Yesterday was a day to relish. I traveled sixty miles from my home to Johns Hopkins Hospital to have what I hoped would be a final follow-up visit at the Kelly Gynecologic Oncology Service where I had been treated five years before for advanced ovarian cancer. And my hopes were realized.
Dr. G. said that he had no real recommendation for further follow-up for me. I was five years post-treatment and had not had a detectable recurrence of my disease. He said, “This is when we begin using words like cured.” He said while oncologists never talk in terms of a 100 percent likelihood of cure, he could say I have a 90 percent chance of never experiencing a recurrence. He said I was extremely lucky and it was a very happy moment for everyone concerned. I thanked him for his help and said I owed my successful survival to everyone on the Hopkins team. It was very clear to me the care was superb and critical to my outcome.
Dr. G. demurred a bit saying he would like to take credit when his patients do well, but some of this is also likely due to genetic make-up. A friend in the room then asked him about any related cancers, that is, if one has had ovarian cancer, is there a likelihood of secondary, related disease. Dr. G. said for those with the BRCA 1 or 2 mutations, breast cancer would be related. He also noted that the BRCA genes, at least for ovarian cancer, seem to provide a protective quality making the cancer more sensitive to the chemotherapy drugs given to destroy it. He said he often wonders about BRCA mutations when a patient has achieved a five year anniversary with no recurrence of disease. He then asked about my family history of breast and ovarian cancer. This issue had been thoroughly discussed with my first GYN- oncologist, Dr. Bristow. My family history is not without breast cancer victims, but all were stuck by the disease in their fifties, some generations skipped disease altogether, and no one but me had developed ovarian cancer. This is not the typical disease profile for a family with BRCA mutated genes. Dr. G. said I might want to talk with the Breast and Ovarian Surveillance Service and Genetic Testing group at Hopkins for the sake of my family members to see what they think. I said I would.
Dr. G. said another related cancer is leukemia, a consequence of chemotherapy, but this was a small likelihood. I had read about this in a fascinating book on the history of cancer and its treatment called, The Emperor of All Maladies, by Siddhartha Mukherjee. It won the Pulitzer Prize in 2010. I also knew that leukemia can be caused by too much radiation absorbed by CT scans, or other radiological tests, and especially as a consequence of radiation therapy.
But these small risks were worth the fight to defeat ovarian cancer. That disease was going to kill me in a matter of a year or so. I may never develop leukemia and I never miss a mammogram. So, as Dr. G. said, I am now at the same risk as everyone else in the population for cancers like colon and lung. It may sound strange to say this, but that sounds good to me!
As I left the exam room and gave my paperwork to the clerk to check me out, she asked me if I needed another appointment. She could not have known how gratifying it was to answer, “No.”