g Quelques mois plus tard , une biopsie révélait la mauvaise nouvelle . Serges a appris qu ’ il avait un cholangiocarcinome hilaire . Cette forme rare de cancer est généralement difficile à traiter parce que les tumeurs se développent là où les canaux biliaires hépatiques gauche et droit se rejoignent , et souvent elles ne peuvent être enlevées chirurgicalement . Serges a été vu immédiatement par le Dr George Zogopoulos , un chirurgien du CUSM spécialisé en chirurgie hépato-pancréato-biliaire et en transplantation , et chercheur au sein du Programme de recherche sur le cancer de l ’ Institut de recherche du CUSM ( IR-CUSM ). Ce fut le début d ’ un long périple .
Un cas nécessitant une expertise de haut niveau « Nous ne pouvions pas opérer Serges , parce que le cancer était situé au milieu des voies biliaires et que sa maladie du foie compliquait la situation , explique le Dr Zogopoulos . J ’ avais un intérêt de recherche pour ce protocole unique en son genre et je savais que nous avions l ’ expertise au CUSM et à l ’ Institut de recherche pour le réaliser , même s ’ il n ’ avait jamais encore été complété avec succès ici . Lorsque Serges a choisi de rester à Montréal , nous avons chapeauté le protocole , puis mis sur pied une équipe multidisciplinaire et admis Serges à l ’ hôpital pour qu ’ il puisse y recevoir le traitement . »
Serges a dû passer une batterie de tests pour pouvoir participer au protocole . « Ils ont effectué des examens sur mon cœur , mes os , ma vésicule biliaire , mes yeux et ma peau , se rappelle Serges . L ’ équipe clinique a fait preuve d ’ un grand professionnalisme et de compassion . Je n ’ ai jamais senti que j ’ étais le premier patient à m ’ engager dans ce protocole de recherche au CUSM . »
Sur une période de trois mois , plus de 20 professionnels incluant des infirmières , des chirurgiens en transplantation , des oncologues et des radiologues ont travaillé jour et nuit auprès de Serges . Le protocole , qui combine la radiothérapie , la chimiothérapie et une greffe du foie , exigeait de franchir de nouvelles étapes quasi quotidiennement . g gg Even if it was still at an experimental stage , Serges decided to go through with it at the MUHC to stay close to his wife and family . “ I also had confidence in the clinical team at the Royal Victoria Hospital ( RVH-MUHC ),” he says . Serges was first diagnosed with primary sclerosing cholangitis ( PSC ), a disease in which the bile ducts – small tubes through which the digestive liquid bile flows from the liver to the small intestine – progressively decrease in size due to inflammation and scarring . At that time he was told by his gastroenterologist he would need a liver transplant in the future , but since no date was confirmed , he went on with his life .
A few months later , a biopsy was the bearer of bad news . Serges learned he had hilar cholangiocarninoma . This rare form of cancer is often difficult to treat because tumours develop where the right and left hepatic bile ducts come together , and often , they cannot be surgically removed . Serges was immediately seen by Dr . George Zogopoulos , an MUHC surgeon who specializes in hepato-pancreato-biliary and transplant surgery and who is a researcher in the Cancer Program of the Research Institute of the MUHC ( RI-MUHC ). It was the beginning of a long journey .
A case requiring high-level expertise “ We could not operate on Serges because the cancer was located right in the middle of the bile ducts and his liver disease made it more complicated ,’’ explains Dr . Zogopoulos .” I had research interest in this special protocol and I knew we had the expertise at the MUHC and the Research Institute to do it , even if it had never been successfully completed in the past here . So , when Serges decided to stay in Montreal , we championed it , put together a multidisciplinary team and got Serges admitted to the hospital to follow the treatment .’’
Serges had to pass a battery of tests to be able to take part in the protocol . “ They performed exams on my heart , my bones , my gall-bladder , my eyes and skin ,” he recalls . “ The clinical team was very professional and compassionate . They never made me feel like I was ‘ the first patient ’ to undergo this research protocol at the MUHC .”
Over a period of three months , more than 20 people including nurses , transplant surgeons , oncologists and radiologists worked day and night with Serges . The protocol , which combined radiation therapy along with chemotherapy and a liver transplant , required different steps almost every single day .
Dr . Zogopoulos collaborated with MUHC gastro-hepatologist Dr . Peter Ghali , who had completed a fellowship in Hepatology and Liver Transplantation at the Mayo Clinic . On top of working with MUHC experts in their respective fields such as Dr . Jamil Asselah , medical oncologist , Dr . David Valenti , radiologist , and Dr . Neil Kopek , radio-oncologist , they were in regular contact with research leaders abroad to get guidance on Serges ’ unique case .
“ The key to success is not just having the expertise but allowing experts to interact frequently ; it is the communication that makes all the difference ,” says Dr . Peter Ghali , who is also a researcher from the Experimental Therapeutics and Metabolism Program of the RI-MUHC . Medical updates on Serges ’ condition had to be done daily and at a very high level of expertise . You need the hospital to be able to put these specialized services under one roof , which is exactly what we have right now at the Glen . And that is why it worked .”
Against all odds After successfully completing the radiation and chemotherapy treatments , doctors had to make sure Serges ’ cancer had not spread . Once confirmed , he finally received his liver transplant . Unfortunately , he developed a severe postoperative infection , and his hospital stay was extended . gg
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