Elissa's journey: A young mom's relentless battle for life after colorectal cancer hit
Cancer is cruel. It doesn’t care that you’re only 37, that you're the mother of a little girl who is your entire world. So Elissa vowed to fight.
It was blue, so blue — the clear sky, the water glistening in the sunlight, the shirts on the backs of hundreds who gathered along the Detroit River, and the ribbons that twirled from the tip of a small wooden stick in 10-year-old Harper Robinson’s hand.
She spun around, making the satin streams of blue dance.
Her mother, Elissa Robinson, stepped before the crowd gathered on the Detroit RiverWalk on a crisp Sunday morning in early September and took the microphone.
Her blue shirt, the color of colorectal cancer awareness, said, “Survivor.”
Elissa spoke about the day when she walked into her gynecologist’s office as an ordinary mother, wife and journalist but left as a cancer patient.
“Talk about a day you’ll never forget,” she said of May 4, 2021. That was the day Elissa’s doctor told her that the fluid she had drained from a cyst on her left ovary two weeks earlier was cancerous.
“The diagnosis blindsided me. Just like that, my husband and I found ourselves in a world that suddenly felt like it had been designed by someone with a really dark sense of humor.”
For months, Elissa had felt abdominal pain and bloating, especially on her left side, she told those gathered near the Detroit River that September day.
Elissa recalled the fear that threatened to consume her as her doctor explained the culprit was not ovarian cancer but colorectal cancer, which had spread to her ovary.
“I started to panic. ‘How far (had it spread)?’ was my first question,” Elissa said. “She didn't know. … The next thing I said was, ‘but I have a 6-year-old.' ”
In that single vulnerable moment, Elissa came to realize what so many already know firsthand: Cancer is cruel.
It doesn’t care that you’re only 37 years old, that you're the mother of a little girl who is your entire world.
When the only certainty was uncertainty, Elissa vowed to live.
She chose to accept nothing less than surviving long enough to ensure Harper would remember her mother.
Long enough to throw a lifetime’s worth of softballs to the little girl with her same wavy, golden hair, long arms and legs, and broad smile.
Long enough to jump herself breathless with Harper’s hands in hers on the trampoline of their home in Macomb Township, Michigan, and to take many more Mother’s Day trips to Longboat Key, Florida, with her family.
Long enough, she prays, to one day help her little girl shop for a prom dress and be there when Harper tosses her cap at college graduation, walks down the aisle and holds her first child.
“It will never be enough,” Elissa said. “I think all the time, is she old enough now that she’ll remember me?”
The price has been steep for even the four years since that unforgettable day at the gynecologist’s office.
Elissa learned in the weeks that followed that her colon cancer was stage 4 and had spread to her liver and ovaries. Now there are about seven cancerous nodules on her lungs.
She has endured 67 chemotherapy infusions that have brought relentless exhaustion along with waves of nausea, diarrhea and vomiting. She underwent surgery that removed 60% of her liver, 25% of her colon, her ovaries and her gallbladder. At times, her hair falls out in clumps and her skin peels. She also has had neuropathy in her fingers and feet and cold sensitivity so intense, she sometimes can’t even reach into the refrigerator for a snack.
“I'm practically a jigsaw puzzle at this point, but I am still here, still standing, still fighting,” she said.
She and her husband, Russell Robinson, have been dogged in searching for the top surgeons, leaders in interventional radiology, oncology and colon cancer research — innovators in treatments who might give Elissa an edge over a disease that is expected to take the lives of 53,000 Americans this year.
“In her journey, all along, one of my roles has been to help identify the best possible people out there, whoever they are, wherever they are,” Russell said.
That’s how Elissa became one of the first five people in Michigan outside of clinical trials and one of the first 15 nationally to undergo a revolutionary new treatment pioneered at the University of Michigan called histotripsy, which uses ultrasound waves to target cancerous tumors in the liver. It essentially liquefies them without so much as a needle poke or incision, without burning any tissue, without radiation or chemo. There’s almost no pain or recovery time with histotripsy, and it is far less risky than other interventions.
It was worth trying with the hope that it might give Elissa another year, another month, another week, another hour to spend not only with Harper, but with Russell, who holds the family together even as pieces of the facade crack and threaten to fall.
It was worth it to potentially buy more time with her parents, Betty and Sam Saputo, who already lost a child far too soon. Elissa’s only sibling, Nick Saputo, whose nickname, “Nicho,” is tattooed on the inside of her left wrist, died in 2010 in a car accident at the age of 28.
She still chokes up when she talks about him, knowing her parents will be childless if cancer takes her life, too.
So she fights every single day — even as she continues her work as a web editor at the Detroit Free Press, part of the Paste BN Network. She's often the person her co-workers rely on when news breaks to optimize and post stories on Freep.com, to come up with masterful headlines and catch spelling and grammatical mistakes. She writes stories, too, including creative historical lookbacks and photo galleries that often are among the site’s top-viewed.
Work, she said, “puts my mind on something else.”
It keeps her busy. It keeps her from stewing about the cancer. She said she’ll keep at it as long as she physically is able.
