By Elaine Sanchez, Brooke Army Medical Center Public AffairsJuly 3, 2014
JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas (July 3, 2014 -- When doctors told Yesenia Ruiz-Rojo she was terminally ill, the pregnant 21-year-old put all thoughts of herself aside. Just save my baby, she asked.
Less than four months into her pregnancy, she was facing aggressive liver cancer and given two to four months to live. But rather than give up, the Army wife and her team of providers at Brooke Army Medical Center, known as BAMC, here, decided they were going to beat the odds.
Four months later, Ruiz-Rojo gave birth to a healthy boy named Luke.
"I love spending time with my son; he's beautiful," she said over the phone from a hospice center in California. "I'm so thankful for him."
She shared a picture of her family on Easter. Her 5-year-old stepson close behind her, and with her baby, in a mini suit and tie, cuddled on her lap. Luke, who turned five months old in June, has received the gift of his mom's care for longer than anyone expected.
Lt. Col. (Dr.) Raul Palacios, BAMC's chief of interventional radiology, calls Ruiz-Rojo's case "a medical miracle."
"She told us all she wanted was for her baby to live," Palacios said. "She was willing to do whatever it took to make that happen."
Ruiz-Rojo arrived at BAMC in her 15th week of pregnancy. Previously healthy, she had become alarmed by a severe bout of abdominal pain and vomiting and went the emergency room at Carl R. Darnall Army Medical Center, at Fort Hood, Texas. Tests revealed a tumor covering more than 65 percent of her liver. She was transferred to BAMC two days later.
When BAMC providers heard about the case, they knew the situation was dire. Based on current literature and case reports, a pregnant woman with this type of aggressive cancer hadn't lived very long, let alone enough to deliver a healthy child.
"There was nothing out there we found in conventional medicine that would offer her any hope," Palacios said. "We weren't aware of anything in the past that had been tried successfully before."
Unwilling to give up, experts from more than a dozen specialties -- including interventional radiology, obstetrics and gynecology, gynecology oncology, gastrointestinal, hematology/oncology, hepatology, transplant surgery, pediatrics, maternal fetal medicine, neonatology, radiation safety, health physics and medical ethics -- met to explore every possible treatment option.
They couldn't cut the tumor out due to its size and placement, and traditional cancer treatments, such as chemotherapy, would cause harm to or terminate her pregnancy, explained Col. (Dr.) Stephen Harrison, BAMC's chief of hepatology and consultant to the surgeon general for gastrointestinal and liver diseases.
Palacios suggested they try a fairly new therapy called selective internal radiation therapy with Y-90, which places tiny radioactive particles in the patient's artery that feeds the liver tumors. The tumor consumes the particles and either shrinks or dies, he explained.
BAMC is the only Defense Department facility that uses this treatment, he noted, which is FDA approved to treat primary liver cancer and colon cancer. It's also shown promise for patients with colon cancer that spreads to the liver.
"After meticulous consideration, the entire team felt there would be minimal risk to the patient and her baby," Palacios said. "We held our breath, acknowledged Mrs. Ruiz-Rojo's desires, and made the best educated decision with what we knew at the time."
Interventional Radiology completed her Y-90 treatment in six weeks, after which there was nothing left to do but monitor her health and pregnancy, Palacios said, noting some early encouraging signs that the tumor was responding. Ruiz-Rojo returned to the hospital at 32 weeks and delivered her baby on Jan. 9.
Her providers were thrilled at the outcome.
"The fact that at a moment's notice everyone dropped everything to come up with a plan speaks volumes about BAMC's dedication and commitment to care for our patients," Palacios said.
"If the team hadn't looked outside the box, we wouldn't have had the chance to give her a viable baby," added Col. (Dr.) Scott Kambiss, chief of OB/GYN. "Just the idea that someone would have that opportunity to bring forth life ... that was incredible for all of us. Every day is a day she didn't have before."
Shortly after, Ruiz-Rojo moved to California to spend time with her family and new baby while relatively symptom free. She has lived there since mid-March, creating happy memories her son can view in pictures and videos as he grows up.
"She didn't want cancer treatments that would impair the quality of time she has left with her baby," Palacios said.
Ruiz-Rojo's journey may end soon, but because of a caring team of BAMC providers, her baby now has a shot at a long and happy life, Palacios said.
"I hope someone tells Luke someday how brave his mother was to allow doctors at BAMC to participate in her health," he said.
"The fact that she is able to be with her child and experience this time with him is amazing," Harrison added. "It's heartwarming for all of us."
Ruiz-Rojo's mother, Olivia, expressed her gratitude in Spanish while at her daughter's bedside in hospice.
"Luke is a beautiful baby -- so active, so playful," she said over the phone. "All my daughter wanted was to have her baby and have some time with him. She was able to do that, thanks to the caring doctors at BAMC."