For months, Kassandra Gomez endured abnormally heavy and increasingly painful menstrual periods and intermittent spotting. When she went to a community clinic for an exam, the doctor detected a mass in her vaginal wall. A biopsy soon revealed a shocking diagnosis: cancer.
“I broke down crying,” Gomez says of that day in August 2020. “Who would have thought an 18-year-old girl could have cancer? All I could think about was this is how I’m going to die.”
The clinic doctor referred her to the highly regarded gynecologic oncology team at UCI Health, where she met with Dr. Jill H. Tseng, a surgeon who specializes in the treatment of gynecological cancers.
“Dr. Tseng was so encouraging,” Gomez recalls. “She kept saying, ‘Everything is going to be all right. We’re going to take good care of you.’”
Extremely rare cancer
Tseng, too, was surprised by the diagnosis: clear cell adenocarcinoma, which is extremely rare in the vaginal tract, especially in young women unless their mothers had taken the now-banned prenatal drug diethylstilbestrol (DES). Gomez’s mother had not. “Her cancer seemed to come out of the blue,” Tseng says.
Because these cancers can be very aggressive, the tumor needed to be removed quickly. There also was a possibility it could return if Gomez did not also receive radiation treatment. But once the uterus is radiated, a patient cannot carry a pregnancy. Tseng knew Gomez hoped one day to have children.
“It was important for me to get rid of her cancer but not rob her of her future fertility while doing it,” she says. “I wanted her to have the same opportunities as other young women.”
To ensure removal of all the cancer so that radiation wasn’t needed, Tseng and UCI Health plastic surgeon Dr. Brock
Lanier performed a radical vaginectomy, removing most of the vaginal tissue. To enable Gomez to bear children in the future, they also preserved her uterus and cervix, and reconstructed a vagina.
This complex, fertility-sparing procedure was the first of its kind, as reported in the August 2023 issue of Gynecologic Oncology Reports. “We basically took one of the muscles from her abdominal wall but kept it attached to its blood supply,” says Tseng. “We rotated it down into the pelvis, reconfigured it into a cylindrical shape and sewed one end to the remaining vaginal tissue. We then reattached the cervix and uterus at the other end, preserving their nerves and blood supply.”
During Gomez' recovery at UCI Medical Center in late November 2020, the COVID-19 epidemic was at its height, leaving her isolated from family and friends. “My mother was only able to visit me once,” she says. “But one night nurse in particular was so nice, it was like having my mother there.”
When she was released, the teenager was very weak and sore, with an incision that ran from her rib cage to her pubic bone. She developed an infection that sent her back to the hospital. In all, she lost 25 pounds and needed a walker to get around. But eight months after surgery, she was walking unaided and spending time with friends again.
A future full of possibilities
Three years later, Tseng is thrilled by her patient’s progress. Gomez’s regular scans and biopsies indicate no sign of cancer.
“She’s a very brave young woman and invested in her care,” Tseng says.
She is confident that Gomez will be able to have children someday, although they would have to be delivered by Caesarian-section.
"Even that would need to be performed a certain way because her bladder anatomy had to be altered for the procedure. I told her that both Dr. Lanier and I would need to be present.”
Gomez, who recently celebrated her 22nd birthday, hopes to start community college classes soon. Her experience has inspired her to consider a medical technician career, possibly in radiology. It has also left her with a reminder of her bravery and stamina.
“At first I was shocked when I saw my surgery scar, but my family and friends tell me it’s beautiful, that it shows I’m a survivor,” she says. “So this scar is my life story.”