor using a sphincter sparing technique and performed a rectal reconstruction by connecting the colon to the anus after removing the entire rectum. Alexiss had a temporary ostomy while her new connection healed, and then had a small procedure to reverse it, resulting in normal bowel function. An ostomy is a surgical connection of the abdomen to the intestines that allows waste to pass into a pouch.

“After surgery, I was so relieved,” Alexiss said. “I wouldn’t trade my cancer team for the world. They’re the best of the best.”

Expert Collaborative Care

Froedtert Hospital is accredited by the American College of Surgeons and the National Accreditation Program for Rectal Cancer (NAPRC), which recognize programs with multidisciplinary experts in the latest rectal cancer treatments. It means our rectal cancer patients can rely on the highest standard of care that meets strict national standards set by the NAPRC.

While TNT is gaining ground as a treatment for locally advanced rectal cancer, it is only recommended on a case-by-case basis.

“The key here is the individualized approach,” said Abdel Alqwasmi, MD, medical oncologist with the Froedtert & MCW Cancer Network. “Each patient benefits from the collaboration of our team. Because Alexiss’ cancer was so advanced and she is so young, we were confident she could tolerate aggressive treatment to give her the best possible outcome and quality of life.”