“I think about my life expectancy several times a day,” Elissa wrote in a June 2023 Facebook post. “It's easy to find that dark hole and climb in. Thoughts of the future and my place in it sit in my brain 24/7. But with laughs, family and memories and quite honestly, work, to keep me busy, I can also put the ugly stuff away and enjoy the moment.”
Those moments include donning Honolulu blue and rooting for the Detroit Lions at Ford Field with her dad, taking Harper to see a Taylor Swift tribute band and making friendship bracelets with her, catching a Broadway play in New York with her mom before a doctor’s appointment at Memorial Sloan Kettering Cancer Center, and date nights with Russell, seeing a comedy show, a movie or a concert.
Through it all, Elissa has been incredibly open about her victories and her struggles with cancer, sharing her story at an event for Gilda’s Club Detroit, on local TV news programs and by posting on Facebook, always ending with the line: “Check your colon” to encourage other people to get colonoscopy screenings.
When the Detroit Walk to End Colon Cancer fell on a chemo weekend − when the crippling exhaustion and nausea that follow treatment can knock her down − Elissa put on her aquamarine “survivor” T-shirt and joined the crowd.
“I can’t believe she’s doing this after chemo the last two days,” Russell said on that crystal clear Sept. 8 morning. “She was kind of worried and she said, ‘I might need a wheelchair.’ But here she is, doing it.”
She walked the whole way. When it was all over, Elissa smiled and said: “The adrenaline of this day always gets me through it.”
Concept of histotripsy takes shape: Can it help Elissa?
Although Elissa and Zhen Xu, a professor of biomedical engineering at U-M, have never met, their stories connect in a way that had the potential to alter the course of Elissa’s life.
But to make that connection, we’ve got to rewind the clock more than two decades to 2001, when Xu was a 22-year-old doctoral candidate.
She had moved to Ann Arbor from China to study biomedical engineering under the tutelage of Charles Cain, Ph.D., who founded the department of biomechanical engineering at U-M and was her mentor. Xu needed a project for her dissertation.
A pediatric interventional cardiologist had come to Xu and Cain to ask whether they could create a tool that would allow him to treat infants with congenital heart problems without the risk of invasive surgery.
“He basically said, ‘It's going to be very valuable to have a medical technology or a tool that will allow us to do real surgery and physically remove tissue, but in a noninvasive way — without having to cut open patients.’ A knifeless surgery is what he was looking for, and it was not available at the time,’ ” Xu said.
She and Cain considered whether there might be a way to use intense, targeted ultrasound pulses to quickly expand trapped air bubbles in heart tissue and then force those bubbles to collapse. The action, called acoustic cavitation, would liquefy the tissue around the air bubbles, allowing doctors to use those concentrated, controlled soundwaves like an incision-free knife.
“That was the inspiration of inventing histotripsy,” Xu said.
The idea was seen as an impossibility, Xu said, because scientists hadn’t yet figured out a way to precisely target a treatment area to control the process of cavitation.
“At the time, commercial devices were not capable of doing that,” Xu said. “So by inventing histotripsy, our group also had to not only come up with the specialized ultrasound pulse sequence, but we also had to reinvent the whole device so it could be specialized for histotripsy.
“We use microseconds of ultrasound pulse at a pressure level or amplitude that is 10 to 100 times of what is used for imaging — so it’s really high. Nobody had ever tried that before.”
In the beginning, the work wasn't glamorous
Xu recalls weekly trips to a slaughterhouse, where she said she begged for permission to rifle through the trash to retrieve discarded pig hearts for use in her research.
“I literally would go every week, and back then, they just threw the hearts in a trash can,” she said. “So I just had to do some digging in the trash can to get the hearts.”
She tried repeatedly testing the theory at a lab in Ann Arbor, using standard commercial ultrasound transducers and probes, but didn’t get the effect she’d hoped to achieve.
Still, Xu didn’t give up.
“We had this huge amplifier that nobody was using. It was running on a 380-volt supply,” she said. “I was like, 'I’m going to run it to the max that is allowed by the commercial device and just see what happens.' ”
On that day, 23 years ago: “I saw smoke coming out of the pig heart, and I was like, 'am I dreaming?' ” Xu said.
She captured the moment on video.
“The cells expand, and then kind of get squished and collapse,” Xu said, showing the black-and-white footage of the phenomenon she recorded more than two decades earlier. “You may not break up all the cells with one pulse, but if you do it over and over, tens and hundreds of times, eventually the cells will collapse.
“You can see there is actually a hole here.”
Shocked that it worked, she repeated the experiment.
“I did it again, and we were like, ‘Oh my God!’ And then the third time, I knew it was real,” Xu said.
“I literally walked into Charles’ office and said, ‘There’s good news and there’s bad news.’ He was like, ‘What's the good news?’ I said, ‘The good news is the experiments worked. The bad news is I destroyed the transducer.’
“At the time, it was a really expensive machine, and I was just in my first year and I was a little worried about that because … I wouldn't be able to afford to replace it.”
Rather than chastise her, Cain encouraged her to continue to refine it.
“We put our heads together and said, ‘If we really want to pursue this, we have to build our own instrumentation because the commercial systems are not designed to produce super high pressure within microseconds.’ ”
They named the phenomenon histotripsy, which is pronounced like this: HISS-toh-trip-see.
