Steve Rogers

Steve Rogers and family

Some friends are convinced that angels pulled Steve Rogers into the Wacissa River.

Late in July 2001, Rogers and five other fathers were canoeing with their sons in Northwest Florida. A cable swing, dangling from one of the many large trees that flank the wide, clear stream, had been a proving ground for youthful daring and bravery for years. Rogers clambered over the roots, shimmied up the tree, grabbed the triangle grip with his muddy hands and launched himself into the river.

"I remember coming through the arc of the swing, and I just couldn't hold on," Rogers says. "I hit the water wide open. At the time, I didn't know I'd done anything other than embarrass myself."

Two weeks later, during a beach vacation in Panama City, Fla., Rogers developed excruciating abdominal pain. He was hospitalized for three days with acute, traumatic pancreatitis, an inflammation of the pancreas. Rogers went home to Tallahassee on a liquid diet, but it only took the edge off the pain.

Instead of working out at the gym at 5 a.m. every day, the IBM sales executive had to force himself out of bed to make two important presentations to the governor. "I was losing weight like crazy, not able to eat," Rogers says. "Doctors tried different enzymes, but nothing was making it better." The pancreas secretes juices that help digest food and hormones that regulate sugar levels in the blood.

Doctors recommended Rogers stop eating for six weeks and receive needed nutrients from a special liquid food mixture injected into his blood. The hope was the prolonged rest would allow the pancreas to heal. "I wasn't willing to spend six more weeks trying something and then going on to the next step," Rogers says. He and his wife Wendy decided to get a second opinion at Mayo Clinic in Jacksonville.

Dr. Michele Bishop, a gastroenterologist at Mayo Clinic in Jacksonville specializing in the pancreas, says traumatic pancreatitis can result from severe blows to the abdomen, but overall, the condition is rare. Trauma usually causes a leak in the tail of the pancreas. "His story was consistent with that," Bishop says. "But all conservative measures were taken, so why wouldn't it heal? That's the first thing I wanted to know."

Bishop ordered an endoscopic retrograde cholangiopancreatography (ERCP). The test, done by gastroenterologist Dr. Stephen Lange, involves passing a thin, flexible tube down the throat, through the stomach and upper small intestine into the opening of the pancreatic and bile ducts. A dye is injected into the ducts and X-rays are taken. The test found a leak in the tail and a stricture or narrowing in the head of the pancreas and at the bile duct. That "double-duct sign" usually means pancreatic cancer unless proven otherwise, Bishop says.

"It was a shock to see that in a 41-year-old man who otherwise had no symptoms," she says. Pancreatic cancer, the second most common gastrointestinal cancer and fifth leading cause of U.S. cancer deaths, usually occurs in people older than 65.

Doctors looked aggressively for cancer, but neither CT scans nor endoscopic ultrasound gave any hint of a tumor. Lange had put in a stent to open the stricture and restore proper flow of pancreatic juices. For two weeks Rogers felt great. But stents are temporary, and soon after it was removed, he became sick again.

"It was the toughest clinical scenario I've had to face as a physician," Bishop says. "I had to consider: Do I send him for a very difficult surgery assuming the stricture was cancer? Nothing was turning up on X-rays, but with pancreatic cancer, by the time you can see it on an X-ray, it's usually too late."

The surgery, called a Whipple procedure, is technically one of the most difficult and demanding surgeries for the physician and patient. The pancreas lies deep in the abdomen, and many important ducts and veins are involved. It can take up to eight hours and requires special surgical expertise and training. Dr. J. Kirk Martin at Mayo Clinic in Jacksonville is one of a handful of surgeons around the country who regularly does the procedure. But this was just after Sept. 11, and Martin, then a lieutenant colonel in the Florida Air National Guard, had been called to active duty. So Bishop referred Rogers to Dr. Mike Farnell at Mayo Clinic in Rochester, Minn., another Whipple surgery specialist.

Farnell saw Rogers on Friday afternoon and operated Monday morning. Surgery involved removing the head of the pancreas, the duodenum, the lower portion of the stomach, the gall bladder and part of the bile duct and reattaching the small bowel to the liver. "Basically, they replumbed my insides," Rogers says.

