Survivor Story: Jill Bach

Tuesday April 10, 2007 I visited my internist complaining of a cough that had lasted approximately six weeks and exhaustion. I imagined that I would be told that I had bronchitis and would be out the door with an antibiotic. He did not hear anything abnormal in my chest but luckily felt that since I had been coughing for so long a chest x-ray would be worthwhile. Ten minutes later his x-ray technician is asking me when I had surgery to remove part of my left lung. He stepped out of the room to get the doctor. Meanwhile, I am sitting in my paper gown staring at a film that showed two-thirds of my left lung obstructed from view. The doctor and his PA came into the room and started talking about the image as I sat feeling invisible. After a couple of minutes of them discussing the different reasons for the image I asked if more imagery would be needed. I knew that the answer was yes and wanted to move away from their hypotheses of what was going on. He drew blood to test my kidney functions to make sure that I could handle a scan with iodine dye and gave me a TB test.
Thursday, I went for a CT of my chest with contrast. Immediately after the procedure the radiologist spoke to me and told me that I had nodules in my left lung and that most likely someone would want to use a needle to determine what they were. He had called my internist who would be following up with me the next morning. I was barely out of the building before my internist phoned to tell me that he had an appointment for me with a pulmonologist the next morning.
Friday the 13th my husband and I went to see the pulmonologist. He is very well respected at the hospital and was able to have me worked in for a needle biopsy of the largest mass that afternoon. He learned that my husband and I work together so he told me that he would call me on Monday as soon as he had the results. He felt that calling me and asking me to come to his office would send the same message as being upfront with the diagnosis over the phone.
Late Monday morning he called and told us that my biopsy results showed I had moderately differentiated adenocarcinoma. The histologic appearance of the tumor was somewhat unusual for a primary lung adenocarcinoma so immunoperoxidase studies were performed. The tumor was TTF-1 negative, CK7 positive and CK20 negative.
My next appointment was with an oncologist who ordered a PET scan for initial staging. The PET scan results showed that my left lung was completely collapsed by a large malignant pleural effusion and that I had peritoneal carcinomatosis and the possibility of ovarian metastases or primary ovarian carcinoma should be considered. Later that afternoon, I had a liter of fluid drained from my left lung.
I did not get a warm feeling from my first oncologist, so I went to a second oncologist. Neither of these oncologists were gynecological oncologists. I had a mammogram to rule out breast cancer and within two weeks I went from thinking I had bronchitis to finding out that I had advanced stage Ovarian or Primary Peritoneal Carcinoma. I was 44 years young.
Since I had such large involvement of my left lung my oncologist felt that standard treatment of debulking surgery followed by chemotherapy was not an option in my case. I did get second opinions from gynecological oncologists, but my case was different enough from a standard presentation that I decided to stay under the care of the doctor that I had the best rapport with.
On May 1st I had surgery to implant a MediPort and May 3rd I started my first of six rounds of Caboplatin/Paclitaxel. I was very fortunate to respond well to Chemotherapy. My initial CA-125 level was 776. After once cycle of chemotherapy it was 415 and after three cycles of chemotherapy it was within normal range in the low 30s. I had some problems with chemotherapy-related anemia and was treated with Aransep.
While under-going treatment I took the approach to enjoy myself as much as possible and keep life for my family and I as close to “normal” as possible. We went for a family vacation to Santa Fe and I even felt well enough to walk through the Bandelier Park. Considering that my summer consisted of having one sick week followed by two well weeks I really look back on the time as positive. I grew closer to my family and we all learned what is important in life. I started a blog which helped me to express my feeling and in turn I received a lot of words and encouragement from my family and friends.
After my last round of chemotherapy, I went for another PET scan. The results were extremely encouraging. I had significant response to therapy with only mild residual activity associated with a 2.6 cm pleural-based mass in the left upper lung. They felt that the degree of uptake could be from inflammation. The other subpleural nodules were below the limits of PET resolution and that all of the other abnormalities in the chest, abdomen and pelvis had resolved.
At this point it was time for surgeries. I consulted with a thoracic surgeon regarding removing the residual mass in my left lung and with a gynecological oncologist to perform a hysterectomy. On October 1st I had a thoracoscopy. I had two masses removed from the pleural space of my lung. No viable tumor was found in either mass. On October 15th I had a total hysterectomy and oophorectomy. All 15 biopsy sites came back clean with no evidence of disease.
For two years following my last round of chemotherapy I had CT scans of my chest, abdomen and pelvis every three months along with a check of my CA-125 levels. I then graduated to having my CA-125 checked every three months and scans done every six months. My oncologist wanted to limit my radiation exposure so I now have chest x-rays with an MRI of my abdomen and pelvis in lieu of CT scans. At this stage, almost twelve years later, I have my CA-125 checked twice yearly and scans every other year. Thankfully I have had no evidence of disease and my CA-125 has stayed stable.
One more part of this story, which I feel is very important, is that I do not have a family history of breast or ovarian cancer but am of Ashkenazi Jewish descent. I asked my Oncologist to test me for the BRCA mutations. I really expected a negative test result due to the lack of family history. I was shocked to find out that I am positive for one of the BRCA1 mutations. My risk of developing breast cancer could be as high as 85%. After the testing I was treated as a high-risk breast cancer patient with alternating breast MRIs and mammograms every six months. I had very large dense breasts and based on the recommendations of several doctors including my breast radiologist I decided to have a bilateral prophylactic mastectomy. The mastectomy followed by immediate DIEP flap (deep inferior epigastric perforator) reconstruction was performed in March 2009.
I have two daughters. My consolation in all of this is my firm belief that “Knowledge is Power.” My daughters have chosen to be tested for the mutation and one daughter tested positive. She is under-going surveillance as a high-risk patient.
Did I have warning signs? Yes, I had abnormal bleeding the summer before my diagnosis. The doctor tried to regulate my cycle with hormones and did a vaginal ultrasound which showed a small cyst. The hormones did not help the problem and a blood test showed that I was in the early stages of menopause. I did not give any of this a second thought until I had the cough. I experienced some weight gain around the time of my cough which was due to the fluid in my lungs. I was tired but isn’t everyone who works hard tired? I had no other aches and pains to speak of. Ovarian cancer whispers.
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