An active, healthy then 36-year-old, Kendall knew something was wrong. She went to her local primary care doctor who sent her to physical therapy. Bone cancer was not suspected due to her age because sarcoma usually strikes children or young adults in their early 20s.
“PT didn’t help alleviate the pain, but I had a wedding to focus on,” Kendall said. “My busy life took priority.”
Minor mishap reveals major diagnosis
In February 2022, Kendall and her husband, Jim, were married and soon a rescue puppy named Loki joined the family.
In May, their world turned upside down.
“My pelvis became so weak that it fractured one day with a simple twisting motion when my dog’s leash was caught in the wheel of our golf cart, and I was pulled suddenly in one direction,” Kendall described.
The injury during the outing with Loki is what led to a cancer diagnosis
Scans were performed to determine why her pelvis shattered so easily. That’s when a mass was detected. A needle core biopsy followed to identify the type of tumor, which would help determine the best course of treatment.
“I was diagnosed with a cancer known as undifferentiated pleomorphic sarcoma of the bone,” Kendall said, with the tone of someone who had educated herself thoroughly about the disease.
She explained that the word “undifferentiated” is used because the cancer cells do not resemble other types of sarcomas. The term “pleomorphic” refers to the cells growing in different sizes and shapes. It was a rare and aggressive sarcoma.
‘Avengers’ team assembled
The cancer center’s sarcoma services group was brought in immediately to review Kendall’s complex case. The team included radiation oncology, medical oncology, and other surgeons who focus and specialize in the treatment of sarcoma.
UC Davis Health surgeon Steven Thorpe, an associate professor with the Department of Orthopaedic Surgery, was assigned to lead a team that Kendall later named her “Avengers.”
“Chemotherapy was started right away, to decrease the risk of metastasis and hopefully to shrink the tumor, but this cancer is notoriously resistant to treatment, and it grew. The tumor invaded not only the pelvis but also part of Melissa’s sacrum,” Thorpe said. “I let her know what was at stake and I recommended an external hemipelvectomy and partial sacrectomy, which meant removing her pelvis along with partial removal of the sacrum and her leg.”
It was a life-changing moment.
“Dr. Thorpe gave me all the information to make the decision,” Kendall said. “I relied on my faith and prayed about what I should do. It was a big decision but ultimately, with the support of my family, I decided to proceed with the surgery, which I knew would leave me with only one leg.”
Thorpe pulled together the team that would see Kendall through the day-long surgery. It included experts in urology, orthopaedic spine surgery, general surgery and plastic surgery.
One of the team members was Osama Raslan, an assistant professor in the Department of Radiology. He specializes in using advanced 3D radiographic imaging technologies like 3D printing and augmented reality. His goal is to help surgeons plan and safely execute complex surgical procedures such as hemipelvectomies while sparing as much healthy tissue as possible.
3D model of her pelvis helped prep for surgery
Raslan and his biomedical engineering partner Steven Lucero used Kendall’s CT and MRI images to create a real-life 3D printed replica of her pelvic region. It was complete with the tumor, major arteries, veins and nerves running along the tumor. Both Raslan and Lucero work in the UC Davis 3D Printing and Visualization Lab.
Using specialized software and a CT scan of Kendall’s pelvis, Raslan meticulously defined the boundaries of the normal bone, the tumor, and the surrounding critical structures. The computer then generated a digital 3D replica of these structures, which the team reviewed and authenticated before the replica of her pelvic region was created.
Raslan said the size and location of Kendall’s tumor were unique. It was very closely connected to the major arteries, veins and nerves that supply the pelvis and left leg.
The model not only helped surgeons prepare for her complex surgery, it was also used to help Kendall’s family visualize what she was undergoing while they waited for her to come out of surgery.
Due to her positive attitude, faith and family support, Melissa was able to go home from the hospital earlier than expected.
Looking ahead to an exciting future
“Dr. Thorpe encouraged me every step of the way, which helped keep up my spirit. His fist bumps and high fives really meant a lot to me. And even though we all wore masks, Dr. Thorpe’s eyes tell you he is in it wholeheartedly,” Kendall said.
The Auburn resident is in physical therapy and is hoping to return to many of the outdoor activities she loves, thanks to a prosthetic leg and a lot of rehabilitation. That includes skiing at nearby Tahoe resorts.
Through social media, Kendall has connected with other hemipelvectomy patients, including one woman who after her surgery was able to become pregnant and have two sons.
“That’s one of my goals — to be a mother,” Kendall said. “I feel so supported at UC Davis Health as I pursue starting my own family. My ‘Avengers’ saved my life, and I will be forever grateful.”
3D printing technology guides sarcoma surgeries
3D-printed surgical technology is helping guide UC Davis surgeons in the operating room where a millimeter means the distance between success and failure.
UC Davis Health orthopaedic surgical oncology surgeon Steven Thorpe uses custom 3D-printed surgical guides for bone cancer resections and reconstruction.
“These cutting guides come from scans done before the surgery. They show us where to make cuts around the tumor with excellent margins, so we can preserve as much good bone or normal tissue as possible,” Thorpe said. “The guides are like a template, but specific to each patient and planned in three dimensions. We can narrow what we take out, which cuts down on recovery time and we can make more complex cuts with confidence.”
The custom plastic guides are currently made by a company specializing in commercial 3D-printing applications. Magnetic resonance imaging (MRI) and computed tomography (CT) scans of the patient are used to create the 3D-printed custom guides and 3D planning of custom metal implants.
The widths and geometry of the guides vary depending on the individual tumor. Each guide is about a half centimeter thick — or two-tenths of an inch. After moving aside the soft tissue, the guides are then placed against the bone, any necessary saw cuts are made, and then the tumor is removed.
The lab is where it all begins
Osama Raslan is the co-founder and co-director of the 3D Print and Visualization Lab (3D PrintViz Lab) and an assistant professor of clinical radiology.
“Our team’s 3D printing brings tumors to life, so to speak,” Raslan said. “This allows surgeons to intuitively know the size and extent of the tumor, or, for example, how much of the pelvic bone needs to be removed. It also gives an intimate understanding of the relationship between the tumor and the major arteries, veins and nerves.
Thorpe and Raslan said life-size 3D models of regions that contain tumors are becoming essential to better surgical outcomes for patients.
Surgeons refer to the model during the surgery. For example, if a patient’s operative position must change, such as moving from lying on the back or belly, the model can enhance the surgeon’s visual reorientation.
