Good luck trying to keep up with 75-year-old Margaret Baker of Pinehurst. She is a local tennis champion. Avid swimmer. She has hiked in most Western states and parts of Canada with Jack, her husband of 56 years and best friend. Ovarian cancer was never on her agenda.
Ovarian and other cancers are seldom on any woman’s agenda. Therefore, Margaret and FirstHealth of the Carolinas are sharing information about cancer affecting female reproductive organs, including the ovaries, cervix, uterus, fallopian tubes, vagina and vulva, in observance of Gynecologic Cancer Awareness Month in September.
“In August 2019, I started feeling very tired and out of breath,” Margaret said. “Almost overnight I went from swimming a mile at a time to not even four laps. Something was wrong.” She originally attributed her tiredness to thyroid issues, but tests came back with normal levels. An electrocardiogram (EKG) showed the heart of a woman decades younger than 75. A lung x-ray revealed pneumonia, but treatment did not alleviate her fatigue.
“My husband reminded me of my age and said that perhaps I was just doing too much,” Margaret said. That did not go over well.
A CT scan revealed fluid in her lungs and an enlarged omentum, a usually delicate tissue that hangs like a curtain from the colon. At that point, she was referred to FirstHealth gynecologic oncologist Michael Sundborg, M.D., “because those two markers gave us a good idea of what it was,” he said. A biopsy of the fluid and omentum told doctors where the cancer was coming from and informed her diagnosis: stage 4 ovarian cancer.
Understanding the symptoms of gynecological cancers is the key
“Ovarian cancer spreads throughout the abdomen, like leaves falling off a tree,” said Dr. Sundborg. “It doesn’t get into the bloodstream but spreads within the abdominal cavity. It also often generates fluid around the lungs, as in Margaret’s case, but we don’t yet know why. With fluid compressing her lungs, they couldn’t expand to get enough oxygen in and that’s why she was tired.”
Ovarian cancer is sometimes called the “silent killer” because some presenting symptoms are often mistaken for everyday issues, particularly ones that affect the gastrointestinal system or simply changes in a woman’s body as she ages. Symptoms can include fatigue, pelvic and abdominal pain and bloating, difficulty eating or feeling full quickly, abnormal vaginal bleeding, and urinary issues, including changes in frequency or urgency to urinate. “Out of every 100 patients we see with ovarian cancer, 85 will have advanced cases because the signs and symptoms are so vague,” said Dr. Sundborg. “Plus, unfortunately, we don’t yet have an effective screening test for ovarian cancer.” A pap smear, often thought to screen for a range of gynecologic cancers, covers only cervical cancer.
The Centers for Disease Control offers a chart showing symptoms and the types of gynecologic cancer they may indicate as well as a symptom tracker. These tools are not substitutions for a professional diagnosis, and women are encouraged to see their doctors with any concerns.
“The good news is that when diagnosed and treated in the earliest stages, the five-year survival rate of gynecologic cancer is more than 90 percent,” said Dr. Sundborg. “The key to early detection of gynecologic cancer is knowing your body, noticing what’s not right and talking with your doctor.”
Dr. Sundborg also said that while every woman is at risk of developing gynecologic cancer, increased risk factors include obesity, menopause at a late age, smoking, never having been pregnant, advanced age and a family history of cancer.
The most significant risk factor for cervical cancer in particular is the human papillomavirus (HPV). The Centers for Disease Control (CDC) reports that more than 9 of every 10 cases of cervical cancer are caused by HPV, but they can be largely prevented by the HPV vaccine. The CDC recommends HPV vaccination for girls ages 11–12 to protect against cancers of the cervix, vagina and vulva. (It’s important to note that HPV affects not only women. Nearly 4 out of every 10 cases of cancer caused by HPV occur among men and the CDC also recommends the vaccine for boys ages 11-12.)
Margaret is among the 1 in 78 women nationwide who develop ovarian cancer in her lifetime. The American Cancer Society (ACS) estimates that in 2020 about 21,750 women nationwide will receive a new ovarian cancer diagnosis and 13,940 women will die from the disease. In North Carolina, the estimates are 680 new cases and 430 deaths. And that’s just ovarian cancer. An additional 91,770 women in the United States will be diagnosed with other cancers of the reproductive system this year and 19,680 will die, according to the ACS.
