Surviving one-two punch of thyroid cancer and sarcoma

UCLA Health article
Jennifer Marquez has survived not one but two bouts with cancer. Her first diagnosis and treatment for thyroid cancer went smoothly enough. It was the second diagnosis with a rare form of sarcoma that presented a life-threatening challenge.

By the time her sarcoma was diagnosed, Marquez had a mass the size of a football growing on her hip. The first doctors she consulted said she required surgery and that she might never walk again and could be paralyzed. The family instantly sought a second opinion and found their way to Dr. Fritz Eilber, an associate professor of surgical oncology and a researcher with UCLA’s Jonsson Comprehensive Cancer Center.

“It turns out I was misdiagnosed with that specific type of sarcoma, and Dr. Eilber was much more optimistic about my outcome and future,” said Marquez, 33, of Santa Ana. “He told me that I’d absolutely walk after surgery.”

Eilber enrolled Marquez in a clinical trial that used FDG-PET (fluoro-2-deoxy-Dglucose Positron Emission Tomography) to determine whether his patients were responding to chemotherapy after just two rounds of treatment, much more quickly than is usual. In her case, the chemotherapy was not working and she was spared further rounds of treatment, which required hospitalization and a 24-hour intravenous infusion of a very toxic drug.

Generally, doctors monitor patient response to therapy using CT scans, which measure the size but not the metabolic activity of the tumor, or how much glucose it is consuming. Tumor size changes on CT scans often are not evident for up to six months into a treatment regimen, meaning Marquez would have had to endure multiple additional rounds of chemotherapy, which have many significant long term side effects, including infertility.

“I had to be in the hospital for eight days straight with round-the-clock chemotherapy. I felt miserable, between the side effects and going stir crazy,” she said. “The drugs made me feel bloated, nauseous and tired and achy. My hands and feet throbbed all the time, and my entire body was sore.”

Eilber’s study was designed to determine as quickly as possible if chemotherapy is helping his sarcoma patients. If it is, then the survival benefits of the harsh drugs outweigh the unpleasant side effects. But if it’s not helping, as was the case with Marquez, then it’s time to move on to something else and spare patients further pain and suffering.

“There’s no point in giving a patient a treatment that isn’t working. These treatments make patients very sick and have long-term serious side effects,” Eilber said. “We knew patients either responded to therapy or did not respond, but we weren’t sure how early we could determine this. We also knew that size changes by CT correlated poorly with response in sarcoma patients. I really wasn’t sure we would be able to see effectiveness as early as we have. Based on our most recent study using FDG-PET, we can tell if someone is responding to therapy after a single cycle, within two weeks.”

In Marquez’s case, Eilber was able to gauge her lack of response in less than two months and move on to surgery.

Marquez’s one-two bout with cancer started in her mid-20s. She noticed her hair was thinning, her weight was fluctuating drastically and she was exhausted all the time. Thyroid problems ran in her family, so she figured that was what was happening to her. The doctor said it was stress. At that time, she also was experiencing pain, discoloration and a visible bulge in her right hip. X-rays and a visit to an orthopedic specialist and other doctors over several years led nowhere. She was misdiagnosed repeatedly. One doctor said it was a rash and prescribed an ointment. Another doctor told her that her belt was too tight, in turn causing pain to her hip, and asked her to wear loose dresses for six months.

“I was starting to wonder if I was a hypochondriac. I’d gone to so many doctors and none of them could find anything wrong,” she said. “So I moved on and put it in the back of my mind, but I knew deep down that something was wrong.”

Finally, in an effort to stop her snoring, Marquez saw an ear, nose and throat specialist, who felt a tumor on her thyroid. She was diagnosed with thyroid cancer in early 2007. Her thyroid was removed along with several lymph nodes and she received radiation iodine treatment. Later that year, she saw another orthopedic specialist about her recurring hip pain. He ordered an MRI and this time saw a large mass on her hip.

Marquez was referred to an oncologist, who did a biopsy and told her in September 2007 that she had cancer—again. After getting what turned out to be an incorrect diagnosis and the grim prognosis she received from her doctors elsewhere, Marquez found her way to UCLA and Eilber. After performing his own tests, Eilber diagnosed Marquez with myxofibrosarcoma, an aggressive subtype of sarcoma. Eilber recommended chemotherapy prior to removing the mass surgically.

She was given a baseline FDG-PET scan and in October of 2007, she checked into the hospital for her first round of chemotherapy. Marquez received a second round three weeks later. Following her second round of chemotherapy, Marquez underwent a FDG-PET scan to see how the treatment had impacted the tumor. When Eilber discovered the treatment wasn’t effective, he surgically removed the tumor.

“The good news was I could walk. I had no paralysis,” Marquez said. “The bad news was that I was told the chemotherapy might have affected my ovaries and my ability to have children. But since the tumor was so big and aggressive, I had no time to see a fertility specialist about preserving my eggs prior to treatment.”

Two years ago, Marquez married the boyfriend that she had been dating only three months when she received her first diagnosis of cancer. Within a month of their wedding, she and her husband, Christian, were pregnant. Their daughter, Mckenzie, turned one in August.

Being able to assess response, or as is Marquez’s case a lack of response, early in the course of therapy spared Marquez the infertility side effects of a treatment that was not impacting her disease.

“She is our own miracle baby. After the health scares that I’ve been through, we feel so blessed to have her,” said Marquez, who continues to be monitored for a recurrence of her sarcoma.

So far, all scans monitoring for return of the cancer have come back clean.

Her experience with her early doctors led her to believe that it’s vital for patients to be their own advocates, and if they truly know something is wrong with their bodies, don’t give up on finding an answer. Marquez also found herself taking a job in healthcare communications because of what she went through.

“I now have a whole new appreciation for my life and everything in it,” Marquez said. “I let the little things go and focus on the big things—my health, my family and loving relationships. I find a reason to smile every single day, and I always try to focus my energy on the things in my life that bring happiness.”

By Kim Irwin