When Clay Adams' phone rang on a Sunday morning in January 2016, he braced himself for bad news. Doctors don't call on weekend mornings when test results are sunshine and daisies.
"You're positive for carcinoma," the doctor told Adams, now Assistant Vice President for Duke Student Affairs.
"You're talking about cancer?" Adams said, interpreting - but dumbfounded by - the medical terminology.
Adams was 37 and in the best shape of his life. Wrapping his head around the doctor's news that he had colorectal cancer was difficult to square with the knowledge that six months ago he'd competed in a half Ironman triathlon. Three months earlier, he'd run a half marathon.
After Adams hung up, he quickly googled "colon cancer survival rates" and what his next tests at Duke University Health System would mean.
"I knew enough in 30 minutes to be both terrified and also know what the important indicators were going to be," said Adams, now 47. "If it's still isolated and hasn't metastasized, then I've got a pretty good fighter's chance."
Ten years later, Adams is part of a growing number who can celebrate National Cancer Survivors Day this June 7. The American Cancer Society reported a milestone this year, as 70% of patients diagnosed with cancer are now living at least five years post-diagnosis - a survival rate that has increased from 50% in the mid-1970s.
Duke, home to the 35th-ranked cancer center in the country according U.S. News & World Report and a level of expertise found in the top 4% of U.S. cancer centers , plays a role in improving that survival rate with breakthrough research and specialized treatments.
"This place may be my employer but the mission and focus of this place is personal," Adams said. "To put it simply, I owe my life to this place."
A softball-sized tumor
A six-hour surgery in 2016 removed a softball-sized tumor that likely had been growing at least five years - possibly as long as 10 - and resected a foot of Adams' colon, leaving an 11-inch scar on his abdomen.
The cancer hadn't spread, he learned.
But the tumor had been tearing the lining of Adams' intestines, sending toxins into his bloodstream and causing him to feel ill. He'd been losing weight and had acute abdominal pains for months, which sent him to the doctor searching for answers.
"I didn't realize how sick I was," Adams said. "I ignored a lot of signs."
Adams was not yet 45, what is now the recommended age to begin routine colonoscopy screenings. Nida Corry and Adams had just begun dating that fall, and she encouraged him to see a doctor when she saw his symptoms worsen over months.
"I certainly wasn't thinking 'cancer,' but maybe I should have been because he clearly was not well," she said.
But when he called to tell her the diagnosis, it was a defining moment for their relationship.
"It was like the world kind of stopped, hearing that from him, because I cared so much about him," Corry said, "It was this whole shifting, to this is about the person, his life and his survival."
Immediately, the focus was on the best course of treatment for Adams - whether he should undergo chemotherapy treatment and how he would recover.
Sue Wasiolek, then Duke's Dean of Students and Adams' supervisor, lost her father and her brother to cancer, worried about the next steps.
"I had seen a number of different types of treatments and none of them are good, none of them are simple, none of them are easy," Wasiolek said. "I was just imagining what was going to be ahead for Clay."
Advancements in cancer treatment
When Duke Medical Oncologist David Hsu treated Adams 10 years ago, the protocol for Stage 2 colorectal cancer treatment was not all that precise.
Generally, for Stage 2 cancer, the risk of recurrence is estimated to be between 10 and 30%, Hsu said. Chemotherapy can reduce that risk by about 20%.
Adams had low-risk Stage 2, and Hsu estimated his risk of recurrence to be 10 to 12%; chemo would further reduce that risk to 8 to 10%. Weighing the relative low impact with the toxicity of chemotherapy, Adams opted not to undergo chemotherapy treatment. It was a roll of the dice.
But if Adams received his cancer diagnosis today, he could make a more educated decision, Hsu said. Advances in testing can now detect whether circulating tumor DNA is in a patient's bloodstream. A simple blood test can determine if a cancer patient is likely to benefit from chemotherapy after surgery.
"Instead of using the stage to ask the question and estimate his risk of recurrence, what this has allowed us to do is use this as an additional test for our patient to determine whether or not they need additional treatment," Hsu said.
Hsu and his lab at Duke also are studying whether a patient's tumor profile can help develop targeted therapies to eliminate individual tumors. These precision oncology trials are used "to guide therapy per the individual patient," Hsu said.
"We're getting better, we're getting closer," Hsu said. "We still have a long way to go. But we are understanding cancer more and more."
A celebration of life
Adams' father, Larry, was a kind and generous man from Summit, Mississippi, a pastor who earned a degree from Duke Divinity School, but not one to share his emotions freely with his children.
After Adams' surgery, as the two sat in the serenity of the Duke Cancer Center's Quiet Room, Larry Adams turned to his son and put his hand on his child's knee. The two had just learned that Clay Adams' cancer had been contained to that single softball-sized tumor.
"Well, that was a close one," Larry Adams told Clay. "Let's try not to do that again."
And then, for one of the only times Clay Adams can remember, he watched his father cry.
"And of course, I lost it," Adams said. "Because when you see your father cry, that's a rare thing."
A year later, Adams and Corry wed in what she called "a celebration of life for him," that included Adams, his brothers, Christian and Clark, and more than two dozen friends and family members running a 5K to benefit colon cancer during their wedding weekend.
Eight years ago, Adams and Corry welcomed their daughter, Isabella. Four years ago, their son, Nicholas, was born.
After his surgery, Adams went from follow-ups with Hsu every three months to every six months to every year. Each time he waited for test results, his anxiety would flare.
"It leaves an indelible mark," said Corry, a clinical psychologist who grew to recognize Adams' unease.
When Adams reached five years post-diagnosis, he was considered cured.
Not long after Isabella was born, Adams remembers walking past the Duke Cancer Center with Corry and their newborn baby, flooded with emotions.
"The resulting, overarching one is just gratitude and being thankful that I have almost a second chance at life," Adams said. "And now, it's one of those phenomenal stories to look back and think, 10 years later, I'm still here with this organization.
"It's one of the reasons I care so deeply about this place."
