'I was getting ready to die': Woman with rare parasite misdiagnosed with terminal liver cancer

·4 min read

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Cassidy Armstrong. Courtesy
Cassidy Armstrong. Image via TODAY. Courtesy of Cassidy Armstrong.

Cassidy Armstrong had been living with pain on the right side of her body that would come and go for years. After undergoing a series of X-rays and blood tests that revealed nothing abnormal, Armstrong did her best to stop worrying about the pain that would randomly occur near her ribcage.

In 2019, Armstrong’s health began to deteriorate. The 36-year-old motorcycle mechanic lost 25 pounds, developed digestive problems and anemia and began having trouble sleeping. As the pain in her side intensified, she decided to ask her doctor for an ultrasound.

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Armstrong was initially worried that she had gallstones, but was not prepared for the diagnosis she received. Doctors discovered a grapefruit-sized mass on her liver, and diagnosed her with fibrolamellar carinoma (FLC), a rare form of liver cancer that typically affects people under 40.

Cassidy Armstrong. Image via CBC.
Cassidy Armstrong. Image via CBC.

Doctors informed Armstrong that even with treatment and surgery, it was likely she had only a few more years left to live. Approximately 44 to 68 per cent of people with FLC live as many as five years after diagnosis.

“I was getting ready for the worst,” Armstrong said in an interview with TODAY. “I was getting ready to die.”

The Edmonton, Alta. resident was making peace with her fate when she underwent surgery to remove the mass. Armstrong told TODAY that doctors removed her gallbladder, two-thirds of her liver, nodules on her lungs and scraped her diaphragm. As Armstrong recovered in her Calgary hospital room, doctors delivered more shocking news: The tumour wasn’t cancer, but a rare parasite, alveolar echinococcosi (AE), that had been growing in her body for the past decade.

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“I wasn’t sure what to think,” she recalled of learning the life-altering news. “I asked them, ‘Is this good?’ and they said, ‘It’s much better than what we thought you had.’”

An MRI of Armstrong's abdomen. Image via Sam Houston/AHS. Courtesy of CBC.
An MRI of Armstrong's abdomen. Image via Sam Houston/AHS. Courtesy of CBC.

Dr. Stan Houston, a professor of medicine at the University of Alberta, said Armstrong’s case is part of a growing trend in North America.

“We’re definitely in the hot spot,” Houston told CBC News. “[Before this past decade] we never had people with this disease in all of North America. In the last six years, we’ve had 15 proven cases, just in Alberta.”

According to Alberta Health Services, AE is caused by echinococcus multilocularis, a tapeworm often found in foxes, coyotes and domestic dogs. Humans can accidentally ingest the eggs of the tapeworm through contact with contaminated feces or by ingesting food that has come into contact with contaminated soil (i.e. grass, herbs, greens or berries).

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In humans, AE presents as a tumour-like tapeworm larvae that grows in the body. In nearly all cases, AE targets the liver, but can spread to other organs. The Centers for Disease Control and Prevention notes that because the parasite is slow-growing, it can be years before people experience symptoms or know they have been infected. However, symptoms such as abdominal pain, general weakness and weight loss occur as the larvae cyst continues to grow, mimicking the signs of liver cancer. If left untreated, the parasite can prove fatal.

Dr. Stan Houston. Image via CBC.
Dr. Stan Houston. Image via CBC.

Houston said the best defence against AE is washing your hands, especially after petting dogs and ensuring your pet has regular vet check-ups to check for worms. Thoroughly washing produce that may have been grown in areas where coyotes frequent is also crucial to prevention.

Although many AE patients were dog owners, Armstrong told CBC News she doesn’t know how she became infected. She believes she could have been exposed when working to fix farm equipment or from eating tainted produce sold at farmers markets.

While there is no known cure for AE, Armstrong now takes medication on a daily basis and will receive blood tests once a month and a CT scan every six months to make sure the parasite is under control.

“I have mixed feelings about it,” Armstrong admitted. “I’m happy - I like being alive. Psychologically, it’s been really tough. I’m grateful and I’m happy that it’s not what they thought it was. But it’s been very hard.”

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