Doctors found a small tumor less than half an inch wide in the head of the pancreas. It was just big enough to cause a stricture but too small to show up on X-rays. In a few months, it would have become inoperable.

"We were shocked," Rogers says. "We went to Rochester for surgery, but not for cancer surgery. But the doctors and nurses were very excited, because they normally don't catch pancreatic cancer early when they can make a difference."

Rogers had volunteered for research protocols, and as a result, 56 nearby lymph nodes were removed and checked for cancer cells. All were negative. Lymph node status is one of the most important factors influencing long-term survival, says Dr. Alvaro Moreno-Aspitia, a Mayo Jacksonville oncologist. Because the recurrence rate is unacceptably high even in patients who have successful Whipple procedures, chemotherapy or radiation are usually recommended.

Rogers again opted for a clinical trial and received three weeks of chemotherapy followed by six weeks of abdominal radiation and chemotherapy followed by more chemotherapy at Mayo Clinic in Jacksonville. Rogers' last treatment was in mid-May 2002. "He came through it reasonably well and has been doing well so far," Moreno says. "It's too soon to evaluate the long-term benefits of all these treatments, but we're cautiously optimistic that he'll beat his cancer."

Not that life has been a breeze since then. Rogers has been hospitalized a couple times for intestinal blockage and fever. His intestines don't work as well as they used to, in part because of the trauma caused by surgery and radiation therapy. He must take pancreatic enzymes with every meal and snack, and although he can eat anything, he has cramps and diarrhea. "But that's OK," he says. "I'll take it."

Rogers was fortunate that IBM let him take a yearlong medical leave. When not dealing with doctors' appointments, tests and trips to Jacksonville, he's been able to spend more time with his wife Wendy and three children. "When something like this happens," says Wendy Rogers, "you really focus on living every day."

"This has helped us as a family," Rogers says. "Someone told us it's in the valleys that you grow, and it's true. We were always riding the top of the wave until this happened."

"You don't choose what you get," Rogers says. "It's how you deal with it. You can go home and cry, or you can get on top of it and decide to beat this thing."

"Every patient I see, I think of Steve Rogers," says Bishop, pointing to the family's Christmas picture. "I have his picture in my office to inspire me. With pancreatic cancer, you see so many sad cases, and you so often have to give bad news. A patient like Steve really keeps you going as a physician."

"We'll keep an eye out for cancer," Bishop says. "We don't want to take for granted that he's been cured. We would never have found that cancer until it was too late without that fall. If ever there's going to be a patient who survives pancreatic cancer, it's going to be Steve Rogers."

Rogers' case is unique for many reasons, Moreno says. "The lack of specific signs and symptoms make early diagnosis of pancreatic cancer very difficult. In an odd way, he was fortunate to fall off that swing. Even though his clinical picture matched post-traumatic pancreatitis, doctors pursued more investigations and considered cancer despite his young age. They didn't just write him off as having pancreatitis. He's very young to have this type of cancer, especially considering how healthy he was and what a healthy lifestyle he had." Pancreatic cancer is rare in people under 50. Cigarette smoking and previous chronic pancreatitis are important risk factors. Some controverial studies also have fingered coffee drinking and high-fat diets. Rogers was 40 and did not smoke.

Rogers is outgoing, the kind of guy who never met a stranger. He hopes his case can help doctors learn more about pancreatic cancer. Maybe he can help patients find hope by telling his story.

"You ask God why, why did You pick me, but you never get an answer," Rogers says. "Maybe He knew I would get the word out. This has really strengthened our faith."

According to the American Cancer Society, very few patients with pancreatic cancer are alive five years after diagnosis. Rogers plans to be one of them.

"We know it could come back, and if it does it has to be caught quickly," Rogers says. "But we don't dwell on it. Too many things have gone right. I have a lot of talking left to do before I check out."

"I do think Mayo Clinic, here and in Rochester, makes miracles and saves people," Rogers says. "The doctors there do things that they don't do in normal hospitals. But the real miracle was falling off the swing."

Postscript: As of August 2004, Steve Rogers reports that he's still doing great and feeling fine. He's back at work and tries to play golf with his sons three times a week.