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t m c ยป p u l s e | n o v e m b e r 2 0 1 7 24 24 T he growth on Marian Fields' back started out in the fall of 2011 as a lump the size of a half dollar, right along the center of her spine. At first, the 66-year-old and her twin sister, Mary Jane, thought it was an innocuous cyst. A dermatologist sliced it out, but within nine months, the growth grew back again. And again. And again. And again. Marian endured six surgical procedures and 30 radiation treatments to remove the growth, but the tumor and radiation damage had sprouted into a painful, hard, leathery mass that engulfed nearly every square inch of her back. For years, she was unable recline in her seat or sleep on her back because of the pain. The radiation fibrosis "was like the worst sunburn you ever had," Marian said. Mary Jane would continuously rotate through ice packs to help alleviate the burning on her sister's back. In October 2016, Marian went to see a plastic surgeon at the University of Kansas Hospital in hopes of finally freeing herself from the incessant nightmare on her back. But when the doctor saw the severity of her condition, his response crushed her. "I walked out of the doctor's office crying and scared to death," Marian said. "He was very discouraging and said that he didn't see how I would ever have anything beyond a major hole in my back. There's no amount of skin that could cover what would have to be cut out. There was no way it could be done. My quality of life would be signifi- cantly diminished." Soft tissue sarcoma After Thanksgiving 2016, Marian noticed that she had developed multiple lumps on her back, some of which had grown so quickly that they became necrotic, and the open sores exposed raw flesh. In a Hail Mary attempt for a cure, the Fields twins traveled in March 2017 from their home in Independence, Missouri, to The University of Texas MD Anderson Cancer Center, where sarcoma expert and surgical oncol- ogist Keila Torres, M.D., Ph.D., diagnosed Marian with plexiform fibrohystiocytic sarcoma, an extremely rare and aggressive type of soft tissue cancer. Soft tissue sarcoma accounts for less than 1 percent of all cancers, but Marian's specific type of sarcoma is so rare that there have only been 150 reported cases since the 1980s, Torres explained. The tumors grow in interlaced nodules that multiply on top and beneath the skin's surface. Because of the rarity of the disease, coupled with the inconspicuous nodules, there is a 50 percent chance of the tumor recurring. But Marian's tumor had grown back every single time, seven times. (continued) Three TMC doctors, two identical sisters and one extraordinary transplant By Shanley Chien Right: Mary Jane Fields (left) donated a large portion of skin from her abdomen to her identical twin, Marian (right), who underwent extensive surgery at MD Anderson to remove tumors on her back.