World-class cancer care at FirstHealth of the Carolinas
Women in the Sandhills facing a gynecologic cancer diagnosis have access to first-rate care at FirstHealth Cancer Care with its full continuum of gynecologic cancer services: genetic testing, diagnosis and counseling, surgery, medical management, chemotherapy, clinical trials and long-term follow-up.
“When you hear cancer, it’s like someone kicks you in the gut,” said Margaret. “No one in my family had cancer and even if someone had, we would have never talked about it.” Baker said she “lucked out” with Dr. Sundborg, physician assistant Adara Starr, PA-C and oncology nurse navigator Natasha Candy, R.N. “I can’t tell you how helpful Natasha was,” Margaret said. “When I first met with Dr. Sundborg, he shared wonderful information, but my husband and I couldn’t absorb it all. Natasha was there and wrote everything down for us to refer to later. We went in scared but left hopeful.”
Candy also told the Bakers about FirstHealth’s comprehensive cancer services available to patients and their families, including patient navigation, integrative medicine, nutrition and dietary assistance, stress management, massage therapy, clinical trials and more. Many of these services are funded by the Foundation of FirstHeath and more information is available at www.nccancercare.org.
Margaret added, “Dr. Sundborg is kind, honest and very upfront, which means a lot to me. He said my case was serious and we needed to jump on it right away.” Her plan called for six chemotherapy treatments with the goal of eliminating most of the cancer. This was followed by surgery that included a total hysterectomy, with the removal of the ovaries, fallopian tubes and the omentum in February 2020. Her procedure was minimally invasive using robot-assisted laparoscopic surgery. Three more chemo treatments followed in the spring and she now takes a monthly maintenance drug by infusion for a year.
Dr. Sundborg explained that patients like Margaret are benefitting from dramatic advances in gynecologic oncology in the last year “because we better understand the molecular aspects of cancer. We can drill down and target weaknesses in the DNA of cancer cells that we could never detect before.” He also said new medications are proving effective at suppressing cancer for patients with genetic predispositions and that the research is extending into cancers that are typically not genetically predisposed.
“It’s also important for people diagnosed with cancer to know that FirstHealth has advanced capabilities usually reserved to a university setting,” Dr. Sundborg said. “That enabled us to quickly design a viable treatment plan for Margaret that would allow her to return to winning tennis matches.” He cited a team approach to care, including the interventional radiologist who was able to draw fluid from Margaret’s lungs and biopsy her omentum with minimally invasive methods as opposed to surgery. A gynecologic pathologist onsite at the time of Margaret’s biopsy could ensure specimens collected were adequate for testing so she would not need to repeat the tests. “These specialists are unusual for a community health care system,” said Dr. Sundborg.
The Bakers were relieved that Margaret could receive quality care right at home. “Instead of driving 1.5 hours to Raleigh, Durham or Chapel Hill, I could get to FirstHealth in just 15 minutes. We moved to the Sandhills for the wonderful health care and it turned out to be a great choice.”
“Jack and I just love Dr. Sundborg,” said Margaret. “We laugh together, and he just feels like a member of our family. And I know he’s like that for all of his patients, not just me.”
For seven years Dr. Sundborg was the only gynecologic oncologist in the Sandhills but now patients can also receive care from gynecologic oncologist Brian Burgess, D.O., Ph.D., a new addition to the FirstHealth family. “We are very excited for Dr. Burgess to join FirstHealth’s cancer care team,” said Dr. Sundborg. “His highly regarded training and philosophy for patient-focused care make him a wonderful addition to our team.”
Cancer care in the Sandhills is set to expand further with a four-story, 120,000 square-foot comprehensive outpatient cancer center to be built on the Moore Regional Hospital campus in Pinehurst. Announced in 2019, the facility will allow patients to receive FirstHealth’s full continuum of cancer care under one roof with an emphasis on enhanced support services and patient navigation. “I’m eager to see the new freestanding facility,” said Margaret.
Margaret is also eager about her life—today and in the future. “Dr. Sundborg told me that my best friend through this cancer journey would be my positive attitude and he’s been absolutely right,” said Margaret. “Sitting and doing nothing is just not me and he knows that. I plan on living a long time.”