Growth and recovery: Overcoming ovarian cancer
As 31-year-old Melissa Selmes’ daughter grew inside of her, so did an ovarian cyst. Starting out the size of a pea, it developed into an 18-pound tumour.
“During my first pregnancy ultrasound, they noticed there was a small cyst. This is something that can happen naturally and isn’t always of concern,” says Melissa. “But by the time I was eight months pregnant, it had grown significantly.”
After Melissa’s daughter, Irelyn, was delivered safe and healthy through a caesarean delivery (C-section) at London Health Sciences Centre (LHSC), Melissa’s care team surgically removed the tumour and her right ovary. The tumour was sent for laboratory testing. While it had borderline cancerous properties, no further treatment was needed at the time.
Two years later, Melissa started noticing new symptoms. “I wasn’t retaining weight, so my family doctor suggested that I increase my diet to 5,000 calories per day. I did that for about a week and I lost another 10 pounds. Given my history, my doctor ordered an ultrasound.”
In early 2013, the ultrasound revealed a new mass growing on Melissa’s left ovary. She was referred to Dr. Jacob McGee, a gynecologic oncologist at LHSC.
“I had another surgery which included a full hysterectomy. They described the tumour as a sticky, plaque-like substance. When they tried to remove it, it resisted and they were able to remove only 10 per cent of it,” explains Melissa.
She was diagnosed with stage III mucinous adenocarcinoma of the ovary (mucinous ovarian cancer) – a rare form of ovarian cancer that is much less responsive to standard chemotherapy. The likelihood of surviving three years with advanced-stage mucinous ovarian cancer is only 25 per cent.
“I was told that without treatment I would have approximately one year to live and that standard treatment had a poor success rate. That was extremely difficult to hear, especially as I had recently had my daughter. How could I miss a moment of her growing up?” reflects Melissa. “But I was quick to flip it around in my mind. I was determined to work with my care team to explore other therapies.”
It was then that Melissa was referred to Dr. Stephen Welch, a medical oncologist at LHSC. Specializing in gastrointestinal and gynecologic cancers, Dr. Welch is renowned for his expertise in precision medicine where he matches individual cancer patients to novel therapies based on the unique genetic makeup of their tumour.
“I aim to identify specific therapies for specific patients by studying tumours on a molecular level,” explains Dr. Welch. “Since standard treatments don’t work as well for mucinous ovarian cancer, we explored other options with Melissa.”
While Melissa started on a four-month regimen of standard chemotherapy, Dr. Welch began researching alternate treatments. He became aware of case reports from colleagues in British Columbia who were successful in treating mucinous ovarian cancer with a breast cancer drug called Herceptin.
“Herceptin targets a specific protein called HER2. While the protein is not commonly associated with ovarian cancer, it is associated with a small percentage of mucinous ovarian cancers,” notes Dr. Welch. “We therefore asked our lab to test Melissa for HER2 and it turned out she had it.”
Dr. Welch discussed these findings with Melissa and they decided to add Herceptin to her treatment plan. Since the drug is not typically used for ovarian cancer, Melissa’s case was first reviewed and then approved for funding by Cancer Care Ontario. As that process was underway, her family and community began fundraising on her behalf.
“My hope was rejuvenated as I went in to start treatment,” reflects Melissa. “By the sixth week, we were seeing progress on my ultrasounds. The treatment was starting to work.”
Melissa was treated with Herceptin for the next 18 months and it continued working. Since 2015, her CT scans have been clear with no remaining signs of cancer.
“It’s rare to see a patient with stage III mucinous ovarian cancer live five years past diagnosis as the cancer normally recurs within one year,” says Dr. Welch. “Melissa has now been cancer-free for close to six years. She had something unique about her cancer that we were able to target, and it benefitted her. That’s a powerful example of science put to good use.”
Melissa continues to see Dr. Welch regularly for monitoring. She has also participated in research studies being led by Dr. Welch to further analyze the tumour removed from her body. The genetic information could be used to inform treatment decisions if the cancer returns.
“We had a plan A and a plan B for treating my cancer, but now we also have a plan C and a plan D if needed,” says Melissa. “We call Dr. Welch our guardian angel for good reason. He recognizes that cancer is so complex and individual to each patient. I believe I wouldn’t be here and wouldn’t have just celebrated my daughter’s 10th birthday without him.”
Melissa credits her entire care team at LHSC for their dedication, compassion, and innovation.
“With LHSC, I learned there’s so many people working around the clock that you don’t see. They go above and beyond in every way,” she notes. “I knew that if I needed to go home and not think about cancer for a night, I could do that because someone was thinking about it for me.”
For Melissa, cancer has been a life-altering journey. “It made me realize you don’t have a lot of moments in life and so you need to live each one to its fullest. I now raise my daughter in that light.”
Reflecting on the COVID-19 pandemic, she notes that it’s important to find moments of happiness even in difficult times. “I try to experience every little thing that life has to offer. I’m still young and have many years ahead of me, and for that I’m forever grateful.”