A first for Mississippi, a second chance for UMMC patient with rare type of cancer

Ashley Castle had almost given up hope in her fight against bile duct cancer.

She needed a liver transplant, “and we had four to five dry runs,” said Castle, a Meridian native who’s lived in Brandon since childhood. She’d grab her suitcase and prepare to leave for the hospital only to find out it hadn’t been the match she needed.

“I was to the point of thinking I was not ever going to get one.”

On July 23, a day Castle said was worth the wait, she received a liver that was a perfect match at the University of Mississippi Medical Center. The transplant for her condition, hilar cholangiocarcinoma, a rare form of bile duct cancer, is thought to be the first in Mississippi.

Castle’s treatment underscores the importance of having a strong organ transplant program alongside an advanced cancer center, said Dr. Chris Anderson, James D. Hardy Professor and chair of the Department of Surgery at UMMC.

“While liver transplant is a well-known treatment option for liver cancer, it is also a treatment option for select hilar cholangiocarcinoma patients such as Mrs. Castle,” Anderson said, noting that liver transplant can also be an option for some patients with other types of bile duct cancer or cancer that has spread to the liver from colorectal cancer.

“Our liver transplant team and our multidisciplinary cancer teams can incorporate all these options for our patients,” he said.

UMMC’s cancer mission benefits from having a thriving organ transplant program, said Dr. Rod Rocconi, Ergon Chair for Cancer Research and director of the UMMC Cancer Center and Research Institute.

“Mrs. Castle’s transplant shows the lifesaving potential our transplant expertise at UMMC brings to the state,” he said. “It’s the kind of second chance we work to provide every day.”

Castle’s successful transplant surgery followed a years-long medical journey, said Dr. Mark Earl, chief of the Division of Transplant Surgery and Castle’s surgeon.

“Mrs. Castle’s transplant was the culmination of years of care and treatment for her bile duct cancer and requires expertise truly across the entire spectrum of multidisciplinary cancer care,” he said. “Specialists from medical oncology, radiology, radiation oncology, anesthesia and surgery amongst many others, played essential roles in her journey.”

An endoscopy for an unrelated gastro-intestinal condition revealed her cancer in February 2024.

“It’s been quite the rollercoaster,” she said. “I didn’t understand when earlier transplants weren’t possible, but those were not meant for me. This one was, and it was perfect. If I didn’t believe in God, I do now. He sure touched my life.”

The endoscopy finding her cancer was fortunate, she said, since she had no symptoms at the time. “From the beginning, my doctors were saying, ‘Somebody up there likes you,’ because they found my cancer early.”

Symptoms of bile duct cancer often don’t surface until its later stages when it is more difficult to treat.

Hilar cholangiocarcinoma is typically treated by removing part of the liver, Earl said. “However, in some cases, that’s not possible due to tumor factors or liver disease.”

In Castle’s case, a liver transplant was needed, but only if her cancer didn’t spread. To keep that from happening, she underwent chemotherapy and radiation therapy to shrink the size of her tumor and keep it from spreading.

Castle, who with her husband of 33 years, Nick, has two daughters, Vallie and Lily, saw care close to home at UMMC as a way to have more time with family as well as the advanced care her rare cancer required.

“We thought about moving to Houston, Texas, but we had no idea how long the wait would be,” she said. “Too many things were up in the air. Then we realized that there’s a great team here in Mississippi. Dr. Earl, Dr. Praise Matemavi and Dr. Chris Anderson have made me feel so comfortable – the whole transplant team has.”

Her cancer journey has been difficult, Earl said, “but Mrs. Castle made it through these many challenging steps and was fortunate to receive a priceless gift from a person who had selflessly chosen to donate their organs.”