Brushing past ovarian cancer

Still-life painter plans to be among the 30 percent of women who survive the deadly disease

September 18, 2011

Alice Hernandez-Gaona had no doubt: 2010 was shaping up to be the best year of her life.

Her first foray into art shows culminated in an invitation to Laguna Beach’s juried summer arts festival, Art-A-Fair. At 47, her childhood passion for art had flowered into a painter’s career.

Back at her easel after the festival ended, Gaona made a doctor’s appointment for abdominal pain and bloating that had been nagging her for more than a week. Her visit to a gastroenterologist on Sept. 9 ended in the emergency room at a community hospital.

Doctors said the accumulated fluid in her abdomen suggested ovarian cancer that had spread. The stunned artist from Long Beach was admitted immediately and they called in a UCI Health specialist.

“I thought, ‘Oh my god, the best year of my life is turning into the worst,’” says Gaona, a recently remarried mother of two who had run five miles and played a round of golf only a few days earlier. “Here I thought I was healthy, and now I’m going to die.”

Dr. Krishnansu Tewari, a leading gynecologic oncology specialist and researcher at UC Irvine Medical Center, confirmed the diagnosis the next morning. He told her that he needed to operate as soon as possible at the medical center's UC Irvine Douglas Hospital, where he would have access to the most advanced surgical facilities in Orange County.   

Tewari didn’t sugar-coat the situation. Ovarian cancer, the fifth most common cancer among women, is the most lethal, killing an estimated 15,000 women each year, mainly because it isn’t diagnosed early enough. But Gaona found his direct explanations, coupled with his aggressive plan of action, calming at a time of great personal upheaval. 

Four days later, Tewari and his team performed extensive surgery, removing Gaona’s ovaries, uterus, fallopian tubes, spleen, appendix and part of her colon and rectum. As part of the “debulking” surgery, he also excised all visible cancer and reconnected her colon to ensure normal bowel function. Based on the size and extent of the tumors, he determined that she had stage IIIC ovarian cancer.

Her treatment didn't end there. As a patient at Orange County's only university hospital, Gaona had access to clinical trials not readily available elsewhere. She volunteered to undergo extensive chemotherapy in one of the largest research trials for ovarian cancer in the nation. The study—being led at UC Irvine's Chao Family Comprehensive Cancer Center by Tewari and sponsored by the nonprofit Gynecologic Oncology Group in collaboration with the National Cancer Institute—is designed to attack ovarian cancer in multiple ways at the cellular level.  

Patients enrolled in the trial are randomly assigned to three different groups. Gaona is in the group receiving intraperitoneal therapy, which involves delivering a drug directly into the abdominal cavity; a second drug given intravenously in higher doses weekly instead of every 21 days; and a third drug to starve lingering tumor cells. “These are three of the most important areas in ovarian cancer research, so I’m really excited,” says Tewari.

On Nov. 5, Gaona began receiving a weekly dose of Taxol®, delivered intravenously through a port implanted in her chest, and a second drug, carboplatin, delivered directly into the abdominal cavity every 21 days to target any remaining cancer cells. 

“Those are the ones that made me lose my hair,” Gaona says, recalling how she and her daughter, Alyssa, now 10, played dress-up with her wigs. 

On Nov. 26, Gaona also began getting bevacizumab intravenously every 21 days. Also known as Avastin®, the drug works by preventing a tumor cell from forming blood vessels to nourish itself. Gaona later developed two blood clots in her lungs, but Tewari says this known side effect of the drug has been managed with blood-thinning medication. 

Now that Gaona is in the trial’s final phase, she gets only bevacizumab every three weeks at the hospital’s infusion center, which she has dubbed “Club Med” because of the attentive ministrations of the nurses, staff and volunteers. Her chemotherapy ends in early March 2012, but she’s already doing well enough to be considered in remission. 

Her blood tests for the protein CA125, an indicator for ovarian cancer, have dropped from more than 400 at the time of her debulking surgery to between 4 and 6 after about four months of chemotherapy. Anything less than 35 is considered normal for healthy women. Such low numbers suggest the clinical trial is having the hoped-for effect. Given that seven in 10 women with ovarian cancer die within five years of diagnosis, Tewari says he’s cautiously optimistic.

“She’s doing great. Now if we can get her to five years in remission, we’ll have a party at her studio.”

Through it all, Gaona has continued running, golfing and, of course, painting. Her hair is growing back and is just long enough to wear in a pixie style framing her face. She is grateful to Tewari and his team of doctors, nurses and other staff members, most of whom attended opening day at this year’s Art-A-Fair, where Gaona won the award for best painter in oils. 

“Dr. Tewari has always done exactly what he said he would do,” Gaona says. “That first day he assured me that he would keep me alive—and he has.”

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