In October 2018, Amy Short-Ashworth prepared for an advanced cancer procedure involving both surgery and chemotherapy, her chance to get rid of the rare and often fatal stage IV adrenal cortical carcinoma she had been treating for more than two years.

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The 44-year-old mother of three had flown from her home in Scottsdale, Arizona, to the University of Michigan Rogel Cancer Center for a procedure known as hyperthermic intraperitoneal chemotherapy, or HIPEC.

HIPEC is offering hope to people with advanced cancers originating from the lining of the abdomen or recurrent or metastatic tumors scattered throughout the abdominal cavity. These cancers are either not responsive to traditional chemotherapy — which travels through the bloodstream to reach and kill cancer cells — or can't be completely treated by chemotherapy alone.

HIPEC is a two-part process that takes a different approach.

First, a surgeon, Barbra Miller, M.D., would explore Short-Ashworth's entire abdomen, searching for cancerous tumors and removing them. 

When the visible cancer was out, high doses of heated chemotherapy would be pumped into her abdomen to bathe and destroy any remaining microscopic cancer cells.

"We want patients to experience long-term, durable benefit if they're going to risk the complications and extended recovery associated with a high-risk operation," says Miller, assistant professor in the Division of Endocrine Surgery. "Amy was a good candidate and her tumors had partially responded to the chemotherapy used to treat adrenal cancer."

Getting approval

Short-Ashworth would be the first patient with adrenal cancer to receive HIPEC at the Rogel Cancer Center. However, getting final approval had not been easy due to complications from her illness and side effects from treatment. She had to be healthy enough for surgery.

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With her mother and sister by her side for support, and her husband and kids back in Scottsdale for work and school, Short-Ashworth learned from Miller that her HIPEC procedure would go forward as scheduled.

"I was like, 'heck yes, let's do it,'" Short-Ashworth says. "It was major surgery, but they wouldn't recommend it unless I might get some serious benefit from it."

One-in-a-million diagnosis

Short-Ashworth's cancer journey began in August 2016 when she and her husband, Gavin, returned home from work at their family-owned Thai bistro. It was time to relax. But Short-Ashworth began having terrible abdominal pain.

Doctors found that one of her adrenal glands had ruptured. This small gland sits atop each kidney and is responsible for regulating hormones related to stress, sex, the immune system, metabolism and blood pressure.

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An ultrasound found a mass. Short-Ashworth received a shocking cancer diagnosis.

Adrenal cortical carcinoma is so rare it affects only 1 to 2 people out of 1 million.

Short-Ashworth had surgery in Arizona in January 2017 to remove her adrenal gland, followed by radiation therapy. She also took a hormone suppressant and an artificial steroid. When her follow-up scans showed no cancer, she and Gavin breathed a sigh of relief.

Adrenal cancer, however, is aggressive in nature and tumors are difficult to remove without tearing or rupturing the tumor wall, which can leave microscopic cancer cells in the abdominal cavity.

When cancer returns

Short-Ashworth and Gavin were back to busy days working at the restaurant and caring for their three children, ages 6, 9 and 18.

She became concerned in July when pain suddenly came on near her surgery site. Tests confirmed her cancer was back.

Her doctors referred her to the Rogel Cancer Center, where Gary Hammer, M.D., Ph.D., leads the world-renowned Endocrine Oncology Program.

"Adrenal cancer is one of the rarer cancers and challenged by the fact that most physicians have never seen a case," Hammer says. "We see patients at U-M from around the country and around the world who need our expertise."

Hammer confirmed Short-Ashworth's adrenal cortical carcinoma had returned and spread.

The cancer was stage IV. The largest tumor was already 8 centimeters with many more growing throughout her abdomen.

She was not a candidate for a second surgery, so Short-Ashworth began a regimen of three chemotherapy drugs taken intravenously, plus another taken in a pill. Hope returned when her cancer responded to the drugs and her treatment team presented a new option.  

Beth Hesseltine, a nurse practitioner on Hammer's team, told Short-Ashworth about HIPEC, the complicated surgery followed by chemotherapy applied directly into the abdomen. Since her cancer had already responded to the chemotherapy, she might be a candidate.

Miller assessed her response to treatment and weighed the risks.

Surgery was delayed to give Short-Ashworth time to recover from a pulmonary embolism that resulted from her cancer.

By the time Miller approved her for HIPEC, Short-Ashworth understood that the procedure was her best chance for a cure or, at worst, extended time to parent her children.

"I wanted them to take everything possible that was cancer out of my body," she says. "I missed my son losing his first tooth and his sixth birthday. I want to be there for the rest of it. HIPEC was my chance."

Major surgery with potentially serious benefits

Short-Ashworth flew to Michigan for surgery, stayed in the hospital for two weeks, and a hotel in Ann Arbor until doctors said it was safe to fly home. Despite the high stakes and being far from home, Short-Ashworth had no hesitation.

Surgery went as planned, with Miller consulting with Clifford Cho, M.D., chief of hepatopancreatobiliary and advanced gastrointestinal surgery at Michigan Medicine, who has trained in HIPEC and introduced it at the Rogel Cancer Center.

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"Amy came through with flying colors," Miller says. "She had two large tumors and a lot of little disease. We cleared it all out. That makes us hopeful the chemo will act on all the microscopic disease we can't see."

Hammer will continue to manage Short-Ashworth's care.

Short-Ashworth was happy to be the first adrenal cancer patient to receive HIPEC at the Rogel Cancer Center. She hopes her case will give hope to other adrenal cancer patients in the future.

"Because the procedure was technically a success, with the multidisciplinary group engaged, we hope to employ HIPEC more widely in patients with a predominance of disease in the abdominal cavity," Hammer says.

Amy Short-Ashworth died in 2020.