Spring 2012
Knocking Cancer Out of the Park

Baseball fan and cancer survivor Carmella Marranzino of Stratford sported her favorite baseball cap after losing her hair during her life-saving treatments.
In this story
 
Masoud Azodi, MD
Masoud Azodi, MD
Chief, Gynecologic Oncology
Sheida Mani, MD
Sheida Mani, MD
Chief, Radiation Oncology
 

“I was at work when I got the call,” says Carmella Marranzino of Stratford. After hanging up with her gynecologist Phyliss Shapiro, MD, that April morning in 2010, Carmella immediately called her daughter, Laurie, and asked her to stop by the house that evening. “When we finally spoke, I tried to downplay the diagnosis,” remembers Carmella. “I told her I had been spotting for a while and that my doctors had done some tests that detected uterine cancer.” True to her nature, Carmella had held it together for months, but finally saying the words out loud to Laurie, she broke down. “We hugged and Laurie replied, ‘You’re going to be alright. I know it, I just know it.’ I kept thinking, this feels real but not real. Is this really happening to me?”

Dr. Shapiro recommended that Carmella meet with Bridgeport Hospital Chief of Gynecologic Oncology Masoud Azodi, MD, to discuss her treatment options.

Among Dr. Azodi’s recommendations was a complete hysterectomy with the da Vinci® “S” robot-assisted minimally invasive surgery system, followed by possible radiation and chemotherapy.

“Dr. Azodi was excellent. He really took the time to talk to me and my daughter and answer all of our questions,” she says. “We heard he had done this surgery hundreds of times. I left feeling confident. I knew I was in good hands and that this was the best decision for me.”

On May 12, 2010, as the nurses were getting her ready for the hysterectomy, Carmella’s emotions bubbled up unexpectedly. “I was a bundle of nerves,” she remembers. ”But the nurses were wonderful, and the anesthesiologist explained everything that was going to happen. They eased my last-minute fears and made me feel calm and prepared for surgery.”

In the operating room, Dr. Azodi guided the da Vinci robot’s tiny mechanical “fingers” through several very small incisions. The surgical instruments are half the thickness of a dime and can be moved as little as a millimeter at a time. The 3D imaging system and high-powered magnification of the da Vinci allowed Dr. Azodi to clearly visualize the surgical area up close.

A few hours later, Carmella was in the recovery room. The next morning, she felt well enough to go home. “It was amazing. I needed only a couple of ibuprofen for the pain,” she says.

Carmella began the additional treatments about five weeks later. “Although my doctors felt that I was cancer-free after my surgery, as part of the initial plan, I received radiation and chemotherapy treatments to reduce the chance of recurrence,” she says.

Carmella was referred to Bridgeport Hospital’s Department of Radiation Oncology for her radiation therapy. There, Chief of Radiation Oncology Sheida Mani, MD, determined that High-Dose Rate (HDR) radiotherapy would be the best type of radiation treatment for Carmella.

“HDR is a very focused treatment using a radioactive source (brachytherapy). With this technique, a high dose of radiation can be delivered to the surgical site, while protecting the bladder and rectum,” says Dr. Mani. “HDR radiotherapy following a surgical procedure can reduce the recurrence rate of cancer from 10–15% to less than 3%.”

HDR radiotherapy is an outpatient procedure at Bridgeport Hospital. This means patients can return to work or home right after the treatment. Each session lasts only 6 ½–12 minutes. “HDR radiotherapy has replaced other brachytherapy procedures, thereby eliminating multiple hospital stays and any associated risks,” explains Dr. Mani.

The first time Carmella went for HDR radiotherapy treatment at Bridgeport Hospital, her nerves crept up again. “Uterine cancer had already put me through hell and high water, but the mere thought of starting a new procedure was suddenly making my stomach do flip flops,” she remembers. “As I turned the corner to the treatment area, wouldn’t you know it, I recognized a nurse I’d met before. Her children go to the school where I work. She recognized me, too, and just seeing her friendly face calmed me down. I felt even better when she walked me the rest of the way.” And the treatment? “It was really like nothing—I had no pain and no shaking. I felt fine.”

When it was clear that Carmella had tolerated the HDR radiotherapy, she was on to the final leg of therapy: chemo. After the first treatment, she was fortunate. She felt none of the nausea and fatigue she expected.

