Michael Mendiola almost gave up – until he talked to “Dr. A”

“I recommended proton therapy both times for Mr. Mendiola because he had multiple prior treatments to the liver,” says Apisarnthanarax.

In 2019, Michael, who is in his 50s, was diagnosed with hepatocellular carcinoma (HCC), the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, which for Michael was cirrhosis caused by a hepatitis C infection.

Michael was diagnosed with hepatitis C in 2006, and eventually developed cirrhosis, a type of liver damage where scar tissue replaces healthy cells. Although cirrhosis cannot usually be cured, there are ways to manage the symptoms and complications and stop the condition from getting worse. Michael received both surgery and ablation, a treatment that destroys liver tumors using radio waves or microwaves. Ablation is typically recommended when a patient has a few small tumors and surgery is not a good option.

When Michael was first was diagnosed with HCC, he was angry. He knew there was an increased risk of liver cancer from cirrhosis, but it felt like it was yet another thing he had to worry about. After undergoing treatments over several years, he was frustrated and felt like giving up. But then he was referred to speak with radiation oncologist Smith Apisarnthanarax, MD — who specializes in gastrointestinal cancer and is often called “Dr. A” — about proton therapy, which gave him hope. Michael decided he would go through treatment, first in 2019 and then again in 2022. 

Scan showing proton therapy for liver treatment.
Proton therapy was able to spare more of Michael's healthy liver tissue.

“I recommended proton therapy both times for Mr. Mendiola because he had multiple prior treatments to the liver,” says Apisarnthanarax. “This included internal radiation treatments called Y-90 radioembolization, and that likely compromised the function of some parts of his normal liver already. And because he had multiple tumors throughout his liver, it would have been more challenging to treat them with standard X-ray therapy.”

Proton therapy is an advanced treatment that sends radiation to the exact size, shape and depth of the tumor. It allowed Apisarnthanarax to treat the cancer while helping to protect nearby tissue. This also makes proton therapy a good option for treating tumors near healthy organs in general. In Michael’s case, proton therapy allowed his care team to treat his various small tumors and prevent the need for surgery, which was important to him because it meant less time off from his job as a postal delivery truck driver.

“My sister died of breast cancer, and it was really hard for me to watch her suffer through treatment. Because of her experience, I didn’t want to go through that" Michael recalls.

"I didn’t want to do anything about it. But Dr. A really helped me understand the benefits of proton therapy, and, in the end, it was so much easier than I could have imagined."

Michael hopes that by sharing his story, more people will learn about the benefits of proton therapy for certain cancers. Before his diagnosis, he believed surgery and chemotherapy were his only treatment options, something other people he spoke with thought as well. He encourages others who may be looking into cancer treatment to discuss all available options with their physicians.

Michael received a lot of moral support from his wife of 20 years, Carol, who is a breast cancer survivor. She attended every appointment with Michael and said the experience with proton therapy was different from any other medical facility they had visited.

“When we would go for proton therapy, the waiting area was beautiful and calming. Everybody there was sweet and wanted to help,” Carol says. “In the past, we found that we often had to advocate for ourselves. But with the proton staff, we were able to leave everything in their hands and trust that it would be OK.”

The couple agreed that while the limited side effects and precise treatment were appealing, it was really the people that made their experience with proton therapy special.

“With Dr. A, we didn’t have to remind him about our case or what we talked about, and we didn’t have to constantly follow up with him for answers,” Carol says.

"He checked in with us and made sure that Mike had what he needed. It was really comforting to have a doctor that cared and treated us so wonderfully. Dr. A walks on water, as far as I’m concerned."

“The people at Fred Hutch really do their best to get your mind off the worries that come with treatment,” Michael adds. “I wasn’t treated like I was sick or like my illness came first. I felt cared for as a person.”

As part of his follow-up, Michael receives an MRI and does routine bloodwork every four months to monitor his liver. “Right now, he’s cancer free,” says Apisarnthanarax. The couple is hopeful that things will continue to improve.

“Cancer is something that happened to me, but it’s nowhere near the most important or prominent thing in my life,” Michael says. “I’m a person first and with the help of Dr. A and proton therapy, I won’t let it stop me from continuing to do what I love.”

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