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Lebanon, Mo., Resident Survives Deadly Bile Duct Cancer With Novel Treatment

Mike Morgan jumps for joy one year after receiving a liver transplant to treat his bile duct cancer.

Mike Morgan gives a thumbs-up after his six-hour liver transplant surgery.

May 20, 2011 – Two photos have been making the rounds in the Barnes-Jewish Hospital transplant office. One photo shows a pale, gaunt man in a hospital bed, a tube in his nose and blood pressure cuffs on his arms. The other shows a well-fed man in a checkered shirt and jeans, jumping in the air and clicking his heels in front of a row of banjos.

Two photos. One year apart. Same man.

The photos are of Mike Morgan, 56, of Lebanon, Mo. Morgan celebrated the first anniversary of his liver transplant on April 7 by e-mailing the photos, captioned, “One year later and STILL KICKING,” to liver transplant coordinator Melissa Behr.

Morgan had suffered from a rare form of cancer – cholangiocarcinoma – cancer of the bile duct. Until a few years ago, the prognosis for cholangiocarcinoma was uniformly dire. Patients were usually told to go home and get their affairs in order.

Morgan, however, was lucky enough to be referred for treatment to Washington University physicians at the Siteman Cancer Center and Barnes-Jewish Hospital, where a pioneering protocol of chemotherapy, radiation and organ transplant is giving certain cholangiocarcinoma patients, such as Morgan, a second chance at life.

“This is a very novel therapy,” says William Chapman, MD, chief of general surgery and transplant surgery at Washington University School of Medicine. “You can probably count the number of centers in the country that offer something like this on one hand. But it’s been very effective thus far.”

Morgan’s transplant story began in late 2008 when a drunk driver fleeing police crashed into the music store he had owned for almost 30 years and burned it to the ground. Morgan worked nonstop to re-open the store, which was known in southern Missouri as a mecca for bluegrass and other musicians.

“Mike always says if you can play it, we sell it,” says his wife, Kathy, a third-grade teacher in Lebanon.

Despite support from his staff, his wife and their two daughters, Morgan found the rebuilding process extremely tiring. He chalked it up to stress until July 2009, when one of his daughters remarked that his eyes looked yellow.

Kathy, too, noticed the jaundice, and Mike saw his family physician. The results of lab tests and an exam led the family physician to refer him immediately to a gastroenterologist in Springfield, Mo. The family doctor thought Morgan might be suffering from pancreatic cancer.

“We knew it wasn’t going to be pretty,” Kathy says.

In Springfield, Morgan had the first of several endoscopic procedures to examine his pancreas and liver. The exam revealed that his jaundice was actually caused by a biliary tumor, a growth on his bile duct. The tumor was obstructing the flow of bile from his gallbladder and damaging his liver, causing him to become jaundiced.

The gastroenterologist immediately referred Morgan to Siteman. Morgan first saw upper gastrointestinal surgeon Stephen Strasberg, MD. Initially, Strasberg gave the Morgans bad news – simple surgical removal of the tumor wouldn’t be possible. The good news, Strasberg told the Morgans, was that they were at one of a handful of centers in the United States that could offer a therapy protocol for cholangiocarcinoma.

“In 2005, we put this protocol together,” Chapman says. “One of the unique aspects of our center is that we have the expertise here to be able to offer an in-depth, multidisciplinary therapy like this.”

The Morgans met with Chapman and the liver transplant team. “As soon as we met Dr. Chapman, I had this feeling of calm come over me, and I knew everything was going to be okay,” Kathy says. “He has an air about him that just inspired confidence in us.”

But Chapman explained to the Morgans that the treatment protocol had strict criteria and several complex stages. Over the coming months, Mike would undergo a six-week course of chemotherapy followed with a five-week course of chemotherapy, with concurrent radiation treatments to shrink the tumor and keep it from spreading. He would also have to undergo a surgical procedure to make sure the cancer had not spread outside of his liver. And he would have to be on oral maintenance chemotherapy drug until a donor liver became available. Then he would have a transplant.

Despite losing weight, making frequent trips to St. Louis for checkups, treatments and hospitalization, and battling fatigue and infections, Morgan tried to live as normal a life as possible, even opening a new music store. Then, late on April 6, the Morgans got a call that a donor liver had been found and they needed to get to St. Louis as quickly as possible.

The three-hour drive from Lebanon was bittersweet, Kathy says. “We could finally see the end of the road for Mike’s illness. But at the same time, we felt guilty. We knew that getting a donor liver meant that someone had lost someone they loved. We prayed the whole time we were driving.”

Morgan received the donor liver in a six-hour surgery performed by Chapman. Afterward, he was taken to the surgical intensive care unit. In a hospital gown, with tubes in his nose and his arms, Morgan gave a thumb’s up. His sister took a photo.

Morgan progressed quickly and was soon out of the hospital. Over the past year, he has recovered – though he’s had some bumps in the road. Chapman says that evidence so far is showing the cholangiocarcinoma protocol is effective in eradicating the disease and that Morgan has an excellent prognosis. 

“I can’t say it was easy or fun,” Kathy says of the experience, “but it was worth it.”

The proof, she says, are in two photos.