When Carol reflects back on her journey with cervical cancer, she has a daily reminder of what helped her get through it each time, a tattoo on her arm with her personal motto inspired by her Great Aunt Anna.
"More Sunny Days."
When Carol was young she asked Great Aunt Anna how old she was, and her aunt replied, "Carol, I stopped keeping track a long time ago and now only count my sunny days." It was a mantra and life philosophy that got Carol through each round of treatment and each challenge she was faced with after three recurrences over the span of six years.
Carol's cancer journey began in 2011 when her OB-GYN found a lump on her cervix and ordered a biopsy. The lump turned out to be seven centimeter tumor, and she was diagnosed with cervical cancer.
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"I think unfortunately, there's still a bit of a stigma when it comes to cervical cancer and with what we call 'below the belt' cancers, because it's related to the human papillomavirus (HPV) and HPV is a sexually transmitted infection," said Carol.
Carol was referred to Dr. Albert Pisani, a gynecologic oncologist on El Camino Health's medical staff, and soon began pre-surgery chemotherapy before undergoing a radical hysterectomy.
"When you have to go through chemotherapy, the sessions are pretty long," she recalled. "For me, the first few sessions were seven to eight hours long, so being able to have a playlist was important to me."
When you spend hours undergoing medical treatment, the silence at times can feel unsettling, and for Carol, having a good playlist was therapeutic. Her playlist included a mix of calm, meditative music, some fun, upbeat tracks, and as the wife of a musician, a few songs by her husband. The playlist helped her get in the right mindset to fight cancer and prepare for surgery.
Dr. Pisani performed Carol's radical hysterectomy using the DaVinci robotic system, which allows for precision, flexibility, and control throughout the surgery process. Carol said she healed well after surgery and returned to her normal life soon after, but in 2012, her cancer returned.
"Carol's options were limited at this point, with the average life expectancy measured in months," said Dr. Pisani, "so I asked her to consider a rarely performed, but sometimes curative, radical surgical procedure called a Total Pelvic Exenteration, to which she agreed."
During this procedure Dr. Pisani removed the recurrent tumor, which was fused to surrounding tissues from her prior radiation, along with the entire reproductive system, bladder, and lower colon.
"I'm a self-proclaimed double-bagger, I have a colostomy and urostomy," said Carol, laughing. "But I have to laugh about it, because it's a life-changing procedure. Humor helps normalize things, it reminds me that I’m alive and the darker days are behind me."
Carol's sense of humor, playlist, and desire to keep going would get her through two more recurrences, in 2015 and 2017. With the cancer recurring despite salvage chemotherapy, Dr. Pisani asked her to consider participating in a clinical trial which was looking at a new category of anti-cancer drugs called immune checkpoint inhibitors.
"Although immunotherapy was becoming more common in the treatment of lung cancer and melanoma, immunotherapy wasn't being to treat cervical cancer routinely at that time," said Dr. Pisani. "Thankfully, immunotherapy worked well for Carol. With help from a few more rounds of traditional chemotherapy, she was cancer free."
Throughout her cancer journey, Carol joined support groups for cancer patients, but found it hard to connect with other cervical cancer survivors as most women in the group were breast cancer survivors.
"There's so many things that only other cervical cancer patients can understand, and the only one I connected with was through Dr. Pisani," she recalled.
Shortly after her last recurrence, Carol connected with Cervivor, a global community of patient advocates that inspire an empower those affected by cervical cancer. She is currently an ambassador for the organization.
"Now my cancer story has a purpose and my voice is part of a community bringing awareness to a preventable disease," said Carol. "I want other women to know that they're not alone, because it can feel so isolating with a cervical cancer diagnosis. As a survivor, I also want them to know that it's okay to have the anger and sadness, but it's also important to find those moments of joy, and keep counting your sunny days."
Eleven years and many sunny days later, Carol is celebrating five years of being cancer free.