Knocked Down
Happy with life in Atlanta for the next three years, the Montenegrin and Canadian transplants were decidedly rooted in the U.S. Trish, a Canadian citizen with long-time U.S. residency, had since become an American citizen. Bogetic had just applied for American citizenship. They planned to stay and start a family.
But in June 2016, Bogetic got sick.
“I started feeling acid reflux every morning. I was taking Tums, which was helping, but one morning I was eating a sandwich and a piece of bread got stuck in my throat. I had to drink water to swallow it. I knew I had to see a GI doctor,” shared Bogetic. “My doctor was very confident that I, a healthy, athletic 30-year-old, could only have acid reflux, an ulcer at worst.”
The doctor ordered an endoscopy just to be sure.
When Bogetic woke up in post-op his wife was standing next to him and a nurse was present.
“I asked, ‘How did it go?’” Bogetic recalled asking the nurse as came out of anesthesia. “And she said, ‘The doctor will be in soon.’ So that was kind of my hint that it wasn't flawless. And, you know, when the doctor came in — he was quite a young doctor, I would have guessed likely not too far from exiting his fellowship — he was pretty bummed out, you could see. He said, ‘I’m sorry to have to tell you this, especially since you’re so young, but you have cancer. Esophageal cancer.’ I found it comical that, you know, such huge life changing news was being delivered in this six-by-six room that was only giving us privacy with its curtains … all the patients in the room next to us were hearing what was being said to us.”
The median age of an esophageal cancer patient at diagnosis is 67. Bogetic was decades younger.
“It was surreal. You go in thinking they're going to send you home with ‘it's an ulcer,’ and you come home looking at 8% chance of survival. And that’s pretty bad.” [According to the National Cancer Institute, the overall five-year survival rate for esophageal cancer patients ranges from 5% to 30%.]
Esophageal cancer is a rare cancer, but rarely curable. While it accounts for only one percent of cancer diagnoses in the U.S., it causes a disproportionate percentage of cancer deaths — 2.7% of all cancer deaths and 4% of cancer deaths in men, who are three times as likely as women to develop this type of cancer.
Based on the pathology report, Bogetic’s official diagnosis was adenocarcinoma of the esophagus. A subsequent PET scan showed his cancer was already stage 3; having penetrated the walls of his esophagus and spread to at least 11 nearby lymph nodes. The biggest risk factors for getting his type of esophageal cancer are gastric reflux, Barrett’s esophagus (a condition in which the esophageal lining is visibly damaged by acid reflux), and obesity. Acid reflux issues run in his family, Bogetic said, but no one had gotten Barrett’s esophagus or cancer from it.
“Naturally, after the shock wore off, we searched for the best doctors our health insurance could buy,” said Bogetic.
After a couple of consultations with top cancer specialists in the area, he settled on Emory, where he worked. For the next three months that summer, he underwent six rounds of chemotherapy (paclitaxel and carboplatin) and 28 radiation treatments.
Concurrently, he started treatment with Herceptin (trastuzumab), which targets the HER2 protein, after genomic sequencing of his tumor tissue revealed he was HER2-positive. In normal cells the HER2 pathway is a biological pathway involved in cellular replication and growth. When a patient’s cancer cells are HER2-positive, it means that there’s too much of that protein on the surface of the cancer cells. This drives aggressive cancer cell replication. Approved first in breast cancer in 1998, and approved in 2010 in gastro-esophageal cancers, Herceptin is designed to stop this or slow it down. [An estimated 15 to 30% of breast cancer patients and 10 to 20% of gastroesophageal cancer patients are HER2-positive.]