“Charles Cain is the one who came up with the name because he was trying to parallel it with lithotripsy,” Xu said. “Tripsy means mechanical breakdown in Greek. Litho actually means stone. So lithotripsy is the breakdown of stones.
“Histo means soft tissue in Greek,” Xu said, “So histotripsy is the breakdown of soft tissues, even though it’s a tongue twister.”
Xu and Cain knew “we were onto something really, really important,” but convincing the rest of the scientific world that what they’d just discovered was real took a lot of time and effort.
“For the first 10 years of my career — after I discovered the phenomenon — nobody believed me,” she said. “I kept presenting data, and it's consistent data, but people just don't think you can control cavitation in a predictable way for surgery.
“It took another 10 years to work on the mechanism and to understand what was happening and to come up with instrumentation. It was a long road.”
Something borrowed, something blue
As Xu worked to develop a technology that could revolutionize surgical care for people with advanced-stage cancer, Elissa graduated from high school and went on to study journalism and electronic media at Eastern Michigan University.
She interned at a local TV station, where she later landed a job as a news producer. It seemed as if life was coming together the way it should.
She and Russell were engaged in 2008 and her career was taking off.
Then came 2010, a pivotal year for Elissa and for Xu — in ways both good and bad.
In April, Elissa mourned the sudden death of her brother, Nick. Three months later, Elissa and Russell were married in Kauai, Hawaii.
Her brother was supposed to be there, celebrating with them.
“His plane tickets were bought,” she said. “His girlfriend was in my wedding party. We struggled with whether to go forward with it, but we agreed that he wouldn’t want us to put it off.”
In keeping with the tradition of the bride wearing something old, something new, something borrowed and something blue, Elissa slipped an opal ring onto her pinky. Her father gave that ring to her mother when they started dating. It represented her something old.
Elissa's earrings were new, and she borrowed a tiara from her cousin Jill Saputo, who, unbeknownst to them at the time, would be diagnosed with colon cancer six years later; she died from the disease in 2017.
Elissa also wore an ankle bracelet made by her aunt. That was her something blue.
As Elissa and Russell said their vows, Xu and Cain were working to build HistoSonics, the company they’d formed in 2009 with Tim Hall, a professor at the University of Wisconsin-Madison, and J. Brian Fowlkes, a professor of radiology and biomedical engineering at U-M.
Their company created the Edison System, a device with a robotic arm that delivers precision histotripsy treatments using a specialized, high-powered ultrasound transducer through a tub of water.
Although Xu’s experiments began in a quest to develop a tool for pediatric cardiovascular surgery, her efforts eventually shifted toward targeting tumors in soft tissue, especially those that couldn’t be surgically removed.
“Instead of having to cut open the patient, now they just outline where they want to treat on the image,” Xu said. Software can then be used to plan the path for the robotic arm.
The sound waves then travel through the body to the target zone, and blast away the tumor without damaging surrounding tissue.
“After treatment, the debris is absorbed by the body,” Xu said. “You see that the tumor has completely resolved and there’s like a 1-millimeter scar and that’s all that’s left. It’s almost like a surgeon went in and carved out the tumor.”
As they tested the effects of histotripsy in mice, Xu and her team discovered a surprising phenomenon.
If they treated one liver tumor but left another tumor untreated in the mouse, the second tumor would shrink or disappear altogether — as if destroying one mass with histotripsy triggered the immune system to attack cancer elsewhere on a cellular level — something called an abscopal response.
“We said, ‘What is going on? The tumors were in two different lobes. They were not even in the same lobe,’ ” Xu said. “They were pretty distant. What we found out is that histotripsy … actually stimulates T-cells and other immune cells, too, not only locally, but also systemically — in other places in the body.”
Xu described another experiment in rats with highly aggressive liver cancer. Scientists deliberately treated just 50% to 70% of a tumor with histotripsy.
“It was to test what would happen if a clinician mistargeted and didn’t treat the entire tumor,” Xu said.
One month after treatment, “the tumor was gone — even though we only treated 50% to 70% of the mass. It seems to stimulate more immune response than radiation or thermal ablation,” she said.
Xu began to imagine what this might mean for people with cancer if histotripsy activates the human immune system in a similar way.
“With a lot of cancers, people don’t get diagnosed until it’s at a really late stage. So, the body’s immune system doesn’t attack it because it doesn’t even know the cancer is there. It hides behind the cell membrane ... and the body doesn’t even know the invader is there. It can’t even start the first step of attacking.
Histotripsy disrupts the cell membrane, releasing tumor antigens that alert the body to a foreign invader.
"So the body's reaction is: 'Something is invading. I need to check what's invading.' Then, a cascade of immune response can be triggered. ... But you also caused cell death with histotripsy. It is not natural within the body. And the body's first reaction to any unnatural cell death is to start a defense mechanism."
Eight people were enrolled in the first human clinical trial of histotripsy in 2019 in Barcelona, Spain. One person had primary liver cancer. The others had cancer that originated in the breast, gallbladder, colon or rectum that had metastasized to the liver.
