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What Orioles star Trey Mancini’s colon cancer diagnosis means, and what his road to recovery might look like

A diagnosis of stage 3 colon cancer has Orioles star outfielder Trey Mancini on a twice-monthly regimen of chemotherapy, he wrote in an online essay Tuesday, making it likely that if there is a baseball season in 2020, he won’t be part of it.

But in sharing some details of his medical struggle, Mancini provided information that helps determine his possible prognosis for a return to full health and, eventually, to the Orioles’ lineup.

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Mancini, 28, left the team shortly before spring training was cut short by the coronavirus pandemic to prep for surgery to remove a malignant tumor on his colon. The successful surgery March 12 came the same day that baseball shut down, and Mancini took to social media shortly after to thank the team and the fans for their support as he moved forward with his treatment.

According to his essay on The Players’ Tribune, Mancini had a mediport put into his chest April 6 ahead of his first chemotherapy treatment April 13. The twice-a-month treatments will continue for six months, he wrote, effectively ending his 2020 season before it begins.

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Baseball is just one piece of a larger picture when it comes to colon cancer, however. Mancini noted how fortunate he was to have identified the tumor and have it removed so quickly. An issue with his bloodwork during his spring training physical led to further testing and the eventual surgery.

Now that more information is available about Mancini’s official diagnosis and treatment, there’s plenty that can be gleaned on his prognosis and what the next few months will look like for the face of the Orioles.

What does a diagnosis of stage 3 colon cancer mean?

In stages 1 and 2, colon cancer typically presents as polyps that can be removed without surgery. If it hasn’t metastasized, the next step is surgery, said Joseph DiRocco, director of gastrointestinal oncology for the Sandra & Malcolm Berman Cancer Institute at the Greater Baltimore Medical Center.

Said DiRocco: “During the surgery, regardless of approach, the section of the colon with the tumor is removed along with all the blood vessels and lymph nodes that drain that area because the way colon cancer spreads is either through the blood vessels or the lymph nodes. In order to figure out how far gone it is and to try to remove all the cancerous cells, we typically remove all the lymph nodes that drain that area.

“If there are tumor cells in the lymph nodes, then that’s considered stage 3. And there are low-risk stage 3s and high-risk stage 3s, depending on how many lymph nodes are involved or whether the tumor invaded any other structures.”

Anton Bilchik, a surgical oncologist, chief of gastrointestinal research and chief of medicine at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California, said that chemotherapy is the typical route of treatment for such patients once the tumor is removed.

What factors go into the chemotherapy treatment?

Depending on whether it’s considered high risk or low risk, the chemotherapy treatment prescribed can vary. DiRocco said that “fewer lymph nodes and lower risk is the only situation in which you can offer somebody a three-month course,” though the inverse isn’t always true about six-month treatments, meaning the case is high risk.

“There may be other factors that would make somebody decide to pursue a longer course,” he said. “But typically, a six-month course is reserved for high-risk patients.”

How effective is the chemotherapy?

Bilchik said that medical advances in the past few decades have improved survival rates for stage 3 colon cancer patients “significantly,” with minimally-invasive surgeries and more effective chemotherapy contributing to that.

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Having high-risk and low-risk stage 3 colon cancer patients grouped together puts cases with varying levels of severity within the same statistical groups despite those different sub-classifications.

DiRocco said that generally “the likelihood you’re going to survive five years is somewhere around 70%” for stage 3 patients, though that could be lower if high-risk classifications were taken alone.

The chemotherapy can address the risk that the cancer will recur, he said.

“There’s a possibility that there could be small islands of tumor cells somewhere else in the body that are just too small to be picked up on either blood tests or CT scans or seen during surgery,” DiRocco said. “The point of the chemotherapy is to eradicate these little islands, so the risk of the cancer coming back is lower.”

Is it unique for a young person to have colon cancer?

Both DiRocco and Bilchik said that cases of young people being diagnosed with colon cancer or colorectal cancers more generally are on the rise.

“There’s a five- to six-fold increase in young people under age-45 getting colon cancer,” Bilchik said. “There’s really been an epidemic of colon cancer among younger people. That’s part of the reason the American Cancer Society recommended lowering the screening age from age 50 to age 45, because of this uptick in younger people getting colon cancer.”

Since young people aren’t typically screened annually the way people over 50 years old might be, the symptoms can be attributed to something else early on, DiRocco said.

“Typically, people at a younger age are diagnosed at a later stage just because it’s not on peoples’ radar,” he said. “Just by the nature that people are young, the tumors tend to be slightly more aggressive in nature, just because there has to be something wrong for them to develop colon cancer.”

Mancini said that he hopes to be able to continue training to the extent that he can during treatment. Are there any side effects to that?

Bilchik said that the chemotherapy regimen typically prescribed for stage 3 colon cancer patients is “very well-tolerated, mostly,” with few complications. One of them, he said, was numbness in the fingers and in the feet, “but most of the time it goes away.”

DiRocco referred to that as “peripheral neuropathy, where there’s numbness and tingling in the hands.”

In some cases, he said, that can last beyond chemotherapy or cause an adjustment in dosage if the symptoms are debilitating during treatment.

Another side effect, DiRocco said, is “hand-foot syndrome, which typically causes redness and issues, basically a rash and discomfort of hands."

“One of the recommendations is to avoid using your hands, like, on gardening tools — or a baseball bat — because that can worsen the symptoms,” he said. “It doesn’t happen with everybody with those regimens, but it happens up to half of the time.”

What does the diagnosis mean for a return to full health and, eventually, baseball?

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While there’s no baseball to be played at the moment, DiRocco said that many people can continue to work through chemotherapy for colon cancer. Even without that possibility for Mancini, the treatment is “certainly not life-altering or permanently debilitating,” DiRocco said.

Bilchik said that all the baseball activity that Mancini hopes to get back to could actually help him get through the treatment and regain his health quickly.

“Many people with colon cancer who undergo surgery and chemotherapy, most people get back to normal activity,” Bilchik said. “Exercise, fitness all impact survival. It all impacts the ability to tolerate chemotherapy. People that are exercising and fit, eat well actually do better with chemotherapy and have better survival. There’s an excellent chance of getting back to normal function.”

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