Mark Carles, 25, from West Brighton, Staten Island, was prone to hurl during running, whether it was during his high school cross-country practice, midrace, or afterward.
“I would get sick after every run. I’d throw up after or during every race. It didn’t matter if I ate or didn’t eat,” he says to Runner’s World. “My coaches were old school—if you weren’t puking, you weren’t working hard enough.”
But for Carles, who went on to run for Hunter College’s DIII cross-country team, he’d later learn that the vomiting was due to a tumor on his liver that was blocking two arteries in his intestines, restricting blood and oxygen flow. It was an early sign of liver cancer that would be officially diagnosed in 2018.
Learning of the rare diagnosis was a blow for Carles, but he refused to let the uncertainty rule his life. After he received a motivating message of hope from late pro runner Gabe Grunewald—who passed away in June from cancer—Carles was determined to keep fighting for his life. And running, he learned, was just the way to do it.
Throughout 2014 and 2015, Carles kept pushing through tough practices, not wanting to ease up on his training. Soon, though, his symptoms got so bad that he needed to seek medical help.
“I went to see a gastroenterologist for the puking, who diagnosed me with acid reflux,” he says. “And I also started getting allergy tests because I was getting bloody noses all the time. I was tired.”
By his last cross-country season in 2016, his times started to tank. In 2014, he was running a sub-30 8K, but by 2016, he was five minutes slower.
“I was posting 60-mile weeks with workouts, so it didn’t add up. I thought I was getting old,” he says. “My coaches were really upset with me because they thought I was going out partying because I was throwing up. I was physically unwell, which translated mentally.”
After finishing college, he entered grad school for integrated media arts, was working two part-time internships, and commuting from Staten Island to New York City, all while running 20 to 30 miles a week. But his health continued to decline. Like many runners, he just pushed through—until he couldn’t anymore.
He knew there was a serious problem when a 5K in October of 2018 clocked in at about 30 minutes.
From there, his symptoms grew: enlarged and swollen lymph nodes, night sweats, and terrible pain in his abdomen.
“Everyone thought my appendix burst—I was walking around hunched over,” he says. “I thought I had gallstones or kidney stones.”
Eventually, he passed out, and when he came to, he phoned his dad to pick him up. They scheduled an emergency appointment with his general practitioner for the next morning.
“The doctor took a look at me for less than 15 seconds and was prodding my stomach. He asked, ‘Can you stop flexing?’ And I told him I wasn’t,” Carles says. “He basically said, ‘Uh oh, this might be a tumor.’
Carles was sent to the ER, where he had several X-rays, CT scans, and blood tests. What doctors found was devastating: a 7-pound tumor. It was eventually biopsied and came back with another blow. Carles had a very rare liver cancer called fibrolamellar heptocellular carcinoma, so rare that 1 in 5 million people get it.
In November 2018, he was sent to top cancer surgeons at NYU and Memorial Sloan Kettering. After more scans CT scans, they determined his cancer was stage 4, and had metastasized to the entire right side of his body, into his pancreas, stomach, pelvis, small intestine, and gallbladder. He was given three months to live.
“I was crying. I was with my brother, sister, parents, and uncle. We were all just so sad. What do you do with news like that? We decided to go for sushi, my favorite food,” he says. “When they tell you you’re going to die, it might as well be your favorite restaurant.”
Ultimately, his rare cancer meant that there wasn’t a known treatment, so his doctors started him on chemotherapy later that month.
He was losing weight every week, was always cold due to neuropathy—nerve damage in his hands and feet caused by chemotherapy—and was extremely weak. He used to be able to crank out 70 push-ups in a row, but could no longer do five.
But he still tried to keep running, though at a much lower intensity.
“To do a half-mile, it would take me 16 minutes,” he says
By the end of January 2019, scans showed that his chemo didn’t work at all, and his tumor had grown by 20 percent. He would soon be in liver failure.
It was time for another treatment option: Docs recommended a major surgery to remove the 7-pound tumor. Only one doctor had ever performed it before.
He received the 16-hour surgery on February 27, 2019. It was successful, though it left him with huge incisions across his abdomen, and battling major infections during an extended hospital stay.
It was during his recovery when he received a message of hope from another runner battling cancer who had a similar surgery: Gabe Grunewald.
“I had read her big article in The New York Times in 2017, and I saved it. At the time, I didn’t know I had liver cancer, but something subconsciously connected me to this article and to her. I taped it above my bed,” he says. “Fast forward to when I got sick, and this package comes to me from her. It was incredible.”
His friends had reached out to her to tell his story, and she wrote him a sweet letter in return, which he says meant more to him than anything in his battle.
“Her story was all about why she kept fighting—she had hope. It was really inspiring for me to get out of my hospital bed, do laps in the corridor. To try to walk up and down stairs,” he says. “And when I eventually got out but couldn’t run yet, to go on walks in the park and on my old running trails.”
Grunewald’s inspiration kept him going and motivated him to make his way back to running.
He worked with a physical therapist, who had Carles walk for two minutes, then run for 15 to 30 seconds. Eventually, he built up to running straight through, and he hasn’t looked back since.
“Running is easier, but harder at same time now,” says Carles. “It’s easier for me to breathe, and I’m not getting sick anymore. But the surgery cut across muscle in my abs, so I don’t have the same core strength.”
Carles will start more chemo later this fall to try to get rid of the residual cancer in his lungs, lymph nodes, and pelvis. (His pancreas is now cancer-free.)
Besides running, he’s found enjoyment in swimming and riding his bike, which provides lower-impact cross-training. He tracks them all in Strava to keep tabs on his progress.
Throughout all of it, Carles has turned to running for his mental, physical, and spiritual health, and the progress has been encouraging to him. His times have been decreasing—he ran a 5K race in July under 31 minutes, which has dropped to an unofficial 25-minute performance since then—and he’s looking only to build upon that.
“My goal is to break 20 minutes in the 5K again,” he says. “My training is paying off. My body is weaker, but I dig deeper mentally. I close my eyes and just think about every staple being removed after my surgery. There were over 150 of them. I think about all the pain I had in the hospital, and just keep going.”
Carles is considered a terminal patient, but he is not letting that stop him from setting goals and pressing on.
“There are good days, and then there are we’ll call them medium days,” he says. “I’m just happy to be alive.”
Earlier this fall, he helped coach cross country at College of Staten Island High School and offered motivation to the kids and his friends and family.
“I’ve been challenging a lot of my friends and dragging my dad to Spin classes,” he says. “I joke with him, ‘You don’t want someone with stage 4 cancer to beat you, do you?’”
He’s still running, although it’s getting tougher.
“I ran a nice Veterans Day Fun Run in Staten Island with my brother David, and got second place for my age group,” he says. “Other than running, I have been doing a lot of research on my cancer, changed my diet to macrobiotics, and am trying to be the best-looking cancer patient there is.”
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And he keeps Gabe’s words close to him.
“Everyone has it bad, whether it be something emotional or physical, but that shouldn’t stop you. It didn’t stop Gabe. She kept doing her thing. No excuses,” he says.
He credits running as a reason to keep fighting.
“It’s helping to keep me alive—me scheduling races is extending my life even more,” he says. “I plan to run the NYC Marathon in 2020 or 2021. I’m gonna make sure I make it.”