The Cancer is Back...

Bad news. Today we learned that Stephanie’s cancer has started to grow again. It has been just over 5 years since her original diagnosis on September 22, 2014. Ovarian cancer has a high recurrence rate, unfortunately.

So what does a recurrence of ovarian cancer mean and how is it treated?

When Stephanie was originally diagnosed it was through an exploratory surgery triggered by a very large tumor growing from her ovaries. In that case, there was a large mass that needed to be taken from her body and that was the most effective way to remove the bulk of cancer. After the surgery in 2014, although the visible portions of the disease were removed, cancer still existed at a cellular level or at a concentrated level not visible to the human eye. To treat the remainder of cancer left in her system and that was visually present on organs that couldn’t be removed (like her colon), they used traditional chemotherapy. The traditional chemotherapy targets fast-growing cells in the body and, in Stephanie’s case, delivered a substantial blow to the remaining cancer cells in her body. However, in most, if not all cases of ovarian cancer, all of the cancer cells were not removed and were not killed. Ovarian cancer doesn’t cause problems unless it is growing. For the last 5 years, Stephanie's remaining cancer has either not grown or it has grown very slowly.

Last week Stephanie had her regularly scheduled appointments with her oncologists. These are appointments she has every 6 months. Once a year she has scans of her abdomen to inspect for physical evidence of cancer. This year, the CT scan uncovered a few abnormalities which prompted an MRI scan and a biopsy of the suspicious areas found. The biopsy results suggest the suspicious areas shown on the scan are in fact, the same ovarian cancer that was originally discovered in 2014. Stephanies specific ‘flavor’ of cancer is low-grade serous carcinoma (LGSC) is a rare subtype of cancer of the ovaries/peritoneum. There are two types of this ‘flavor’ of cancer: low grade and high grade. My understanding of the difference between low grade and the high grade is the rate and nature of growth. Low grade grows slowly and, as Stephanie’s doctor suggested, sneakily. High grade, conversely, grows more rapidly and distinctly; presenting in the form of tumors or concentrated masses. When LGSC recurs, it often doesn’t present in ways detectable with scans. When it grows it starts as somewhat of a ‘glaze’ over organs in the gut and peritoneum. (Imagine sugar glaze over a donut.) What was noticed on Stephanie's scans was a thickening of her peritoneum, which is the lining of your gut. So her cancer is growing alongside the inner liner of her gut while also spreading to cover the outer layer of organs such as her colon.

The most effective treatment of cancer is to get it out of the body. Surgery is the only way to get it out. In Stephanie’s case, you cannot cut out her ‘gut liner’ and she would prefer to keep her intestines and her colon intact. The only other way to treat cancer is through therapies that target and kill cancer cells. Traditional chemotherapy is one way she could move forward with treatment and it proved to be effective in her first battle with ovarian cancer. There is also a new treatment called a mek inhibitor which targets and treats low-grade cancers. Stephanie will soon start taking a mek inhibitor as Plan A. If it works, she will continue to take the medicine indefinitely or until the medication no longer works. If the mek inhibitor doesn’t work, she will then be treated with the more traditional chemotherapy options. At this point, there is no Plan C so we hope Plan A and Plan B work. One of the great things about a mek inhibitor is the lack of severe side effects. Traditional chemotherapy amounts to injecting your body with poison and there are terrible side effects. Although mek inhibitors do have several side effects that are certainly substantial, it pales in comparison to traditional chemotherapy.

Stephanie is shaken by the news her cancer continues to grow inside her. From speaking with her, I gather one of the toughest aspects of going through this is the complete and utter lack of control she has over it. Also, the uncertainty of it all causes her a great deal of fear and stress. Lets all hope and pray that the initial treatment works well because, if it doesn’t, her journey becomes harder and more uncertain.

P.S. I am sorry if I ruined glazed donuts for you. I don't know that I will ever see a Krispy Kreme donut the same.