Phuong Gallagher - Beating Cancer is a Team Effort

2006 was a life-changing year for Phuong Gallagher. She married the love of her life, Ed Gallagher, a colleague and fellow data consultant at the same insurance brokerage. The couple skipped their honeymoon to move to Petaluma so they could be close to Ed’s young daughter, Taylor. They had barely gotten settled when Phuong was diagnosed with stage 3 rectal cancer, at just 29 years of age.

Phuong had been experiencing stomach pains for months, but her primary care physician never considered colorectal cancer. Although diagnoses in young adults have been on the rise, the doctor looked at cancer through the stereotype that it is an “old man’s disease.” Suspecting irritable bowel syndrome (IBS), the doctor put Phuong on a bland diet. But the pain continued, and Phuong was losing weight. A few months after the wedding, she suddenly felt winded while playing in the backyard with Ed and Taylor. When she sat down to rest, she couldn’t muster the energy to get back up. Ed insisted on taking Phuong to her new doctor at Novato Community Hospital, where the couple was stunned to learn that her weight had dropped to 85 pounds. Phuong was referred to a gastroenterologist, who immediately ordered a colonoscopy. The test revealed a large mass in Phuong’s rectum.

The gastroenterologist recommended Phuong seek treatment at MarinHealth Cancer Care (then Marin General Hospital's Cancer Institute), where the exceptionally collaborative approach to treatment was ideally suited to her complex and unusual case. The Cancer Institute holds four weekly “tumor boards,” one general cancer board and the other three focusing on breast, genitourinary, and gastrointestinal cancers. The doctor who knows each patient best, medically and personally, presents that individual’s case history to a team of experts, including medical oncologists, radiation oncologists, surgeons, and support staff. Phuong’s lead physician, MarinHealth oncologist Dr. David Gullion, stresses the importance of establishing a personal connection with his patients. “I like to know what the patients are going through, not just the medical part, but their life,” says Dr. Gullion, “And that makes a difference in prescribing therapy as well.”

During the tumor board, an expert team consisting of medical oncologists, radiation oncologists, surgeons, and support staff, comprehensively reviews each case. Cases to be discussed are decided in advance to ensure that a patient’s personal team is in attendance. In essence, the tumor board gives patients the benefit of multiple second opinions. “Phuong is a perfect example of someone who needs a team approach,” says Dr. Joseph Poen, Phuong’s radiation oncologist. “Not one of us could have treated her as well as we have by ourselves. In order to make these decisions, you have to get all of us in the same room at the same time.”

Since her cancer was first diagnosed, Phuong’s team has seen her through several recurrences. As Dr. Gullion points out, “Phuong is very unusual, to have metastatic disease that’s been present for almost a decade. We’re fortunate that our treatments have been able to outpace the disease.” Phuong’s initial treatment began with radiation to shrink the tumor as much as possible before surgery. This entailed a difficult decision for a newlywed couple. The Gallaghers had planned to have children, but fertility treatments for egg harvesting would have taken three months, too much time for Phuong’s tumor to grow and spread. Instead, Phuong had three weeks of chemotherapy and low-level radiation to shrink down her tumor. Dr. Gullion marvels at her exceptional resilience in the face of life-threatening illness. “She would come in for chemotherapy and she would just be smiling and positive,” he recalls. “I think how well she handled everything was an inspiration for all of us. I felt very privileged to take care of Phuong.”

Once Phuong’s tumor had shrunk to a more manageable size, surgical oncologists Dr. Nora Saba Azimi and Dr. Mark Bazalgette performed surgery at MarinHealth Medical Center (then Marin General Hospital). Phuong’s tumor was quite large, and the necessary radiation had caused some of her tissues to fuse together. The two surgeons worked valiantly for nine and a half hours in order to remove the tumor without having to perform a colostomy/ileostomy. A temporary chemo port was implanted in Phuong’s torso for several weeks of “mop up chemo” to kill any stray cancer cells.

For the next two years, Phuong was in remission, with careful quarterly monitoring by Dr. Gullion. Her care team remained hyper-vigilant: stage three tumors have a 40% chance of recurrence, and in 2008 a routine scan revealed a metastasis in Phuong’s liver. Her cancer had now progressed to stage 4. Phuong endured a highly complex operation, in which an entire lobe of her liver was removed. Surgery was followed by six months of chemotherapy, but the cancer proved persistent and she developed a lung lesion the following year. This time, the tumor was located in such a way that surgeons were able to remove just a small section of lung using video-assisted thoracoscopic surgery (VATS). As a result, Phuong was able to enjoy three years of remission before another lesion was discovered in her liver.

With medical science advancing at a record pace, Phuong now had a non-surgical option for treating her liver tumor: radiosurgery. Dr. Poen performed the procedure using the latest advancement in radiotherapy technology from Varian Medical Systems – the TrueBeam™. To provide the clearest possible target, a gold seed was placed inside the liver tumor with a hollow needle before radiosurgery. This allowed Dr. Poen to destroy the tumor while leaving healthy surrounding tissue unscathed. Dr. Poen describes the TrueBeam as “A combination of a targeting and treatment tool all in one.” TrueBeam eliminates the need to use gold seeds by allowing the radiological oncologist to obtain an incredibly detailed CT scan of the patient’s tumor right from the treatment table. TrueBeam’s software analyzes the images, identifies the location and moves the patient precisely into the correct position so that the tumor is exactly in the center of the beam. Phuong recently had additional treatment with this technology and reported back that it was a seamless and painless experience. “I continue to be amazed at the speed of advancements in cancer therapies. MarinHealth Cancer Care and the doctors there continue to be at the forefront of leveraging these advances for each of their patients.”

Throughout nearly a decade of cancer and remission, Phuong has managed to live a full and active life. Her husband Ed has proven to be a remarkably supportive and caring partner. Because the couple works from home for the same company, Phuong has been able to work full-time throughout her treatments. She has been a highly involved soccer mom for her stepdaughter Taylor. Even when Phuong was so weak that Taylor begged her to stay home and rest, Phuong insisted on attending practice, using the soccer schedule as a form of discipline. It was, Phuong explains, “A constant in her life, one of those things to live for.” Next to the love and support of her family, Phuong’s greatest refuge is music. She is a classically trained musician, and playing her violin always takes Phuong to a healing place. “When I close my eyes and go into my music,” she explains, “it’s a feeling of peace. The emotions that I feel, everything is okay in that place.”

Despite her busy lifestyle, Phuong has found a very personal way to give back through advocacy and support for other colorectal cancer patients. She is part of an international online group called The Colon Club, where patients can share stories and discuss the latest therapies. “When I see a story like mine, I private message the person.” Phuong says, “This experience has given me the ability to help so many people, and that’s what fuels me through it.” Phuong also went to Washington, DC to lobby her state representatives as part of an annual colon conference, Call on Congress, through the Fight CRC organization. She has expanded her advocacy efforts by joining The WunderGlo Foundation as a Wunder’s Warrior Advocate. The foundation turns over 100% of the funds they raise to research for colorectal cancer. In recognition of her dedication to fight against colorectal cancer, she received their Cancer Warriors Award in September, 2016.

With Taylor off to college in San Diego, Phuong and Ed have moved to Los Angeles to be closer to Phuong’s family. However, she has no intention of leaving behind her care team at MarinHealth Medical Center. “I am moving to LA but I refuse to change my care team. These are the people who have kept me alive all these years.” Phuong explains, “My team has always treated me with compassion and the utmost care. There’s a very open dialogue between us. They don’t tell me only what I want to hear. I trust them absolutely, with no doubt whatsoever. They are a part of my family now."

This story was first published in October, 2016.