In two of the patients, other tumors that hadn’t been treated with histotripsy also began to shrink eight weeks after the initial mass was treated. Researchers noted that there was a reduction in patients’ tumor markers, too. Xu and her colleagues published their findings in 2021, showing what might have been the first evidence of an abscopal response in humans.
But Xu and her colleagues would need far more evidence than just two people in a trial that enrolled a total of eight, so that research remains ongoing.
However, the U.S. Food and Drug Administration found that histotripsy is a safe and effective treatment for liver tumors — both primary liver cancer and cancers that originated elsewhere, but metastasized to the liver. In the fall of 2023, it authorized HistoSonics' Edison device as a noninvasive ablation treatment option.
In late December of that year, the first patients outside of clinical trials would undergo histotripsy treatments.
Just when she thought it was over, Elissa's fight begins anew
The Robinsons dared to dream about what histotripsy might do for Elissa.
Nothing about the first three years of her treatments had been as simple — or filled with as much possibility — as histotripsy promised to be.
In the fall of 2021, surgeons at Memorial Sloan Kettering (MSK) in New York City removed more than half of Elissa’s liver in a massive surgery that also took her sigmoid colon, gallbladder and ovaries.
She spent weeks in New York recovering.
In true Elissa-like comedic fashion, she wore a blue T-shirt with the words “Chopped Liver” on the front to a follow-up appointment on Nov. 3, 2021, with her New York medical team.
That day, she was declared cancer-free — an enormous win.
“My cancer journey may not be over quite yet, but it sure feels like the beginning of the end ... and that feels amazing,” she wrote at the time.
She also underwent several rounds of postsurgical chemotherapy in Michigan to try to kill off any remaining cancer cells floating around in her body, and got CT scans every three months afterward to monitor for changes.
Unfortunately, her cancer-free status didn’t last long. In early 2022, doctors spotted liver tumors once again on one of Elissa’s surveillance CT scans.
“To say I'm heartbroken is an understatement,” she wrote. “My thoughts went from ‘this could all be over’ to ... this fight is just beginning. Again.
“Another summer of chemo and all the harsh side effects it comes with brings tears to my eyes. I'm angry at my body. I'm scared for the future. I just want to hug my family and never let go. To stare into my daughter's eyes and tell her over and over just how much I love her.
“This isn't fair.
“I find myself begging God, on repeat: Heal me. I'm holding onto the faith that He will. I just need to keep doing my part. I'll get there.”
Doctors changed Elissa’s chemotherapy regimen, and she had thermal ablations to zap those tumors in March 2022 and again in March 2023.
The Robinsons have a high-deductible preferred provider organization (PPO) health insurance plan through Russell's work as an education consultant.
Each January brings a mountain of new medical bills as the health plan's deductible resets. The Robinsons have money withdrawn from their paychecks that goes into a Health Savings Account to help shoulder some of the cost. They set up payment plans for the rest.
A GoFundMe account helped pay for Elissa's initial travel expenses in New York, but that money is gone now, and the Robinsons pay out of pocket for the airfare and the hotel rooms and the other expenses every time Elissa has to go back.
"We are racking up credit card bills for travel to New York," Russell said. "Every time she's gone to New York, no one's paying for that. No one pays $300 a night to get put up in a hotel. ... There are a lot of expenses that we have incurred."
Though finding a way to finance it all can be a struggle, Russell says he knows they are fortunate.
"It is a blessing to have employer-sponsored health coverage ... to have insurance that covers care in that particular state," he said. "That's huge."
Despite all their efforts to treat the cancerous masses in Elissa's liver, one tumor just wouldn’t go away. By early 2024, two additional spots had sprung up.
She and her family hoped histotripsy could be the answer to their prayers — and not only destroy those tumors, but perhaps also even trigger her immune system to attack the small nodules in her lungs.
Still, they knew it wouldn’t likely be able to vanquish the fear that accompanies life with stage 4 cancer. It’s a life lived in increments between chemo, surgeries and imaging scans as they try to overcome the anxiety of what the next set of tests might show.
Because even when treatments seem to be working, even when there is no evidence of advancing disease, even when Elissa feels pretty good, all things considered, it’s impossible to escape the knowledge that the cancer is there, lurking.
“What else is there that we can’t see?” she asked, as if to herself.
A birthday celebration and new hope
Elissa’s 40th birthday was just six days before her first histotripsy treatment in late February 2024.
Her mother, Betty, arranged for friends and family to send her an avalanche of birthday cards, which Elissa set up in a colorful display on a table at their house — a visible show of the love and support all around her.
She snuggled with Harper, then 9, the night before the procedure, and they said their bedtime prayers.
“We've been very open with her from the very beginning about my situation, but we don't really stress the gravity of my health concerns to her,” Elissa said. “She knows that I've been sick, and she knows that I go to chemo every two weeks. She knows that I really wanted this procedure. She knows that I advocated for myself to get this procedure … and it took us a while to get here.
“But we say prayers together every night about it. So I'll say my prayer, and then she'll say her prayer, and you know, she'll always say that she prays mommy's chemo is working, and that her procedure goes well, things like that.”
