After a routine endoscopy revealed esophageal cancer, Juan Trevino, 68, was told he was too high-risk for surgery because of his other health conditions. Facing limited time and few options, he and his wife, Gloria Trevino, turned to an innovative, minimally invasive procedure available at only a handful of centers in the country — one that would ultimately give him a second chance at life.
‘Nobody would touch me’
Juan Trevino said he had not experienced any symptoms and that the diagnosis came as a shock to him. It was especially devastating given his complicated medical history. In 2019, he was diagnosed with leukemia and underwent a stem cell transplant that put the disease into remission. Later, he was diagnosed with myelodysplastic syndromes, or MDS, a group of disorders caused by malfunctions in the production of blood cells.
Because of the MDS, Juan Trevino takes antirejection medication, which makes major surgery extremely risky. While he was told that removing his esophagus would be too dangerous due to his other health conditions, at the same time, he was warned that without removing the cancer, he might have only two years to live.
“It was just like, boom, boom, boom, one shocking diagnosis after the other, and now they’re saying nothing can be done. Nobody would touch me,” Juan Trevino said.
For him and his wife, the news was crushing.
“I mean, what were we supposed to do? The doctors just told us they’re not going to touch him and then told us you’ve got two years. It was awful to hear that because what are we supposed to do?” Gloria Trevino said.
A Google search and a breakthrough
When Juan Trevino’s oncologist mentioned a specialized procedure that might be an option, Gloria Trevino went home and began researching online. That search led her to Matheus Franco, MD, PhD, associate professor in the Department of Gastroenterology and Nutrition at the Joe R. and Teresa Long School of Medicine at UT Health San Antonio and director of endoscopy at the UT Health San Antonio Multispecialty and Research Hospital — one of the few physicians in Texas performing a technique called endoscopic submucosal dissection, or ESD.
“As soon as we read about Dr. Franco and what he could do, we were very impressed and hoped that he could be the one who would help us,” Gloria Trevino said.
A minimally invasive answer
ESD is a minimally invasive, incisionless procedure used to remove large, superficial tumors, polyps and early-stage cancers of the esophagus, stomach and rectum in one piece using an endoscope. It offers a high cure rate while preserving the organ, avoiding traditional surgery and allowing for faster recovery. The procedure represents an innovative advancement for patients in South Texas.
“Very few centers in the U.S. are offering this kind of technique. We have been offering this procedure to our patients in South Texas, and we have good results with a large number of patients,” Franco said.
Juan Trevino’s cancer was classified as stage T1B N0, meaning the tumor was present in the mucosa and submucosa but had not yet spread to lymph nodes or other organs. That made him a possible candidate for ESD, given the high risk of a surgical procedure, said Franco.
When Juan Trevino arrived for the procedure, he was struck by the advanced technology in the operating room. He said walking inside felt like stepping onto the USS Enterprise starship from Star Trek. Despite his nerves, he found comfort in the care he received from Franco and the medical team, who explained every step and encouraged him throughout the process.
Healing without major surgery
The procedure was successful, and Franco was able to fully remove the tumor. Juan Trevino now follows up with the medical oncology team at UT Health San Antonio’s Mays Cancer Center. While doctors cannot consider the treatment fully curative until five years of cancer-free follow-up, the outcome so far has been extremely positive. Because the procedure was minimally invasive, it was also a much safer option for a patient with Juan Trevino’s complex medical history.
“Everything went well. I was in and out of the procedure and I didn’t have any problems. And most importantly, Franco never said ‘no, I’m not going to be able to help,’” Juan Trevino said.
For Gloria Trevino, the impact was life-changing.
“Franco saved his life. We are so grateful to him. He wouldn’t be here for long without Franco performing this procedure,” she said.
Franco said being able to offer patients like Juan Trevino a safer alternative to major surgery is deeply meaningful.
“It’s the best thing we can do as a doctor. Having a patient who has been struggling and suffering because of a condition and being able to offer a solution for this patient that is a safe and less-invasive approach is very rewarding for me as a doctor. It means a lot to be able to help,” he said.
Juan Trevino’s recovery has gone smoothly. He has experienced only minor, expected issues such as some pain when swallowing, and he will continue to receive regular monitoring and follow-up care.
Warning signs and risk factors
Esophageal cancer is often linked to risk factors such as chronic reflux and smoking. Symptoms can include dysphagia, or difficulty swallowing; pain with swallowing; the sensation of food getting stuck in the esophagus; anemia caused by internal bleeding; and unintentional weight loss from reduced food intake.
Franco emphasizes the importance of both lifestyle changes and paying close attention to gastrointestinal symptoms.
“Lifestyle changes like maintaining a balanced diet, exercising and managing weight can help reduce risk of esophageal cancer, because being overweight or obese is a risk factor for reflux, and over time, reflux can put patients at risk for esophageal cancer. In addition, stopping smoking and controlling or managing alcohol use are also very important,” he said.
Hope for other patients
Gloria Trevino hopes other patients hear about her husband’s story and know help is available.
“The public needs to know that [Dr. Franco] is there and he can help you. He’ll save your life, and he can,” she said.
Less-invasive approaches like ESD are not appropriate for every patient, but they can be life-changing for those who meet the criteria — especially older patients and those with other serious medical conditions who face higher risks from major surgery.
“It’s not something for all patients, but at least for the right patient who can meet the criteria, it’s very rewarding for us as an institution to be able to offer this. It’s one more tool in the toolbox that we have here at UT Health San Antonio,” Franco said.
For more information or to request an appointment with the Advanced Interventional Endoscopy Program, call 210-450-9880.