Surviving Stage 4 Ovarian Cancer

One of the worst days of my life was receiving a call from the ER physician telling me that my youngest sister has metastatic lung cancer. She went to the ER after she had developed a severe cough that would not resolve and had been recently diagnosed with Covid-19. The ER doctor had been worried about a possible blood clot in her lungs as her lab showed elevated D-dimer which is a blood test that detects a protein your body makes to break down blood clots. Her number was extremely high. 

He mentioned seeing something concerning in her abdomen; however, due to the CT being done primarily for the lungs they could not exactly tell what it was but advised getting an abdominal CT as soon as possible. 

Now the scrambling began. Her primary care doctor had left the practice, so she did not have anyone immediately available to order the abdominal CT. We called a local cancer center and set up an appointment with one of their cardiothoracic oncologists. After he reviewed the initial CT he did not feel that she had metastatic lung cancer. He felt it was covid-19 changes. I told him that they also saw something in her abdomen. He scanned past the lungs and agreed that it was something that needed further investigation. We felt relieved that it was not lung cancer and he ordered the abdominal CT within the next few weeks. That joy was short-lived.

Within a few days my sister started to complain about excessive shortness of breath and extreme discomfort – her abdomen was huge. I could not understand how she could have gained so much weight so fast. She went back to the local ER for treatment. You know what they say, seeing the trees from the forest. If it had not been for the fact it was my sister I would have put it together, but I think I just did not want to actually face just how serious this was. My first thought was advanced colon cancer as my uncles had died from it and my father survived his; however, needed to have a resection.

Finally we had the abdominal CT results. Stage 4 Ovarian Cancer. She had developed ascites which is fluid collection in her abdomen secondary to the cancer. They drained nearly 2 gallons of fluid out of her! The fluid was then sent to the lab which confirmed the type of cancer. 

Fortunately, there was a local doctor that specializes in women’s oncology and is also a surgeon. She had a good reputation and I was told that her patients did well after surgery. She admitted my sister to the hospital for treatment of her immediate symptoms and insertion of a Mediport. A Mediport is inserted just under the skin by a radiologist trained in interventional radiology. Medication can then be delivered to the right side of the heart by a small catheter which sits in the blood vessel. This is needed to administer her chemotherapy drugs and is the safest way possible. The port is easy to access by trained personnel and reduces the risk of infection between treatments. So it is a great idea to agree to the port insertion. 

Her doctor felt that she should have several chemo treatments prior to surgically removing the visible tumors, hysterectomy and removal of her ovaries; they call this debulking. This would help reduce the size and possible spread of her cancer. The downside was that she could not have her chemo a month before and after the surgery due to the risk of bleeding. Her blood marker (the CA 125) had been falling, however without the chemo after her surgery,  we feared they would start to rise again.

Originally she was scheduled for 6 rounds of chemo; however, her response was not as promising as her doctor wanted so they eventually increased her to 8 rounds. For ovarian cancer they track something called CA 125, which is a test that measures the amount of the protein CA 125 (cancer antigen 125) in the blood. This test can be used to monitor certain cancers during and after treatment. It can be used to look for early signs of ovarian cancer in women who are at high risk. That being said, it is important to note that it is not an exact test. My sister’s doctor told us that there is no direct correlation between how high the number is and the amount of cancer in your body. It really is just a guide, going up or going down is merely an indicator of likely cancer levels increasing or decreasing. The CT scan really tells the visual story of how much and where the cancer is. 

I know I have talked a lot about my sister’s specific type of cancer; however, while the treatments vary and surgical options differ from one kind to another, when it comes down to it, cancer is cancer. 

Cancer is a disease caused when cells divide uncontrollably. Normally, when cells divide and touch another cell they stop, called contact inhibition. Cells grow, divide and die; called apoptosis or programmed cell death. This is the way the body communicates and says it does not need the cell any longer. With cancer, that does not happen and cells incorrectly spread into surrounding tissues. It is essentially caused by changes to the DNA within the genes, these changes are also referred to as genetic changes.

Specifically cancer cells are:

• They are immature, have no specific function because they are multiplying too fast. 
• Cancer cells may influence normal healthy cells, basically putting them to work making new blood vessels which then feed the cancer cells nutrients (mostly glucose and oxygen). 
• Our immune system does not recognize those cells as damaged as it would with infection and other diseases.
• They are invasive and can spread to other parts of the body (metastasis). Normal healthy cells know exactly where they belong and behave themselves!

Next question was family history. We have no history of anyone in our family who has had ovarian cancer. That in and among itself does not mean you would never get it, but it is more likely if it ran in your family. My sister however loved baby powder and used it for years. I do know that at one time baby powder contained asbestos – we all know that is bad for you and that there was a higher rate of ovarian cancer in people who used it.

The point I am making is that everyone, due to your unique genetic makeup, may have a trigger or it can be acquired (inherited). A trigger is something we are exposed to that causes a cell mutation that is responsible for our particular cancer. I was told by an oncologist I worked with nearly 30 years ago, “if you live long enough you will get some form of cancer”.

Genes (who we are) make sure that the cells can grow and reproduce in a very specific and controlled way– which makes us healthy. However, sometimes when cells divide there is a mutation, which means that a gene was damaged, lost, or copied too many times. Often when the cell is subject to something, like cigarette smoke or environmental toxins, the cell does not understand the instructions any longer and it grows out of control. It is said that a cell needs roughly 6 different mutations before it becomes a cancer cell.

A gene mutation can mean several things.

1. A cell starts making too many proteins that can affect how it will divide.
2. A cell lacks the information to stop dividing.
3. When the cell produces a protein that works differently than a normal cell.

Sometimes people never know why they get cancer, others do. My father had colon cancer which was caught early, and it ran in his family. He had esophageal cancer which, fortunately, we caught early on (secondary to acid reflux with diagnosis of Barrett’s esophagus). More on that at a later time. He also had skin cancer after years of exposure to the sun. 

When my sister was diagnosed, it had been years (29) since I worked in oncology. Strangely enough, the drugs were still similar; however, we had gotten so much better at the dosage and found other drugs useful in other ways. We did not talk about adjunct therapy in my training, just the drugs from the pharmacy, how to administer them and what precautions we needed to take.

I had to go back to the books and read everything I could on the subject. The question now we had to ask was not just why she got cancer, but what she could do to help fight the disease.

First we looked at the risk factors. She had stopped using the baby powder several years earlier. She did not smoke, she did not drink except on a very rare occasion. She was very overweight and her diet had much to be improved. She told me that food helped her cope with life’s bad things, eating her pleasure foods, “chips and cola ” had been her go to’s. She was told to “eat healthy” during her treatment and we thought she was until my husband came across some expert speakers who talked about adjunct cancer treatment. 

Once I understood how it worked it was so simple, easy enough, or so I thought. You will have to wait for my next post as there is no way I can give this topic justice without writing a new blog. 

Please continue to read and hopefully, share my blog with others. What I have shared with friends and family is the entire reason for doing this. I have come to realize that even though I have shared my knowledge with thousands of people over the years, yet I still have much to share. Hopefully this will be my voice of hope and health going forward.