On the morning of the procedure, Harper wore one of her homemade friendship bracelets with blue-and-white beads and letters spelling out the name of one of her favorite Taylor Swift albums, which also happened to be an apt description for her mother: “Fearless.”
She cried as she said goodbye to Elissa, hugging her before she waited for the school bus to pick her up.
Elissa and Russell then made the 90-minute drive to Ann Arbor in rush-hour traffic for her histotripsy treatment, uncertain what the future would hold.
Three tumors in the crosshairs
Dr. Mishal Mendiratta-Lala, an interventional radiologist and the director of abdominal MRI at U-M, had worked for years with Xu, studying histotripsy treatments both in animal experiments and in human clinical trials.
Mendiratta-Lala told Elissa she’d try to treat all three of her liver lesions in a single histotripsy session, but acknowledged that one of them might prove challenging.
That’s because that tumor was in a spot just beneath Elissa’s rib cage. Since histotripsy uses ultrasound, if bones cover the treatment zone, they can obstruct the path of the sound waves used in the therapy.
Still, Mendiratta-Lala said she would try.
It was what the doctor didn’t say that was most hopeful to Russell.
“She said, if she can only get two out of the three … come back in a month, after your scan, and if it's still there, we'll take care of it,” Russell said. “It seemed like she had some knowledge to suggest that it was a very real possibility that that whole process with the immune system could work” to attack that tumor beneath Elissa’s rib cage even if it went untreated with histotripsy.
Three attempts at histotripsy
A few hours later, Elissa wore a baby blue surgical gown and cap along with royal blue hospital-issued socks with the skid-proof treads.
She was placed under anesthesia and intubated — not because the histotripsy procedure itself is painful but because she would have to remain perfectly still to ensure the ultrasound probe delivered the intense acoustic cavitation to the targeted tumors.
The medical team went to work, positioning Elissa’s body to give them the best angle to treat the first targeted tumor.
A wide sheet of white mesh went over Elissa's abdomen. On top of that, the medical team added a clear, soft tub made of a gelatinous material. The tub was filled with water treated to remove any trapped air bubbles — a process called degassing.
Mendiratta-Lala placed her hand inside the water-filled tub and guided the histotripsy transducer across Elissa’s abdomen. Once she identified the tumor, she locked in the target, and the Edison System began to evaluate the tumor tissue.
It determined the frequency and duration of the sound wave pulses necessary to collapse the tumor cells and ensure complete destruction of the mass without damaging surrounding tissue.
The machine then suggested a path for treatment, and Mendiratta-Lala had the option of accepting that plan or declining it.
With the push of a button, the machine went to work, applying histotripsy to the tumor. Each time a pulse of acoustic waves zapped a lesion, lines danced across the blue and black screen — showing the ultrasound energy destroying the mass.
Two of Elissa’s tumors were obliterated that day, but the third was too difficult to reach without repositioning Elissa’s body in a way that would have taken too much time under anesthesia.
So the doctor told Elissa and Russell they’d try again a few months later — if she still needed the treatment.
One month after her initial histotripsy procedure, an MRI showed the tumors that were initially treated with histotripsy had disappeared, leaving behind nothing but tiny internal scars.
However, the third liver tumor, tucked behind her ribs, was still there. It hadn’t shrunk or gone away as part of her immune system’s response to histotripsy as Elissa and Russell had hoped it would.
Mendiratta-Lala made another attempt in May 2024 to get to it, collapsing one lung under anesthesia to create space for Elissa’s liver to shift. That moved the tumor into a place where it could be targeted through the space between Elissa’s ribs.
Try as she might, Mendiratta-Lala still didn’t hit the mark that day. Instead, she treated an area in Elissa’s liver that might have been a new mass forming.
She brought Elissa back to U-M in early June for a third histotripsy treatment that finally liquefied the hard-to-reach cancerous mass.
“The perfect thing would have been OK, boom! All three gone” the first time, Russell said. “That's not reality. It's not how science works. So, we just learned from it. I think what we've thought all along — for the last 3½ years of the journey — is just go to the next thing, whatever that is.”
Although it took three tries to finally treat all of Elissa’s liver tumors with histotripsy, the procedures were so simple and pain-free, Russell was sold on the idea that it might help his wife live longer and with a better quality of life.
Elissa had almost no recovery time after each procedure. She felt a bit sore, like she’d done a few too many sit-ups.
“I told her, ‘Well, hell, if you have to have histotripsy every 12 months to take away two or three liver spots, and you're living for another 50 years, that’s OK,’ ” Russell said.
“What if this becomes revolutionary in cancer care, and you’re at the forefront of this and then you can tell the story from the beginning?” he asked. “Just think about how much people clamor for research and changes and hope in cancer care. It takes forever for something new to come along.”
The bubble bursts: 'We ... don't have control of the cancer anymore'
Ultimately, though, the Robinsons discovered histotripsy wouldn’t be a panacea for Elissa.
She had an MRI in late June, followed by an appointment with her oncologist at U-M’s Rogel Cancer Center.
Elissa was nervous. Results from the MRI hadn’t popped into her electronic patient portal as quickly as normal.
