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With Age Comes Experience

Gerald Ross

At 81-years-young, one patient helps advance research on a rare cancer

At 81, Gerald Ross has traveled the world, taken on risky jobs, raised five children, survived a riot and walked away from a plane crash.

The Detroit native and his wife Anna, now retired near the northwestern Michigan town of Central Lake, have experienced uncomfortable times, but Ross took on his greatest challenge later in life: Staring down an uncommon and deadly cancer.

In November 2014, after blood was found in his urine, tests diagnosed upper urinary tract cancer. Also known as transitional cell carcinoma of the upper urinary tract, this rare cancer is diagnosed in only about 5,000 people each year.

Ross' cancer originated at the junction where the kidneys filter urine through the ureter into the bladder. Although its cause is unknown, Ross believes that his past history as a smoker and exposure to toxic chemicals throughout his career may have played a role in the development of his cancer.

Initially, Ross sought treatment at a well-known cancer center in Houston. There, his oncologist assured him that the advanced treatment he was looking for was available closer to home. He referred Ross to Ajjai Alva, M.D., at the University of Michigan Rogel Cancer Center.

"Few doctors are familiar with treating upper urinary tract cancer," says Alva, who specializes in urothelial cancers. "At the University of Michigan, we take a multidisciplinary approach to treatment, combining surgery, chemotherapy and in some cases radiation to achieve the best outcome for each patient. We also collaborate with other top institutions on research studies."

Like other rare cancers, little clinical data is available and research is only possible when doctors and patients from many centers participate.

Ross was given the option of joining a clinical study at U-M -- one of the first prospective studies on upper tract cancer – to find out whether chemotherapy before surgery improves outcomes.

"We know that surgery is effective in treating the tumor itself," explains Alva, "but it's a local solution. It doesn’t address cancer cells that escape to other parts of the body. Chemotherapy chases down those cells before they return as advanced cancer elsewhere."

It's not about age, but attitude

One major consideration for the Ross family was the aggressiveness of the treatment. Another was postponing surgery for 12 weeks to complete the chemotherapy.

"Dr. Alva kept saying what a robust guy I was," says Ross. "Some in my family had concerns about the chemotherapy, but from the start I believed it would work. All my life I've relied on a positive mental attitude to overcome hardship and I wouldn't allow any negativity to dilute that."

"With this type of cancer, the best outcomes are seen when chemotherapy is delivered in high, concentrated doses," explains Alva. "While some might feel that a 'dose dense' approach is too aggressive for the elderly, it's important to look at the whole person, not just his age. Although Mr. Ross was very sick, he led an active life and had a great attitude. He is far younger physiologically than chronologically."

"We know that making the commitment and sacrifice to participate in a clinical trial isn’t easy," says Clinical Subjects Coordinator Rachel Dedinsky. "There are many factors to consider, including the long distance patients like Gerald have to travel. And throughout the process, lots of questions come up."

In addition to scheduling patients' appointments, Dedinsky's job is to make sure those questions are answered. In the process, they get to know each other well.

"Without a doubt, interacting with wonderful patients like Gerald and their families is the best part of this job," she says. "Urothelial cancers tend to strike later in life, which means I'm quite a bit younger than most of my patients. It's like having a dozen awesome grandparents coming to see you!"

Alva and his team are so grateful to patients like Ross who partner with them in clinical research. "Gerald Ross inspired us all,' Alva states. "He endured very aggressive treatment, made numerous 500-mile round trips to Ann Arbor from northwestern Michigan and never complained. He's a tough guy -- a brave guy."

How is Gerald Ross doing now?

Following the chemotherapy, Ross' kidney was removed and follow-up tests confirmed that adding chemotherapy to surgery stopped the cancer's spread. "Mr. Ross' case reinforces the potential of this multi-modality approach," says Alva. "It's now extremely likely that he is cured of the disease."

"I'm still rebuilding my strength," says Ross, "and I can tell that my memory was affected. But I'm improving all the time."

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