BY SUSAN KEETER

“I am so sorry you have to give me this bad news,” Margit Foti, 71,  remembers telling her urologist, Elizabeth Ferry, MD, on the day Foti learned that she had a rare bladder cancer with a poor prognosis.

“I could see the upset in her face,” explained Foti.

Her symptoms began late last summer, when Foti was traveling on a dream-come-true vacation in Hungary, her childhood home.  During the trip, she developed pelvic discomfort that she suspected was caused by a urinary tract infection. When Foti returned home in September, her primary care physician prescribed an antibiotic to treat what they agreed was likely an infection.

Two days after that appointment, Foti was plagued by a constant need to urinate and was in such pain that she could not sit or lie down. Her son-in-law, a nurse, insisted that she go to the emergency department at Upstate‘s Community campus.

Through imaging, doctors saw swelling in Foti‘s kidneys and increased thickness in her bladder. Suspecting kidney stones, they controlled her pain, alerted Foti‘s primary care physician and referred her to Ferry in urology.

Within a week, Foti‘s condition had deteriorated to the point that she needed diapers.

Ferry scheduled a CT scan of Foti‘s abdomen and pelvis. Then, Ferry performed a cystoscopy, a procedure in which a lighted tube is inserted into the urethra to examine the inside of the bladder.

The cystoscopy revealed a large tumor, and Foti was taken to surgery for removal. Surgical pathology identified signet ring cell adenocarcinoma, a type of bladder cancer so rare that just a handful of cases are reported each year, worldwide.

Upstate‘s urology team met to discuss Foti‘s case. The urologists sought opinions from colleagues nationwide.  Because the condition is so uncommon, there is no protocol for treatment.

Urologist Oleg Shapiro, MD, assisted by Ferry, performed surgery on Foti . The plan was to remove the cancer from the bladder, but they found it had spread outside Foti‘s bladder and into her abdomen, prohibiting removal.

The next day, interventional radiologists implanted tubing through Foti‘s skin into her kidneys to remove urine. Cancer was blocking drainage into her bladder.

Upstate‘s genitourinary multidisciplinary team — including medical oncologist Muhammad Naqvi , MD (and others shown in the accompanying photographs) — recommended six months of chemotherapy with daylong treatments every two weeks. Foti responded well to the chemotherapy and was relieved that the treatments could be done on an outpatient basis.

After three months, the chemotherapy had shrunk the cancer enough that the tubes in her kidneys could be removed, and Foti‘s bladder function gradually returned to normal.

Throughout diagnosis and treatment, Foti has stayed busy, learning everything she can about her disease and looking forward to the possibility that new treatments may be available any day. She exercises regularly, and attends  a cancer survivors program at the YMCA that Foti describes as “a support group with giggles.” She follows a “clean” diet, as recommended by Kaushal Nanavati, MD. That is, she eats mostly unprocessed, whole foods, including fruits, vegetables, whole grains, and lean meats with no artificial ingredients or preservatives.

Through her research, Foti connected with a Long Island police officer and a woman living in England who had the same type of cancer but have since died. Foti accepts that her future is somewhat beyond her control but firmly believes that she and her  medical team are doing everything possible to battle her cancer.

“I especially like Dr. Naqvi. His eyes smile when he talks,” Foti explains. “He is very positive but realistic. He makes no promises but never gives up. There is always something he is ready to try to help me with.”

What‘s in her immediate future? With chemotherapy treatments finished, and the cautious assumption that the cancer is in remission for now, Foti is making plans. With her doctors‘ okay, she took a trip to New York City to visit friends, then packed her bags for a vacation with her two daughters and four grandchildren.

“Some day, my daughters will scatter my ashes over Jones Beach on Long Island,” Foti winks. “But first, we‘re enjoying Myrtle Beach together!"

What is signet ring cell adenocarcinoma?

Signet cells are glandular cells found in the tissue that lines certain internal organs and makes and releases mucus, digestive juices or other fluids. Adenocarcinoma is a cancer that begins in those glandular cells. Signet ring cell carcinomas are found most often in the stomach lining but also develop in the bladder and other organs. The cancerous cells are called “signet ring” because their shape is similar to monogrammed rings of the same name.

Source: National Cancer Institute, Cancer Research UK

Sharing a story

Foti shared her story with the Upstate Foundation. To share your story, email [email protected]. To donate to the Friends of Upstate Cancer Center, click here or call 315-464-4416.

This article appears in the summer 2017 issue of Cancer Care magazine.