• Cancer Patient Stories

    Minimally Invasive Polyp Removal Helps Prevent Colon Cancer

Faced with the prospect of having part of her colon removed to prevent cancer, Rosa Isern turned to Mayo Clinic. Doctors there offered a better alternative. They used a minimally invasive procedure to remove the precancerous polyp without surgery, significantly reducing Rosa's cancer risk.

For years, Rosa Isern has thoroughly enjoyed her job with the Army and Air Force Exchange Service, where soldiers, airmen and their families purchase goods and services. Her work has taken her around the world on several tours overseas, including stints in Iraq, Afghanistan, Greenland and Djibouti.

In 2015, however, Rosa's future became uncertain when she learned she had a large colon polyp that was at risk to become cancerous. Doctors thought they might need to remove part of her colon. But thanks to a minimally invasive procedure available at Mayo Clinic's Florida campus, Rosa was able to have the threatening polyp successfully removed without surgery. That allowed her to get back to doing the work she loves.

An intimidating diagnosis

The first sign of a problem came in late 2011, when Rosa had severe abdominal pain. She visited the emergency room at a hospital in Fort Gordon, Georgia, where she was diagnosed with diverticulitis. Then, in May 2012, at age 56, Rosa underwent a routine colonoscopy, which revealed seven colon polyps. Doctors didn't take immediate action but advised her to have another colonoscopy in three years.

As directed, three years later, in June 2015, Rosa scheduled a follow-up exam with a gastroenterologist in Georgia. When she woke up after the procedure, Rosa was told she had a very large polyp known as a villous adenoma, which had progressed to an advanced, precancerous stage.

"The doctor said it could become aggressive, but he was not able to remove it completely," Rosa says.

The gastroenterologist tried unsuccessfully to remove the adenoma again several months later, and then a third time in March 2016. At that point, he recommended Rosa seek the opinion of a colorectal surgeon.

At the surgical consult, Rosa was told that up to seven inches of her colon would need to be removed to avoid developing cancer. A mother of two, Rosa had lost a son in 2009, and she couldn't imagine leaving her other son alone if anything happened to her. But she wanted another opinion about how she should proceed.

An alternative to surgery

Rosa began researching colon resections. She learned that the recovery can be challenging. For some people it can take up to two years to eat normally again. She began searching the internet for "ways to remove a villous adenoma." The results led her to entries about endoscopic mucosal resection and Mayo Clinic gastroenterologist Michael Wallace, M.D.

"Endoscopic mucosal resection, or EMR, has proven to be a safe, less-invasive alternative to surgery," Dr. Wallace says. "The main goal … is to completely remove superficial cancer or very large flat polyps endoscopically."

"Mayo Clinic has the expertise, the training and the technology to manage the most complex and difficult colon polyps.  — Michael Wallace, M.D.

The procedure requires a different technique and more specialized equipment than standard colonoscopy and polyp removal. Mayo Clinic's Florida campus is one of the few sites in the Southeast that does a large number of the procedures.

"Advances in technology, including enhanced, high-definition scopes, have allowed us to become more specific in the characterization and removal of large flat polyps," Dr. Wallace says. "Large lesions that would have once required major surgery are now able to be successfully removed in a minimally invasive fashion."

With endoscopic resection, recovery is faster with fewer complications when compared to traditional surgery.

An ideal outcome

Rosa asked her primary care doctor for a referral. Not long after, Mayo Clinic called her to confirm an appointment with Dr. Wallace on Aug. 1, 2016. Her procedure would be the next day.

"I had no doubt that we would be able to address Ms. Isern's needs," Dr. Wallace says. "Mayo Clinic has the expertise, the training and the technology to manage the most complex and difficult colon polyps. We have been able to remove more than 90 percent of polyps that other physicians previously deemed unresectable."

"I told Dr. Wallace he was my last hope," Rosa says. "And he told me 'I'm going to do my 150 percent to take care of you.' I put my faith in him. I felt comfortable with him."

"There's no greater satisfaction than knowing you're OK, you're healthy," she says. "You can't put a price on your life."  — Rosa Isern

On Aug. 2, Dr. Wallace performed the minimally invasive procedure. Afterward, he had good news for Rosa. He had been able to remove the tumor completely.

"As I lay there, all I could think was, 'What if I had cut my intestine and had major surgery?'" Rosa says. "It was so much less invasive, and he was able to remove the entire tumor."

In early 2017, Rosa had a six-month follow-up appointment. The results were negative for cancer.

"There's no greater satisfaction than knowing you're OK, you're healthy," she says. "You can't put a price on your life."

Looking forward with confidence

With a clean bill of health, Rosa is looking forward to her retirement in a few years. But she hopes to do one last tour in the Middle East before she completes her 25-year career with the Department of Defense.

"It's one more adventure, and I love taking care of the soldiers," Rosa says.

"When Ms. Isern came in for her follow-up exam, she asked one thing; 'Can you clear me to re-deploy to the Middle East where I can help our troops?' She's an incredible woman and an inspiration to all of us." Dr. Wallace says.

Rosa has the same feelings about Dr. Wallace.

"He is an incredible doctor. He's very intelligent, but he's also very humble. I think this is more than a job to him; it's his calling," Rosa says. "He has no idea how much he means in my life. He's my hero and my guardian angel."