Risk-Reducing Surgery Turns into Much More
Chris Clifton, a dental hygienist for 37 years, was diagnosed with ovarian cancer at age 47. However, it did not happen in the usual way. “I was diagnosed with cancer while on the operating table having elective surgery,” Chris explained.
In 2012, Chris had been having abdominal pain on her right side. A CT scan (medical imaging) didn’t show anything of concern. So, her primary care physician recommended cutting out gluten (a protein found in wheat), but that didn’t help.
“When I started having irregular bleeding, I made an appointment with my gynecologist, Dr. Susan Weil,” Chris explained. Although additional imaging (an MRI) didn’t give her any answers, Dr. Weil, who works for Crozer Health, was still concerned — considering Chris’ abdominal pain and family history of breast cancer.
“Dr. Weil strongly encouraged me to have genetic testing to screen for ovarian cancer,” said Chris. “When the BRCA1 gene mutation came back positive, Dr. Weil said, ‘Now we have some decisions to make.’” Chris’ doctor recommended either removing her ovaries or doing a total hysterectomy (an operation to remove the uterus). She recalled, “I knew I was done having children, so I opted for the total hysterectomy.”
Women with BRCA1 gene mutations have a 35 to 60 percent chance of developing ovarian cancer compared with less than 2 percent in the general population (Medineplus.gov).
Chris continued, “My only request was that I did not want a traditional, open surgery. I preferred to have robotic surgery.” Robotic surgery is a type of minimally invasive surgery which allows surgeons to do complex procedures through small incisions (cuts).
Chris’ gynecologist recommended Dr. Justin Chura, a gynecologic oncologist with Crozer Health. At the time, Dr. Chura was one of the few surgeons doing hysterectomies robotically. Dr. Chura explained, “Robotic surgery techniques were much newer ten years ago. At Crozer Health, we had adopted that technology early.”
Dr. Chura’s experience with complex robotic surgeries and gynecologic cancer was more fortunate than Chris could have ever imagined.
Risk-reducing hysterectomy unexpectedly finds cancer
While performing the preventive hysterectomy, Dr. Chura found a tumor, the size of a fist, that had started to break through the pelvic wall. This might have been the cause of the pain Chris was feeling in her abdomen.
Dr. Chura said, “When we encountered her cancer unexpectedly, we were able to continue doing her surgery and provide her comprehensive cancer staging within that same operation.” (Cancer staging determines the extent of your cancer, such as how large the tumor is and if it has spread.) Chris was diagnosed with Stage IIB tubal cancer, a form of ovarian cancer.
Dr. Chura removed the tumor and her appendix and performed a total hysterectomy. In addition, Dr. Chura inserted a port to prepare Chris for receiving intraperitoneal (IP) chemotherapy. This was all done using robotic surgery techniques.
Chemotherapy is a drug treatment that uses powerful chemicals to kill fast-growing cells in your body. An IP port is a small reservoir that is surgically placed under the skin to provide a way of delivering anti-cancer drugs into the abdominal or peritoneal cavity.
After recovering from surgery, Chris met with Dr. Chura for a consultation. “My husband and mom also came with me,” Chris remembered. “Dr. Chura said that he always encourages a second opinion. He said, ‘Obviously, you weren’t planning to be sitting here doing this, but I will mention that if you see somebody else, another oncologist, they may not use the IP port.’”
Chris recalled that she responded to Dr. Chura, “The IP port is already there; why wouldn’t I use it?” She continued, “My family and I decided to stick with Dr. Chura and begin my treatment right away. I did not go for a second opinion.” Chris liked that Dr. Chura was young and had experience with the most current treatment options. “I had a feeling that Crozer Health was where I was meant to get treated,” said Chris.
In July 2012, Chris started her cancer treatment.
Intraperitoneal infusion chemotherapy
“Ten years ago, IP chemotherapy was a newer treatment at the time, and few doctors were using it,” explained Dr. Chura. “IP chemotherapy differs from IV chemotherapy in that it’s delivering the chemo solution directly into the peritoneal cavity, which is where the cancer is.” He continued, “Therefore, a patient receives a 20 times higher dose of the drug with IP than when it’s injected into a vein with an IV.”
