Cancer claiming lives of women under 30: A mother's love story

Cancer screening in women just entering adulthood is often overlooked during the best of times and, with a global pandemic still raging into its second year of transmission, the Texas Health and Human Services Commission is warning that screening rates for deadly cervical cancer has dipped even further.

“Cervical cancer screening rates have declined nationally during the COVID-19 pandemic,” HHSC associate commissioner for Health and Developmental Services Lindsay Rodgers said, encouraging Texans to turn that trend around by resolving to prioritize cervical health in 2022. “Routine cervical cancer screening is the most effective way to detect cervical cancer early, and the first step is talking with your doctor.”

In 2018, which is the most recent year of available data, there were 1,299 new cases of cervical cancer for women in Texas, according to HHSC data. Cervical cancer is the third leading cancer diagnosis in women ages 20-39 and fifth in women ages 40-49.

Breast and cervical cancers are so prevalently featured in women’s mortality that special awareness months are set aside to warn of their existence, facilitate testing and – hopefully – treat the conditions before they prove fatal. But these are not the only cancers that pose an imminent threat to women of all ages.

Dr. Sandra Cesario, a woman’s health specialist for more than 40 years and Fellow in the American Academy of Nursing, warned of silent gynecological cancers like cervical cancer during a conference held at the Lamar University Dishman School of Nursing at the end of 2021. The event, produced for students and staff of the nursing program, was facilitated by the Julie Rogers “Gift of Life” Program and founder Regina Rogers.

Cesario, who has attended to thousands of patients as a world-traveled medical expert, and taught countless classes of new doctors how to excel in specializations that extended the lives of untold masses, expressed how none of that expertise mattered when her 23-year-old daughter, Anna, was diagnosed with the ovarian cancer that would eventually claim her life. Anna fought the cancer as hard and valiantly as any person could, her mother explained, but it was too late.

The doctor hopes that by sharing Anna’s experience with the rest of the world, the information will come in time to save the next young woman.

A mixture of science, emotion and hope, Cesario voiced her story – and Anna’s – from the viewpoint afforded her through her extensive medical training, as well as the firsthand devastation of personal experience.

“I find it to be a very hopeful, inspiring story,” Cesario explained, although it is a hope that springs from a well of immense loss.

“She was my only daughter, my youngest child,” Cesario said. “When your spouse dies, you’re a widow. But when you’re a parent with a child who dies, what do you call them?

“There is no word for a parent that’s lost a child.”

Cesario had many words to call her precious Anna, though: animal lover, musician, athlete, fighter, “and so much more.”

Easily reaching back into the recesses of her memories to recall the exact moments leading up to her daughter’s cancer battle, Cesario paints a picture of Thanksgiving 2003.

“Anna was tired and her appetite was waning,” Cesario slowly began. She remembered just how unremarkable the symptoms seemed at the time. Anna said her belly button was sticking out “funny,” too. Again, nothing too alarming. “And that’s where we left it.”

By December, Anna was bloated and a visit to the student health clinic at the college she attended seemed to indicate she had an ulcer. But, Anna kept getting worse. A week later, when the usually thin and healthy 23-year-old took on the appearance of a women roughly five months pregnant, Anna was back at the clinic for more tests. Imaging revealed a large mass and peritoneal fluid. It would spark the first of many trips Anna would take to the hospital for diagnosis and treatment.

By the third week of December, Anna had been transferred to yet another hospital and was under the care of a gynecological oncologist.

“Christmas morning at 6 a.m., they came into her room and said that the pathology report is back,” Cesario said. The diagnosis: Stage 4 Epithelial ovarian cancer.

“Stage 1 and Stage 2 are very treatable,” Cesario said. “If we can find it at that stage, we can get rid of it and people can go on and live healthy lives.”

For ovarian cancer in Stage 3 and Stage 4, the prognosis is not so optimistic.

“Pieces of her diaphragm and liver were removed,” Cesario said. Anna’s young body was riddled with cancer. “The cancer reached her colon and other critical organs.”

Chemotherapy and surgical options are available, to mixed success if the cancer has advanced past Stage 2, the doctor/mom described. The pros and cons were explained, still, by Anna’s treating physician, a doctor that Cesario credits with compassionate treatment for a patient with a difficult path ahead.

“He gave her choices – both at the beginning of her journey, and at the end of her life,” Cesario said. “He was honest with her. He listened to her.”

