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All in the family

When a community hospital treats patients like family, magic happens.

Like many people, Terry Silimanis tried to ignore the physical discomfort he was feeling for as long as possible. However, in November 2023, after more than a year, the then 49-year-old road construction worker started to feel generally unwell. He lost a significant amount of weight, found blood in his stool, and knew it was time to see a doctor, even if he wasn’t happy about it. “I don’t like hospitals. If I needed stitches at work, it was basically some tissue and electrical tape,” he says with a laugh.

The results of Silimanis’s colonoscopy revealed the source of his symptoms—his physician found a tumour in his rectum. He was immediately referred to Dr. Sam Babak, a medical oncologist specializing in gastrointestinal cancers at Oak Valley Health’s Markham Stouffville Hospital (MSH). Further tests and imaging confirmed more difficult news: Silimanis had Stage 4 colorectal cancer that had spread to his liver.

“That was a complete shock to us,” says Silimanis’s sister Elaine Makos, who has served as his advocate and support throughout treatment. While there was a history of cancer in the family, everyone was diagnosed much later in life. “We figured we’d get it in our 70s or 80s.”

According to the Canadian Cancer Society, colorectal cancer is the fourth-most diagnosed cancer in Canada, with a projected 25,200 new cases in 2024. What’s more, scientists around the world have been tracking an increase in colorectal cancer rates for people under the age of 50.

A Stage 4 cancer diagnosis sounds terrifying, though ideas around cancer staging may be somewhat outdated, given many of the advances in treatment and more precise surgical capabilities. “Generally, Stage 4 cancer is not curable, however that doesn’t mean it’s terminal,” explains Dr. Babak. “For colorectal cancer, when we combine different treatment methods, we can cure some of these patients, especially ones that have limited disease spread.”

In the case of Silimanis, the cancer had only spread to his liver, making him exactly the type of patient Dr. Babak is referring to.

A Multidisciplinary Approach

In January 2024, Silimanis’s care team—which included Dr. Babak, who oversaw chemotherapy, a surgeon for the tumour in his rectum, another surgeon for his liver, a social worker, a nurse navigator, radiation specialists at another hospital, and more—worked together to determine the best course of treatment. He potentially required surgeries for two different organs, radiation to reduce the size of the tumour, and chemotherapy to stop the cancer from spreading.

The appointments at MSH became something both Silimanis and his sister looked forward to because of the level of care and comfort offered by nurses and support staff in the cancer centre. There, he received chemotherapy in the Systemic Therapy Suite—which also offers immunotherapy, targeted drug therapy, and other supportive cancer treatments—in a private patient bay, complete with his own television.

“Honestly, they made chemo enjoyable for him,” says Makos. “If you had questions, they weren’t afraid to answer. If you wanted a hug, they’d give you a hug. They were like family.”

The continued expansion of MSH’s cancer centre, which is made possible by generous support from the community through Markham Stouffville Hospital Foundation, is vital for delivering compassionate care for this growing region.

They all care—they all know me by name at the clinic, and we joke around every time I’m there. It feels like home now.

Terry Silimanis

Collective Effort

Not every community hospital has access to the wide variety of advanced treatments and surgeries needed for complex cancer cases. While MSH has an exceptional team of oncologists and surgeons, diagnosing certain cancers and providing the most effective treatments available can be challenging. To help bridge that care gap, MSH partnered with the Princess Margaret Cancer Care Network in November 2023, becoming the fourth cancer centre in Canada to do so. “The collaboration has enhanced our ability to refer patients to comprehensive survivorship programs, obtain second opinions, and augment our commitment to refer patients to clinical trials,” notes Dr. Mateya Trinkaus, another medical oncologist at MSH.

Within Canada, the Princess Margaret Cancer Centre (PMCC) offers unparalleled access to clinical trials for testing potentially effective cancer treatments. Ultimately, MSH’s goal is to co-partner with PMCC to run some of these trials with joint monitoring, drug administration, and patient assessments in Markham that otherwise would have only happened at PMCC.

“Travelling to Toronto is a major obstacle for many patients,” adds Dr. Trinkaus. “We hope this goal becomes a reality in the near future so patients can have access to that groundbreaking research closer to home.”

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A Future of Possibilities

After a course of chemotherapy, Silimanis underwent radiation to shrink the tumour as much as possible in an effort to save his sphincter and rectum. Unfortunately, it wasn’t enough, and due to a lack of response to the treatment and the symptoms he was experiencing as a result of the tumour’s location, radiation was cut short.

“I basically hit rock bottom doing radiation,” he says. “But that’s how you show your colours and bounce back. I just said, ‘Screw it, do the surgery.’”

In August 2024, Silimanis had an operation to remove the cancerous tumour, his rectum, and one foot of his colon. He also had a colostomy—a surgical procedure to cut an opening in the large intestine for stool to drain from your colon and out of a hole in your abdomen into a bag. While the recovery process has been challenging, Dr. Babak has been impressed with his progress. The next step is an MRI and CT scan of his liver to determine how much additional surgery is possible.

“With the approach that we take, I think he’s going to have a good outcome,” Dr. Babak says. “I’m just giving him everything possible to get there.”

Silimanis knows Dr. Babak and the rest of the MSH team are rooting for him, too. “He cares. They all care—they all know me by name at the clinic, and we joke around every time I’m there. It feels like home now.”

Story published in the Toronto Life on January 19, 2025

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