Ordinarily, she and Russell would read the report at home, trying to gauge what the medical terminology means so they can mentally prepare for her doctor’s appointment and consider what questions they’d like to ask.
This time, they were going in relatively blind.
The imaging report from a CT scan the previous week suggested things were stable. But the MRI, they knew, would give a much clearer picture of what the cancer was doing inside her body.
Elissa led the way to the second floor of the cancer center, hauling her trademark case of donated Girl Scout cookies with her. She brings cookies from her favorite scout, Harper, to chemo infusions and oncology appointments to pass out to the nurses and others on staff to thank them for taking such good care of her.
They’ve come to recognize Elissa as the cookie lady, and smile broadly when they see her.
That morning, Elissa couldn’t avoid a gnawing feeling in her gut because the MRI results hadn’t posted to her patient portal. What was it they didn’t want her to know, she wondered?
Sitting in the waiting room, Elissa’s fingers ran over the blue-and-white beaded “Fearless” bracelet Harper had made for her.
She and Russell held out hope that it was simply a technology glitch that caused the delay.
Perhaps Dr. Christine Veenstra would tell them the MRI confirmed her histotripsy treatments had successfully destroyed all three cancerous tumors in her liver, clearing the way for a break from chemotherapy and a chance to treat the last of her metastases, the ones in her lungs.
It would be her best chance of getting to the place where everyone saddled with a cancer diagnosis longs to be — cancer-free.
Here’s what they heard instead:
Although Elissa’s histotripsy treatments were successful in blasting her liver tumors, one of them had stubbornly returned in just a few weeks and was growing again. Worse, two new tumors had developed.
“We've got new spots coming up, and that's a sign that we systemically don’t have control of the cancer anymore,” Veenstra said.
Russell tried to console Elissa and somehow managed to keep himself composed, holding up both of them through the disappointment.
There would be no break from chemotherapy for the summer. The what-ifs racing through Elissa’s mind were almost visible on her face.
“It’s not what we were hoping for,” she said, her voice cracking.
Tears spilled down her cheeks and she leaned into her husband under the cold fluorescent lights on another blue-sky day that was far too sunny when the news was so grim.
“I am concerned enough that I really think it's just time to switch the chemo,” Veenstra said. “We've been on this a long time, and I think we just need to try something different. … We've gotten all the mileage out of FOLFIRI as we can for now.”
For more than two years, infusions of FOLFIRI, a combination of several drugs — folinic acid, also known as leucovorin, along with calcium folinate, fluorouracil, known as 5FU, and irinotecan — had somewhat controlled Elissa’s cancer growth. It was combined with a monoclonal antibody called Avastin.
The drug cocktail is so toxic, Elissa is given a biohazard cleanup kit to take home with her in case the medicine that remains in the rubber bulb connected to the port in her chest leaks as it flows into her body for two days after each in-hospital infusion.
Veenstra suggested trying a different treatment, called FOLFOX, which is the same blend of cancer-fighting drugs as FOLFIRI, but without irinotecan. Instead, Oxaliplatin is added to the cocktail. It's a platinum-based chemotherapy that damages the DNA of cancer cells so they can’t replicate. A monoclonal antibody treatment called cetuximab also was added to the mix. The new concoction was to be delivered via twice-monthly infusions — though each treatment would take longer, pushing the medicine into Elissa’s body for eight or nine hours at a time.
Elissa was scheduled for more imaging tests in late August to see whether the tumors responded to the new therapy.
Beyond FOLFOX and FOLFIRI, there are few other effective infusion-based chemotherapy options for Elissa's type of cancer. A few oral treatments have been approved by the FDA, but Elissa acknowledged they generally have a lower success rate and are typically used only after the infusion-based therapies fail.
“It scares me that we have to switch chemo because there's so few options,” Elissa said, tears flowing freely.
She had planned to finish her work shift remotely after her appointment with Veenstra that day, balancing her laptop on her legs in a bed at the Rogel Cancer Center while the poison pumped through her veins — just enough to kill the cancer but not enough to kill her.
But Elissa couldn’t see straight, couldn’t think straight. Her head was in her hands, eyes to the floor.
As Elissa and Russell absorbed the emotional news, a text was sent alerting the newsroom that Elissa wouldn't be able to finish working. “Oh god,” a coworker responded via text. “I’ve got it covered.”
Just about everyone at the Free Press knows there’s a fragile tightrope Elissa walks, one that could unravel at any moment. But she’s been so reliable in working through her cancer treatments that many probably don’t realize the pressure she puts on herself to be sharp enough, to have enough stamina to be “on” at work every day so her cancer is never an excuse, so she never lets down colleagues who also are friends and almost an extended family.
“I’m sorry,” she said in the room that day. “I know this isn’t the story you were hoping for, and it sucks. I’ve never been the perfect patient, you know?”
Nobody expects perfect, Russell told her. It’s too much pressure for anyone.
“We’ll get through it,” he said. “We’ll do what we have to do, right? Every step of the way.”
Already, Elissa has beaten the odds.
She has lived almost four years past diagnosis. According to data from the National Cancer Institute's Surveillance, Epidemiology and End Results Program, just 19.3% of people with stage 4 colon cancer survive to reach that milestone. Only about 10.5% are still alive 10 years past diagnosis.
