After a Year-Long Cancer Battle, Opening Day Has a Different Meaning for Trey Mancini

On the same day MLB shut down last spring, Baltimore Orioles first baseman Trey Mancini underwent surgery for colon cancer. Now, after the most difficult year of his life, he's cancer-free—and back in the game.

On the day he got the worst news of his life, Trey Mancini thought about how lucky he was.

That might not be your reaction if you were a 27-year-old Orioles first baseman coming off the best season of your career and you learned that you had colon cancer. But Mancini saw it differently.

“You’re not thinking about baseball or anything like that,” he says. “You just want to be alive.”

He was fortunate to find out that his life was in danger. He had felt no symptoms other than mild fatigue that he attributed to aging. His annual spring training physical showed slightly reduced iron levels. It was only because a diligent athletic trainer sent him for further tests that anyone realized anything was wrong. He might otherwise not have made a doctor’s appointment until it was too late.

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So on the morning of March 6, 2020, he underwent an upper endoscopy and a colonoscopy. Doctors thought they might find stomach ulcers or celiac disease. Instead, they found a mass in the horizontal portion of his large intestine. That afternoon, a CT scan confirmed his tumor had not metastasized to other organs, meaning his cancer was stage II or III. (Eventually doctors would find cancerous cells in three lymph nodes, placing it at stage III.) And that night, he decided to see how much worse it could have been.

Google told him “how low your chances kind of get,” he says. The five-year survival rate for a patient with a tumor like Mancini’s was about 70%. The five-year survival rate for a patient with a tumor that had metastasized widely—which his likely would have if not for those low iron levels—was more like 14%. So Mancini sorted through his grief and fear and anguish and settled on a new feeling: gratitude. 

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A year later, as Mancini prepares to play the Red Sox at Fenway Park on Opening Day, he only feels more thankful. 

In some ways, the timing of the coronavirus pandemic helped keep him safe. He had surgery to remove the tumor on March 12. When he lost consciousness, his teammates were playing baseball; when he woke up, the season was on pause. There was nowhere to go and nothing to do.

“I did not wish that on the rest of the population,” he says. “But at the same time, I didn't really feel like I was missing out on anything.”

Hospital COVID-19 regulations prevented anyone from accompanying him to his chemotherapy infusions, every other Monday. This was emotionally painful for many, but it came as a relief for Mancini. His girlfriend, Sara Perlman, had tended to him constantly; he was glad he could spare her the twice-monthly image of him enduring four and a half hours of discomfort.

Mostly, he is lucky that this is the worst thing that has ever happened to him.

“The biggest problems in my life had all been baseball slumps,” he says.

There hadn’t even been many of those. Other than an injury-marred 2018, he had played like a burgeoning All-Star for the Orioles after they drafted him in the eighth round in ’13. He put together his most complete season in 2019, with a .291 average and 35 home runs. He agreed to a $4.75 million deal for ’20. He began dating Perlman, a longtime friend from when she worked for MASN, which broadcasts the team’s games. (She now hosts shows for NBC Sports Edge and PointsBet.)

The relationship was so new that she didn’t even know what kind of birthday cake to buy him on March 18, 2020, the day he turned 28 and learned he would need six months of chemotherapy. (Vanilla with chocolate frosting, as it turns out.) But Perlman, now 26, had been holding Mancini’s hand when he woke up from the colonoscopy, and she stayed nearly as close to him for most of the next year.

His mother, Beth, is a former nurse, and his father, Tony, is an obstetrician-gynecologist and himself a survivor of colon cancer. But the pandemic meant that Mancini’s primary caregiver was Perlman ... who studied journalism in college.

“There were no options,” she says. “The nurse came and taught me, and that was it.”

He decided to undergo his treatment at Baltimore’s renowned Johns Hopkins University cancer center. Because he was diagnosed in spring training, he had not yet moved into his regular-season apartment; instead he moved in with Perlman, an hour south in Washington, D.C.

Before the chemo began, doctors implanted a port under the skin just below his right collarbone. They later used that tube, rather than a regular IV in the arm, to send medication into his bloodstream. When the port was in use, he could not get it wet, meaning someone had to bathe him. That someone? Perlman. Someone had to flush the port occasionally with liquid to keep it from getting blocked. Perlman again. Someone also had to feed him, keep him hydrated, update his family and friends on his condition. Perlman, Perlman, Perlman.

