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But when a surgeon opened her up last fall to cut out the deadly tumor that was squeezing her bile duct, he saw that it had engulfed nearby arteries. It was impossible to remove.
Now Correa is trying a gentler-sounding approach at Thomas Jefferson University Hospital: light.
First she was infused with medicine that made the tumor cells light-sensitive. Two days later, physician David Loren carefully threaded a flexible fiber down through her intestines and bathed the cancerous mass with the glow of a red laser.
Called photodynamic therapy, the technique represents part of medicine's continuing quest for treatments that target tumors while sparing the rest of the body from unpleasant side effects. Though far more common in Europe, this light-based therapy is gaining proponents in the United States, where it has long been approved for treating certain lung and skin cancers.
Loren is among the researchers who seek to expand its use. He is participating in a University of
Virginia-led effort to gain approval to use it on bile-duct tumors.
Separately, researchers at University of the Sciences in Philadelphia are using the technique to combat prostate cancer in lab animals.
Correa, 54,feels like something of a lab animal herself. She is among just a handful of U.S. patients who have gotten the treatment for bile-duct cancer, and at first she was a little hesitant. So were her two sons, both in their 20s.
"They asked me if I was going to glow in the dark," she said, before undergoing the first of several treatments last month.
No, but the therapy does have one significant side effect:
The medicine that makes the tumor cells sensitive to light has a similar effect on the rest of the body. Regular cells excrete the medicine more quickly than do cancer cells, yet the kind of drug Correa received still had a fairly long impact. She would have to stay away from bright light for several weeks, or else suffer a bad sunburn.
So when Correa arrived at Jefferson for her first encounter with the laser, she wore a floppy, wide-brimmed hat and dark sunglasses.
Developing a tumor in the bile duct is a grim fate, as it chokes off the path to the intestine, eventually leading to jaundice, malnutrition and often infection. Such cancers kill more than 4,000 people in the United States each year -- though it is likely even more common than that, as some patients are misdiagnosed with pancreatic cancer, said Michel Kahaleh, a bile-duct expert at the University of Virginia School of Medicine. He is seeking funds for a trial at 15 medical centers, including Jefferson.
Chemotherapy and radiation can buy some extra time for the patient, but Correa had been through that already and wanted no more of the nausea and other side effects. So she agreed to try light.
In a randomized European study, photodynamic therapy had extended the life of patients with inoperable bile-duct cancer by more than a year, on average -- in some cases several years. It worked so well that the trial was stopped early.
During that time, the patients reported having a better quality of life. And unlike with radiation, there is no limit to how much the body can take. Patients can repeat the process.
Loren says the laser-light therapy, which costs about $5,500 per treatment and is covered by most insurers, need not be viewed as an alternative. Willing patients can receive it in addition to chemo and radiation.
Correa received her infusion of the light-sensitizing medicine, called porfimer sodium, on Dec. 15. Two days later, she was placed under anesthesia, and Loren inserted an endoscope down her throat and into her small intestine.
"The beauty of this is, we're right there," Loren said as he held the laser in place. "We're touching tumor."
The light from the laser cannot penetrate very far, and so much of her tumor remained unaffected.
"We're coring out the apple," Loren says. "We're not treating the outside."
For some other cancers, at least in the early stages, photodynamic therapy can eliminate the malignant growth entirely, including lesions of the skin and esophagus said pulmonologist Michael Unger, who uses the technique at Fox Chase Cancer Center in Philadelphia.
The medicine being given to the bile-duct patients at Jefferson is not approved for that purpose by the Food and Drug Administration. But doctors are allowed to give it on an off-label basis.
