Fighting Her Way Through Bone Cancer Treatment

The diagnosis of chondrosarcoma, a rare bone cancer, stunned Daniella Cippitelli Abruzzo, a kick-boxer from New York. But she drew on her fighting spirit to endure the bone cancer treatment and get back into the gym. Learn more about her inspiring story. Plus, find out how much you know about bone cancer with our quiz...

At 40, Daniella Cippitelli Abruzzo decided it was time to get back into shape. The Long Island nativeand owner of a web development and marketing company had gained weight during her second pregnancy and looked forward to returning to her active life of scuba diving, practicing martial arts and kick-boxing.

As her body fat melted away, a curious lump on her chest became uncomfortable and more noticeable.

Mammograms ruled out breast cancer, although one technician asked whether she’d ever broken a rib.

“I was active in martial arts, so I thought it was possible,” Abruzzo says.

Tests showed the abnormality was a 4-centimeter mass on her rib, about the size of a Ping-Pong ball.

“It was so big, it had to come out,” she says.

Preparing to fight
“When the surgeon said they had to remove my rib, my husband and I both just stopped breathing and looked at each other,” she says.

Abruzzo had a toddler daughter and a son about to start kindergarten. She had just launched a new business. She wasn’t ready to take time out from her life.

The growth was probably benign, her doctor said, but they wouldn’t know until after it was removed.

“Something deep inside was telling me, Get ready for this,” she says.

Just before surgery, she decided that if she did have cancer, she wouldn’t let it change her life.

“I was definitely going to fight the good fight,” she says.
Waiting for an answer
Surgeons cut through Abruzzo’s pectoral muscle and removed her fourth rib during a 3-hour procedure. They implanted a layer of surgical mesh to take over the rib’s job of protecting that part of her lung.

She had worried that the scar would be disfiguring, but because her surgical team included reconstructive (plastic) surgeons, “you can’t even see the scar,” Abruzzo says.

She began walking the hospital halls for exercise almost as soon as the anesthetic wore off. She was discharged after three days – sooner than the 5-7 days she’d been told – and sent home to await biopsy results.

Nearly two months later with still no word, Abruzzo started getting nervous. (She later learned her oncologist had forwarded tissue samples from her tumor to major cancer centers to confirm the preliminary diagnosis. )

An unexpected diagnosis
Then her doctor called her with the diagnosis: Chondrosarcoma, a primary bone cancer that produces cartilage cells as it invades bone.

“Chondrosarcomas are relatively rare types of malignancies,” says James C. Wittig, associate professor of orthopedic surgery and chief of orthopedic oncology and sarcoma programs at Mt. Sinai Medical Center in New York and Hackensack University Medical Center in Hackensack, N.J.

Chondrosarcoma is the second-most common type of bone cancer after osteosarcoma. Chondrosarcomas develop in an equal number of men and women after age 40. The tumors appear most often in the legs, pelvis or shoulders, Wittig says.
Bone cancers often are diagnosed when they show up unexpectedly in an X-ray taken for another purpose, such as an injury. But because bone cancers are so rare, routine screening is not recommended, Wittig says.

What causes bone cancer is unknown. Researchers don’t believe chondrosarcomas have a hereditary link.

“And it’s not likely to be caused by anything you’ve eaten or been exposed to,” Wittig says.

To keep it from coming back
Surgical removal of the tumor is the mainstay of bone cancer treatment. Chemotherapy isn’t very effective against chondrosarcomas, Wittig says, possibly because cartilage tissue doesn’t have the extensive blood supply necessary to distribute the medication to the tumorfor medication to reach the tumor.

A 2011 study at Regensburg University Medical Center in Germany found that chondrosarcomas contain a gene called survivin that makes these tumors especially resistant to chemotherapy.

“Radiation is used in selected cases, to prevent the tumor from recurring,” Wittig says.

Abruzzo didn’t need any more surgery, and to decrease the chances of her cancer recurring, her oncologists recommended a series of 32 radiation treatments.

The first few treatments were painless and easy.

“Then my skin started to get raw and irritated,” she says. Because of the treatment location, it even became painful to wear a bra.
Inspiration from others
During cancer radiation treatments, Abruzzo found inspiration from young bone cancer patients. “I kept thinking, Geez, there are kids who make it through this. And they don’t even know what’s happening.”

The memory of her father, who passed away from colon cancer a few years ago, also kept her going.

“He was so dignified when he was sick. I wanted to be as dignified as he was,” she says.

Radiation treatments left Abruzzo with darkened, “sunburned-looking” skin on part of her chest. But in the four months since her final treatment, the skin has healed and the tenderness has subsided, though “the area is still sensitive,” she says.

Returning to normal
Abruzzo’s business partner kept their startup running during Abruzzo’s two months of cancer radiation treatment, and health insurance covered most of the expense of surgery and treatments.

Until her pectoral muscle healed, she was forbidden from doing anything strenuous or lifting her toddler daughter. She tried yoga for a few weeks, but was eager to get back to more vigorous exercise.

When a patient returns to exercise depends on the location of the tumor and what was done to remove it and reconstruct the area, Wittig says. In a non-weight-bearing part of the body such as a rib, patients can “start easing back into exercise and start increasing their cardio strength when the wound heals,” he says.

That came not a day too soon for Abruzzo. “As soon as they gave me the OK to walk on the treadmill, I started working out again,” she says.
Back to the gym
Now Abruzzo does cardio and weight training six days per week. She’s even resumed kick-boxing.

But “I do my kick-boxing with a bag now,” she says, and avoids contact martial arts because the radiation treatments may have weakened her bones.

She also pays attention to her body’s signals.

“I stop when it feels like too much,” she says.

People at the gym were surprised to see her back just a few months after bone cancer treatment, but she wasn’t, Abruzzo says.

“I was determined to be healthy, even when life throws curveballs.”

Hope for the future
Research has made some promising discoveries about bone cancers. A 2011 study at the University of Mississippi showed that treating patients with an immune system protein called interleukin-1-beta slowed the growth of cancerous cartilage. And a 2010 study in Greece found that cryosurgery - deep freezing of cells - controlled bleeding and made it easier for surgeons to remove tumors from the spine.

Abruzzo says the hardest part of the experience has been the uncertainty of the future. She will need regular check-ups to track her health.

“Once you’ve had a cancer diagnosis, you’re always going to wonder, What if it comes back?” she says.
Abruzzo has reason to be optimistic. Wittig says a low-grade chondrosarcoma “has a very, very low chance of metastasizing.”

More aggressive, high-grade chondrosarcomas have a 65%-85% chance of metastasizing, he says.

Advice for others
“You’re always stronger than you think,” Abruzzo says to cancer patients. “If you refuse to believe this will destroy you, you have a better shot at beating it. Cancer tried to get me, but I kicked its ass.”

For more information, visit our new Bone Cancer Health Center.

How Much Do You Know About Bone Cancer?
Although bone cancer is extremely uncommon in adults, it’s the sixth most common cancer in children, so parents should be aware of the disease.