Noel B. – Small Bowel Cancer Patient Story

In fall 2023, routine blood work that Noel B.'s primary care provider ordered during her annual appointment showed low hemoglobin and elevated liver enzymes. A week later, she was referred for an ultrasound and advised to see her gastroenterologist near her home in Mechanicsburg, Pa.

After Noel, 52, met with her gastroenterologist in mid-November, she had an endoscopy the next day. The doctor found a duodenal neoplasm (tumor) in her small intestine.

“I asked him, ‘Should I be worried?’ and he said, we can’t tell if it’s cancerous without a biopsy,” says Noel.  

Her doctor expedited the biopsy results and consulted with a pathologist the same day. A second opinion confirmed it was duodenal adenocarcinoma, a rare, cancerous tumor.

With no family history of cancer, Noel was surprised about her diagnosis. “But, as they say, cancer doesn’t discriminate,” she says.

A CT scan of her chest, pelvis, and abdomen revealed her cancer was locally advanced in her duodenum — the first part of the small intestine that connects to the stomach — and hadn’t spread. 

Noel’s gastroenterologist referred her to Charles “Chip” Reninger, MD, a medical oncologist at UPMC Hillman Cancer Center at UPMC Outpatient Center in Mechanicsburg, and Kyo Chu, MD, a surgical oncologist and director of Surgical Oncology for UPMC in Central Pa.

“After meeting them, my husband and I decided we wanted this team,” says Noel, who'd lacked symptoms up to this point but was now experiencing fatigue and jaundice.

She was quickly scheduled to have a Whipple procedure at UPMC West Shore, close to her home, on December 6.

Advanced Surgical Treatment, Close to Home

Also known as a pancreaticoduodenectomy, the Whipple procedure is the most common surgery to remove tumors from the pancreas and adjacent organs, including the duodenum.

Using this complex surgical technique, Dr. Chu, along with surgical oncologist Samer AlMasri, MD, removed part of Noel’s pancreas and GI tract, as well as her gall bladder. They then rebuilt and rerouted the pancreas to her small intestine.

The goal was to fully remove the cancer to prevent it from growing and spreading to other organs. Noel’s surgery was a success — her mass was removed, and there were no signs of spread to her nodes.

“I couldn’t have had a better outcome,” she says. “From the minute we met the hospital team, I was treated with empathy and compassion. I received kindness, hugs, reassurance, and professionalism.”

Noel treasures the memories of her care team and UPMC's "incredible" staff.

"The doctors came in daily, and the two residents were wonderful," she says. "They were encouraging and hands-on. They told my husband, ‘Don’t worry. That’s our job.’ I commend the nurses and aides, who were so attentive. Even the cleaning and food staff members acted like I was their patient. They made my room clean, and it was encouraging. My nurse even gave me a pillow that my care team signed.”

Noel took an eight-week leave from her job. Her mother stayed with her for three weeks, and her husband took six weeks off work.

“It’s a blessing we didn’t have to travel for surgery and care," she says. "My family support is close by.”

Comprehensive Cancer Care

But while Noel recovered physically, she struggled emotionally. She turned to oncology counselor Jennie Lawler, LCSW, for help along with various cancer support services, including a support group for survivors and meetings with a dietitian and genetic counselor, Meagan Elizabeth Smith, MS, CGC.

At a follow-up appointment just three months after her cancer diagnosis, Dr. Reninger and Dr. Chu confirmed she was cancer-free. Still, they recommended residual disease testing, where blood is drawn to look for circulating tumor DNA. In February 2024, those test results came back negative. With no signs of cancer, chemotherapy and radiation weren’t advised.

Noel continues to follow up with Dr. Reninger and Dr. Chu every three to four months for scans and bloodwork. She’ll also need a one-year follow-up endoscopy.

“I feel grateful and blessed," says Noel. "I am so thankful for this program in our community."

Noel’s treatment and results may not be representative of all similar cases.