It’s hard not to be greedy when it comes to time.
She said, ‘Let me have one day of being sad,’ ” Russell said. “And I said, ‘You can have as many days as you want, but then put your bootstraps back on and let’s go.’ ”
New pain and a December chill
Elissa agreed to start the new chemo regimen, but as summer 2024 turned to fall, her imaging scans showed continuing progression of her disease. The doctors switched her back to FOLFIRI with Avastin, but at a higher dose.
She was in New York City in late October, meeting with doctors at Memorial Sloan Kettering to discuss whether they would be willing to treat her liver tumors or go after the lung nodules next when new imaging scans made it clear the calculus had changed yet again.
Several new masses had popped up in her liver and that stubborn tumor that resisted histotripsy and microwave ablation had swelled ever larger.
“There's no consensus on how many there actually are, but we're looking at four to five tumors now,” she said.
The tumor board at MSK — a panel of cancer specialists — discussed Elissa’s case in early November and told her that she ought to continue systemic chemotherapy — and avoid surgery on the tumors in her liver and lungs.
“Their thought was that any kind of surgical intervention could put me at risk for complications,” she said. “And if there are complications, that would take me off chemo. And if I'm taken off chemo, who knows what will happen? It was a big blow to hear that.
“I'm well aware of how limited my options are with chemo. It’s the two main lines, and then you look at third-line treatments, which are grossly less effective. And beyond that, clinical trials.”
A December chill settled in, and Elissa felt it in her core.
It wasn’t just the cold air, but an increasingly foreboding pain — as if she could feel cancer’s ferocious bite in the ache below her rib cage, no matter how much chemo pumps through the port in her chest.
“I would never tell my family this, but I do not have a good feeling at all,” Elissa said through tears on an afternoon in mid-December. “I've never had pain before. I have pain now where my liver is. I am really afraid that this shit has just gotten out of control.
“Everybody says you have to be positive. You have to think positive. But it's impossible not to think: Is this my last Christmas with my family?
“I'm kind of to the point where I've got to say, ‘I'm not willing to accept that.’ ”
She and Russell relentlessly read all they can about the latest advances in colon cancer treatments and seek doctors leading the cutting-edge work.
"People think that you need to be a special person or something to be able to go to these hospitals, but you don't," Elissa said. "You can be just an average, everyday person. Just call the phone number and they will make you a patient. There's no secret sauce to try and get into the best institutions."
Elissa appealed to all the doctors who had treated her in the past and some she’d never met to consider every possible option.
She said: “ ‘I need you to think harder for me, to be more aggressive with me. I'm 40 years old. I need more.' "
She sought an appointment with renowned surgical oncologist Dr. Yuman Fong at City of Hope near Los Angeles, who, in early October, told Elissa what she dreamed to hear: “You’re still curable.”
He suggested she undergo surgery to remove the stubborn mass on her liver, which resisted attempts at thermal ablation and histotripsy. But now that there are more lesions on her liver, he said he’d like to see her next set of scans — taken just before Christmas — to decide how to proceed.
“He says that he would probably cut out the bad tumor that won't respond and then put me on a … hepatic arterial infusion pump — or a HAI pump. It's relatively new. You can't get it just anywhere,” Elissa said. “Basically, it's like a pump that has the chemo inside of it, and they implant it under your skin. So it would be near my liver, and it delivers the chemo directly to my liver instead of through my whole body.
“It's just a straight shot to my liver, and essentially, every two weeks you go and you get it refilled.”
The problem with that strategy, Elissa said, is that she has cancer outside of her liver, too.
“I have disease in my lungs,” she said. “So if I'm only sending chemo to my liver, what's happening to my lungs?”
Fong told her treatment with the HAI pump can delay the development of lung nodules for as long as two years, she said.
But of course, “I already have lung nodules, so that’s not very reassuring. It begs the question: Are we just going to let my lungs grow out of control for the sake of my liver if we do this HAI pump?”
Another surgeon suggested radiation could be added to the mix. A treatment called Y90, or yttrium-90, would imbed radioactive beads into the blood vessels that feed her liver tumors, targeting the cancer but not the healthy liver tissue around them.
And Mendiratta-Lala, the interventional radiologist at U-M who first treated Elissa with histotripsy a year ago, suggested she also could try histotripsy again.
By early 2025, Mendiratta-Lala had treated 45 patients with it outside of clinical trials.
“We don't have enough patient data, but I think in some of our patients, we see a little bit of the abscopal response with certain cancer types,” she said.
The question is what might be triggering the response in some patients but not others.
“If we can find a way to truly elicit the immune system, perhaps in combination with chemotherapy and immunotherapy, I think it can change the face of cancer, because patients can have a better prognosis. You can see cancer regressing and disappearing everywhere in the body. And again, it's very early, so I use caution when I say that, but as a researcher and a clinician, that would be a dream.”
Elissa also met with Dr. Mohammed Najeeb Al Hallak, an oncologist who specializes in gastrointestinal cancers and leads clinical trials at the Karmanos Cancer Institute in Detroit.