Then two weeks after the first chemotherapy appointment, the treatment began to take a physical toll on Carmella’s body. At first, she noticed several strands of her own hair on her pillow. One weekend, her granddaughter Samantha, then 8, slept over. “I hadn’t told her about my health, and I didn’t want her to be startled in the morning when she saw my hairs on the pillow,” Carmella says. Carmella waited until Samantha was asleep, and then put a nightcap on to catch any hair that fell out overnight. In the morning, Carmella woke up first and crept quietly into the bathroom to remove the nightcap. Under the nightcap, Carmella’s hair was matted down. When she touched it, a few clumps of hair came out. She dressed quickly and put on a baseball cap before Samantha awoke.

In the days that followed, her hair began falling out rapidly, this time in small handfuls. “That made me catch my breath,” she says. “At that point I knew, this is for real. This is really happening to me. Going through the diagnosis, surgery and treatments, of course I knew I had cancer, but there was something about losing my hair that made it real.” She purchased a wig—but it didn’t feel right. “I wore it for about three hours and said, no way, this isn’t for me. I felt like Carmen Miranda, as if I were balancing a big bowl of fruit on my head. I donated it to the hospital and bought hats instead.” Her favorite? A blue and pink New York Yankees hat (see cover).

Carmella today with her granddaughter Samantha and daughter Laurie.

Carmella today with her granddaughter Samantha and daughter Laurie.

Today, two years after her diagnosis, Carmella is feeling great. She continues to see Dr. Azodi every four months, and Dr. Shapiro checks her annually. She takes medication to help relieve some slight tingling she feels in her feet (neuropathy), a side effect of her treatment.

“My diagnosis has changed my outlook on life,” Carmella reflects. “I really do live for today now. The thought of the cancer coming back is always in the back of my mind, but the more time that goes by, the more confident I become that it won’t and that I’ll continue to be okay.”

 
Robot-Assisted Minimally Invasive Surgery for Gynecologic Conditions
“Compared to traditional open surgery, robot-assisted minimally invasive surgery is an excellent option,” says Bridgeport Hospital Chief of Gynecologic Oncology Masoud Azodi, MD, who has performed more than 1,000 robot-assisted minimally invasive gynecologic procedures. “Most women who undergo these procedures have less blood loss during surgery, less scarring and a shorter hospital stay. Most patients can go home the next morning. The miniature instruments on the robot provide excellent access to the tiny areas of that region of the body.”

The gynecology and gynecologic oncology teams at Bridgeport Hospital have performed more robotassisted minimally invasive surgeries than any other hospital in Fairfield County.

Bridgeport Hospital gynecologic surgeons who are trained to perform procedures with the da Vinci® “S” Surgical System include:

Gynecology
Lindsey Bruce, MD
Steven Cassell, MD
Robert Deal, MD
Valentine Edusa, MD
Lee Jacobs, MD
Mark Laser, MD
Peter Marcus, MD
Peter Van Dell, MD

Gynecologic Oncology
Masoud Azodi, MD
Dan-Arin Silasi, MD

Reproductive Endocrinology
Shaun Williams, MD

Urogynecology
Elisabeth Erekson, MD, MPH


Bridgeport Hospital surgeons are also trained to use the da Vinci “S” Surgical System to treat colorectal and urological (bladder, prostate and renal cancer) conditions. treat colorectal and urological (bladder, prostate and renal cancer) conditions. For information, please visit www.bridgeporthospital.org/FindPhysician or
call 1-800-794-5013, toll free, 24/7.

Nutrition Counseling Helped Carmella
Fruit
To make sure she was maintaining her nutritional needs, Carmella met with a Bridgeport Hospital nutritionist. The nutritionist helped develop a personalized plan for Carmella, incorporating appealing and nutritious foods. “We discussed how to incorporate more protein and vitamins into my diet. It was helpful,” Carmella says.

“Cancer treatments can take a toll on your body, draining your strength and appetite. But when you have cancer, good nutrition gives your body the energy it needs to heal,” says Bridgeport Hospital Clinical Nutrition Manager Andrea Valenti, RD, LD/N, CD-N.

Consultations are available by appointment with referral from your physician. For more information, please call the Nutrition and Wellness Center at 203-384-4553.