Calming The Waves
It was Christmas Eve 2003—a busy day leading up to an even busier holiday. Sanjaya Kumar, MD, urologist at Milford Regional, had walked into the exam room where Margo waited alone. He put his head down and sat next to Margo on the exam table when delivering the news. “I think it was harder on him than it was on me,” she recalls with emotion. “I said, ‘It’s cancer, isn’t it?’ He said, ‘I’m so sorry, Mrs. Stonionis.’”
Margo, of Millbury, says she initially felt numb. She’d had no visible signs or symptoms and no family history of bladder cancer. Then, she began to ask the questions that any patient stunned with a serious diagnosis would wonder: What would be the next step? Will the process be painful? Would she feel sick?
Margo says Dr. Kumar assured her that he could help her by targeting, removing and closely monitoring her cancer. More than eight years later, Margo, now retired, is happy to report that she is cancer-free. She says being diagnosed with cancer was an eye-opening experience. “When you have cancer, you’re never the same again,” she remarks. “You don’t take anything for granted. It’s as if you fall in love all over again with your family and your friends and the blue skies, the pretty trees, the air and even a wonderful drink of water.”
For Margo, the world changed in 2002 when her gynecologist discovered something suspicious during a routine annual exam. Her doctor quickly referred her to Dr. Kumar for follow-up. According to Dr. Kumar, gynecologists and primary care physicians are frequently the ones who initially spot an abnormal test and refer patients for further evaluation. The most common symptom of bladder cancer is painless blood in the urine. Patients who smoke or who are exposed to certain chemicals at work are at a higher risk for developing bladder cancer. “Smoking puts you at higher risk, Dr. Kumar explains. “It’s directly proportionate to the amount you smoke, the duration of your smoking and how much you inhale. Of all of the bladder cancer patients we see, 60%-70% are smokers.”
Dr. Kumar’s evaluation of Margo included a cystoscopy which provides a visual inspection of the bladder through a flexible, lighted scope. In Margo’s case, this procedure—performed in Dr. Kumar’s office—helped him identify two suspicious tumors on the lining of her bladder. “It was an invasive procedure, but I didn’t find it painful,” Margo recalls. “Dr. Kumar puts you at ease and makes you feel very comfortable. He explains everything he’s doing.”
In order to remove and biopsy both tumors, Margo underwent an outpatient procedure at Milford Regional’s Surgery Center. Under general anesthesia, Dr. Kumar used a resectoscope to transfer an electrical current and cut the tumor away from the bladder. When Margo’s biopsy results indicated the tumors were benign, Margo says she was relieved yet skeptical. “Something in my head said, gee, I hope this is the end of it. Little did I know it would come back again,” she says.
Between 2002 and 2007, Margo’s tumors did come back multiple times—first as pre-cancer and then as cancer in 2003 and again in 2007. Dr. Kumar identified the tumors each time during routine systocopies and removed them in day surgery. The good news was that Margo’s cancer was considered early-stage and superficial, meaning it was confined to the lining of the bladder. This type of cancer, which can be effectively treated with surgery, accounts for nearly 70% of all cases of bladder cancer, Dr. Kumar explains. The remaining 30% tend to be more invasive and require surgical removal of the bladder.
According to Dr. Kumar, it’s important to make the distinction between superficial cancers and those that are more invasive. “When everyone hears the word cancer, they go into shock,” Dr. Kumar explains. “In Margo’s case, it was superficial, so it was totally curable. If we stay on top of it, people can live a totally normal lifespan.”
Dr. Kumar closely monitors patients with a history of bladder cancer to ensure early detection in the event the cancer recurs. It’s not uncommon for patients with bladder cancer to experience recurring tumors, he says. Most tumors recur within the first two years, which is why patients undergo a systoscopy every 3-4 months after surgery during that timeframe. Dr. Kumar also monitors patients’ urine for cancer cells and orders molecular testing on the urine in select cases. Because Margo’s tumors recurred multiple times, she also received BCG immunotherapy once per week for six weeks in addition to surgery. This therapy, which incites an individual’s own immunity to fight cancer cells in the lining of the bladder, is also effective for patients with large tumors.
Margo says she couldn’t be happier with her decision to undergo surgery at Milford Regional. She chose the hospital because it was close to home and her support network. She says everyone from the parking attendants to the nurses and other staff members in the Surgery Center were friendly and accommodating. “The nurses really put me at ease. They were very genuine people who really wanted to make sure I was comfortable and had everything I needed,” she recalls. “I remember being starving after surgery, and they hand me a sandwich in no time!”
Today, Margo follows up with Dr. Kumar every six months to undergo a systoscopy. She looks back on the entire experience with a newfound gratefulness for the love and support of her family with whom she spends much of her free time relaxing and boating at their second home in Falmouth. Reflecting back, Margo says she wouldn’t change a thing, noting the excellent medical care she received at Milford Regional and the compassion and skill of Dr. Kumar. “I really do feel like he saved my life,” she concludes.
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