Chris had six rounds of both IV and IP chemotherapy: one week on, two weeks off. “The first two rounds were okay,” remembered Chris. “After the second round, my hair began falling out, so I shaved it off. By the third round, I was not feeling great at all! For the fourth and fifth rounds, I would just come home, take a pain pill, and sleep.”
Chris’ two children were in high school and middle school, and Chris worried about them seeing her like that. Thankfully, she recalled, her “extended family really stepped in, keeping her children busy with trips to the beach and other activities.”
Dr. Chura explained, “Many patients don’t finish the full course of IP chemo because of the side effects. It’s a rigorous regimen. Neuropathy and abdominal pain are more common with the IP chemo than with intravenous alone. And because Chris is a dental hygienist, we closely monitored her symptoms and were concerned about minimizing the neuropathy.”
Chris recounted that one of her doctors was amazed that she had completed the full course of IP chemo. Chris responded, “I didn’t know there was a choice!”
Chris was able to go back to work in November 2012 once her neuropathy got better. She shared, “However, it wasn’t until my hair grew back in that I finally felt like myself again. I always had long hair.”
Recovery and cautious optimism
After the chemotherapy treatments, Chris saw Dr. Chura every three months for blood work, a transvaginal ultrasound, and a CAT scan. A transvaginal ultrasound is a type of pelvic ultrasound used to identify abnormalities within the vagina, cervix, uterus, fallopian tubes, and ovaries.
When Chris hit the five-year mark, she stopped doing the CAT scans unless she felt something was off. She continues with yearly pelvic and transvaginal ultrasounds.
It’s been almost ten years since Chris’ cancer diagnosis. She said, “Now, I have blood work done every six months. Dr. Chura doesn’t think it’s necessary, but I told him, ‘I’m kind of a freak about it, so you may as well keep ordering it!’” Dr. Chura understands.
In addition, Chris sees Crozer Health’s Dr. Mary Lou Patton once a year for an MRI and mammogram.
Benefits of genetic testing
Chris is very relieved and grateful that her daughter tested negative for the BRCA1 gene mutation.
Dr. Chura encourages patients with a family history of breast or ovarian cancer to get genetic testing. He understands it can be scary, but the information can help you manage your health better through regular checkups and monitoring.
Dr. Chura explained, “When patients are positive for the BRCA mutation, the recommendation is to undergo removal of the fallopian tubes and ovaries at the minimum. In the case of BRCA1, there is a higher risk of uterine cancer, so we often recommend a hysterectomy for those patients.” He continued, “I will frequently see patients with the BRCA mutation. And when they’re done childbearing and depending on their age, they opt for the risk-reducing surgery.”
For Chris, her ovarian cancer was discovered while it was Stage II – when cancer cells had spread from her ovaries to other organs in the pelvis. “Most ovarian cancer is not diagnosed until Stage III or IV because its symptoms are vague,” explained Dr. Chura. In the later stages of ovarian cancer, the cancer cells have spread beyond the abdominal cavity to other organs. Dr. Chura continued, “Chris’s early diagnosis made a significant difference in her prognosis.”
Excellent medical care, along with the kindness of family and friends, made all the difference
Chris is so grateful to Dr. Weil for encouraging her to do the genetic testing. “And when I tested positive for the BRCA1 mutation, she strongly encouraged me to have the risk-reducing hysterectomy,” shared Chris. “I sent her a note of thanks afterward. I sent lots of notes!”
Chris is also grateful for the family and friends who helped her out during her cancer treatment. She shared, “My mom took me to my chemo treatments and even taught my children how to do their own laundry! My neighbors and friends organized meals for our family. It was a gift to see such goodness in people.”
Chris never thought of her cancer as a negative. “I was never angry,” recalled Chris.
“Honestly, the stars were all aligned for me,” she continued. “Because of Dr. Weil, I had the genetic testing and the preventive surgery. And because of Dr. Chura, a gynecological oncologist, I had the best possible surgeon for my situation. I’ll always be grateful that I live in an area with access to great medical care.”
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