Listening – and watching – Anna fight the cancer, Cesario was taxed with empathy for the pain her baby girl was experiencing, as well as amazement in how brave the 20-something was in the face of such adversity.

“It’s upsetting when you stand in the shower and watch clumps and clumps of your hair just flow down the drain,” Cesario said of Anna’s experience. It didn’t just affect Anna’s long, luscious locks either; the alopecia affects eyelashes, eyebrows, body hair, and even nasal hair. “She never went anywhere without a Kleenex in her hand because her nose would just run.”

Anna slept in white cotton gloves and socks due to her skin sloughing off during the night. Nausea so overwhelming it consumed most of her life, pain and fatigue were ever present.

“She was always tired, but she continued to work,” Anna’s mom beamed. Anna threw everything she had at fighting the cancer, too, for roughly six years, until her body could fight no more.

“Even though all of this was going on, I want you to know what she accomplished while all of this was going on,” Cesario said. Anna finished law school, passed the bar and was licensed to practice; she got engaged and got married; she bought a home; she lived life; she gave to others; she shared her story in hopes to save others a similar struggle; she championed for gynecological research and worked for policy reform in women’s health. “As sick as she was, she really accomplished a lot during that time.”

She never gave up hope, and she never gave up control. Days before her death, Anna was still giving orders as to her treatment options. On a Friday, Anna decided she was ready to go home on hospice. Saturday she was set up comfortably in the home she shared with her husband. Anna died on Sunday.

“The symptoms are so vague, it’s hard to predict,” Cesario said. Most people, she noted, have no symptoms at all. “Women need to know their own bodies. If anything feels abnormal for two or three weeks, get it checked out with a health care professional.”

Lab tests can detect cervical cancer early with a pap test, when it can be still treated. Other gynecologic cancers, such as ovarian, uterine, vaginal and vulvar, are not so easily pinned down. Absent a routine test available to detect most gynecologic cancers, Cesario recommends recognizing early warning signs and taking measures to avoid risk such as getting the HPV vaccine. The HPV vaccine is administered to pre-teen girls, available for free at the Beaumont Public Health Department for example, and is linked to preventing gynecologic cancers later in life. Tubal ligation, hysterectomy and oral contraceptives all also help stave off gynecological cancers, she advised.

Some factors increase the risk of developing gynecologic cancers: middle age or older, genetics, obesity, height, prior cancer diagnosis, Eastern European or Ashkenazi Jewish heritage, history of endometriosis, and infertility.

“It is quite a lethal cancer,” Cesario summed up. “Hopefully, we can reach people when it’s in the early stages and treatable.”

Gift of Life’s Regina Rogers said she was so moved when she first heard Cesario’s story that she knew Southeast Texas audiences would benefit from the inspiration and wisdom shared in the message. Rogers, too, relates to losing loved ones to cancers caught too late to beat.

Not a day goes by that Rogers doesn’t recall the immeasurable impact of Gift of Life board members, attorney Julie Richardson Procter, and Georgie Volz, regional director of the Texas Commission on Environmental Quality, who passed away ‎at the ages of 51 and 52, respectively, from ovarian cancer that was diagnosed too late for treatment to be effective.

“They both had expressed a desire for Gift of Life to take an active role in conveying critical information to the medical community and public about this silent disease and killer,” Rogers shared of a mission she still exacts in memory of her cherished friends. Gift of Life has since championed gynecologic cancer awareness through media promotion, grassroots efforts, in high schools, in court rooms, at city halls – and through the streets of the biggest city in Jefferson County during the annual Ribbon Run for Breast and ‎Ovarian Cancer that attracts thousands of participants each year.

“During this time, our commitment became even stronger as two additional dedicated board members and volunteers passed away from this insidious disease: Lola Campbell Wilbur, only 40 years old, who diagnosed herself, but too late, after she learned about the symptoms at our Ribbon Run, and Norma Forey, 68, who courageously and bravely fought ovarian cancer for more than 20 years,” Rogers said.

Alongside fellow crusaders such as Gift of Life Executive Director Norma‎ Sampson, Linda Domino, Dora Nisby, Rev. Dean Calcote, Dr. Gwendolyn Lavalais, Dr. Beverly Parker and countless others dedicated to saving lives in Southeast Texas, Rogers and the Gift of Life program has facilitated the diagnosis and treatment of hundreds of men and women throughout seven Southeast Texas counties. For more information, contact the Gift of Life at (409) 833-3663.