She acknowledged, however, that she’s been holding onto the clinical trial card until she has little else in her hand to play. The odds that she’ll beat the dealer by enrolling in a clinical trial are slim, she said.
“Clinical trials are for the benefit of the trial,” Elissa said. “They’re not really for your benefit. Really, you are helping them. The likelihood of finding a real benefit to you is not great. … It feels like the last resort — like, 'OK, this is it. It’s all we’ve got.' ”
And with the addition of that nagging abdominal pain, these questions swirled in Elissa’s mind with growing urgency: Which treatment would give her the most time with Harper, with Russell, with Betty and Sam?
How would each of these options affect the quality of the life she has left to spend with them? Is the dream of being cancer-free completely unachievable now?
“You have to think about how aggressive you want to be, which is a really scary thing,” she said. “How do you make that decision? Of course, I want to do everything I possibly can to fight it, but do I keep fighting it until the writing is on the wall and give up my quality of life along the way?”
Elissa told Russell she wanted to draft end-of-life planning documents.
“Just the other day, I was telling him, ‘We don't have any of our paperwork lined up,’ ” Elissa said in late December. “So I told him, ‘We really need to get our affairs in line.’ And you know, he agrees, but he's also like, ‘I don't want you giving up. I don't want you to lose hope and just start resigning yourself to this is what the future is going to be.’
“And I said, ‘I'm not. I'm really not. But I also don't want to have to worry about this when I can't think straight anymore or it's too hard to think about or whatever. We have to think about these things now. … We haven't actually done that yet, but it's just another conversation, another thing on the to-do list. It's not fun to think about.”
It is becoming increasingly difficult to shield Harper from the growing angst.
“At what point are we going to have to clue Harper in to how bad this is?” she asked.
Through the holidays, Elissa buoyed her little girl’s spirits and tried to make memories that would last long after she’s gone — whenever that day might come.
On a visit with Santa Claus, Harper handed the jolly old elf a list of goodies she’d love to see under the tree on Christmas morning — things like press-on nails, skin-care products and slime.
It was Russell who asked for what could be the best — and possibly most difficult — gift of all for Santa to deliver: “A cancer-free diagnosis for my wife.”
As a new year dawned, Elissa and Russell agreed to try microwave ablation one more time on liver tumors at Karmanos with Dr. Hussein Aoun, an interventional radiologist, who works in conjunction with Al Hallak.
“He feels strongly that microwave ablation is worth another go,” Elissa said. “We asked, 'Do you typically do this on tumors that are not responding and are recurrences?’ And he said, ‘Yes.’ He said he has an 80% success rate of it not recurring. He has a more aggressive approach than (Memorial Sloan Kettering) seemed to take. … He made it sound like he could get this.
“He would go after the big one first, and then go back, probably a month later, to get another one or two. … As exciting as that sounds, it’s also terrifying. Literally every doctor has a different opinion on what I should be doing. How are you supposed to make a decision?”
On Jan. 22, Elissa's microwave ablation was performed at Karmanos in Detroit, the same day that would have been her brother Nick's 43rd birthday.
"I know he's always with me," Elissa said, "but I said a little prayer, and included Nick and asked him to put in a good word for me. ... It was like I needed a little more that day."
Dr. Aoun treated the stubborn, 3.5 cm liver tumor using heat created with microwave energy to burn away the malignant tissue. He burned an additional 3.5 cm of tissue around the mass to ensure he got clean margins — killing off any potential cancer cells lurking at the edges.
In all, he destroyed 7 cm of her liver. Elissa thought she’d go home the same day, but the pain was the worst she’d experienced after any of her previous treatments. Within a few hours of surgery, she spiked a fever.
Elissa ended up staying in the hospital for four nights as nurses and doctors waited for her fever to break, for the antibiotics to work, for her body to heal.
When she finally was discharged, she said it was a relief to get back home to Russell and Harper, and to prepare for the ocean cruise she and her family planned to celebrate her 41st birthday. The ship departed from Galveston, Texas, and stopped in Roatan, Honduras, along with a couple of ports in Mexico.
She longed for balmy days, gliding across the shimmering blue water of the Gulf of Mexico, soaking up the sun with her favorite people, knowing that maybe, just maybe, better news would await when she returned to Michigan.
She got that better news — the microwave ablation was successful in destroying the large, stubborn tumor. Surgeons went after two smaller liver lesions in April, and she was scheduled to undergo another histotripsy treatment to liquefy what she hopes will be the last liver tumor, embedded near the portal vein.
Then, Elissa will evaluate her next steps. Perhaps, she wondered aloud, it will be time to seek treatment for the tumors on her lungs.
Elissa is considering it all. Because she knows she must be vigilant to stay alive. She must constantly be one step ahead of the disease — scrapping, praying, hoping that maybe the days will stretch out, and the weeks and months will run long enough to make more memories.
So she can see her little girl blow out the candles on the cake she'll make for her 11th birthday.
To celebrate another Christmas at home.
To take another cruise, basking in the sun and in the love of family, surrounded by seas and skies that are drenched in blue — her favorite color, the calming color of hope.
Contact Kristen Shamus: kshamus@freepress.com.
This story has been updated to correct a typo.