“It was just the two of us, so a lot more fell on her,” he says. “She was resilient and I—just—she's unbelievable. I can't even say enough about what Sara meant to me through all that.”

The two of them tried to stagger their bad days. She occasionally revoked his Google privileges. “If we didn't have to feel crappy about the situation, we really tried our best not to,” she says.

And he relied on the mentality baseball players cultivate. “Old clichés like taking it one pitch, one at bat at a time,” he says, “I kind of took that into my treatments. We took it treatment by treatment—we'd say, ‘These four days are gonna suck, but then we'll have nine or 10 days of feeling good after that.' ”

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During the Monday infusions, doctors would pump him full of steroids to keep the nausea at bay. They tended to wear off 45 minutes into his hour-long drive home. For the four days immediately following each treatment, he could choke down only broth and the occasional piece of bread. By that Friday, he was ravaged by what he referred to as his “pregnancy cravings”: turkey Reubens, subs piled with cold cuts, entire pizzas. He daydreamed about the pre- and postgame spreads at Oriole Park at Camden Yards.

He worked out lightly on his good days. The pair adopted a terrier mix, Olympia, who immediately became his favorite dumbbell. Once the baseball season resumed, they spent nights on the couch, Mancini holding a bat and imagining facing the pitcher. He decided the TV angle would probably bolster his scouting reports.

One possible side effect of chemotherapy is neuropathy, a loss of feeling in the extremities, generally the hands and feet. Mancini didn’t care much about his toes, but it’s hard to throw a baseball when you can’t feel your fingers. At his worst moments, he envisioned an early retirement. He decided broadcasting might be a good fit as a second act, and here Perlman’s journalism degree did help. She assigned him imaginary segments—Why is this pitcher so difficult to hit?—and he tried to answer as insightfully and fluidly as possible. He accepted notes graciously. “He says ‘um’ a lot,” she says. “So I said, ‘Try to cut that out,’ and he did! He was so good.”

The whole time, though, he counted back from April 1, Opening Day. Sometimes that date seemed far away, but other times he could almost smell the pine tar. He had his last infusion on Sept. 21—Perlman waited in the parking lot with balloons—and three days later, doctors removed his port. 

“That day was a little more emotional, even, than chemotherapy ending,” he says. “I knew that it was over.”

He was jogging around the neighborhood by October. On Feb. 1, he reported to Ed Smith Stadium in Sarasota, Fla., his first time at the complex since the day he held back tears and told his teammates he had cancer. 

Throughout spring training, opposing players and coaches shook his hand and welcomed him back. He couldn’t believe how many people knew who he was.

“I think I’ll enjoy my career even more than I would have if I didn’t go through this,” he says.

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All this gratitude is a wonderful attribute in a person, but it can be a dangerous one in a ballplayer. You don’t want a first baseman who grins as he flails wildly at a slider. Mancini had been exhaustingly competitive his whole life—"My mom says I’m a sore loser,” he’d explain to other kids—and he worried the cancer might have stolen that from him. If I strike out, he wondered, Am I going to laugh it off? “I'm just happy to be here”?

In his first game back, on Feb. 28, he received a standing ovation from fans as well as both dugouts. He immediately lined a single to center field. But he did not really feel like himself again until two innings later, when he whiffed on three pitches—"way late on a fastball,” he says now—and berated himself as he stalked back to the dugout. He laughs now, remembering. 

“Some things don’t change,” he says.

He will need follow-up scans every three months, then every six, then every year. He will never be totally rid of this disease. But he has closed that chapter and opened a new one: one in which he can make a difference. Early detection saved his life, and he wants to help other young people get screened. He plans to partner with Squatty Potty, which this year announced a Give a Crap Challenge, in which people could mail the company their stool to have it tested for cancer markers. When he heard that someone in his hometown of Winter Haven, Fla., needed a colonoscopy but couldn't afford one (they can run some $2,000 without insurance), he offered to pay for it. He hopes to formalize some kind of fundraising initiative.

In the meantime, he has baseball games to play. On Friday, he will button his jersey over the scar from his port. He will take the field at Fenway Park. And he will play a baseball game. How lucky is he?