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Dreams of Tuscany: Janet’s Story

08/14/2015

Standing on one foot as part of a brain-challenging exercise in her bedroom early in 2013, Janet Dinanno closed her eyes, lost her balance, and fell toward her bed—her arm grazing her abdomen. Mid-fall, “I noticed a lump—a pretty good-sized lump. I thought it was a hernia,” she says, and made an appointment at her local doctor’s office.

Upon examination, the nurse practitioner “immediately sent me downstairs for an ultrasound,” recalls Janet. “I really didn’t think of cancer to tell you the truth. Maybe I was blocking it out.”

But the ultrasound led to a CT scan, which did reveal cancer—widespread cancer—at which point, Janet’s son Jim  Dinanno  consulted trusted friend Dr. John Erban, Clinical Director of the Tufts Cancer Center, and together they recommended she transition her oncology care to Tufts MC.

Janet, now 75, soon found herself and husband Luco meeting with Tufts MC Gynecologic Oncologist Dr. Eloise Chapman-Davis who ran a battery of scans and tests to pinpoint the exact diagnosis. “They eventually told me it was ovarian cancer, Stage IV,” Janet recalls.

When blood tests discovered elevated CA125 (a blood sugar protein/tumor marker known to spike with ovarian cancer) and a CT scan and pelvic ultrasound revealed a left ovarian tumor and multiple abdominal growths, Dr. Chapman-Davis says, “I recommended a FNA (fine needle biopsy) of one of the abdominal masses that subsequently confirmed ovarian cancer. Due to the advanced extent of disease, I recommended chemotherapy treatment initially instead of surgery,” and Janet began meeting with Rachel Soffer, NP, who guides and follows all Tufts MC Gynecologic Oncology chemotherapy patients.

Light in the Face of Dark

Despite this grim diagnosis, Janet radiated her characteristic unflagging optimism. Regularly hooking up to Dr. Chapman-Davis’ prescribed 12-week series of intravenous neoadjuvant chemotherapy at Tufts, “I just felt that it was magic going into me, and thinking, this is going to cure me,” says Janet.

Seeing Janet responding well to the chemo treatment, Chapman-Davis reserved no punches in her next oncologic attack. Twelve weeks to the day after beginning chemo, Janet underwent aggressive interval debulking surgery to eradicate every cancer cell.

For cases as widespread as Janet’s, says Chapman-Davis, “studies show the patients with the best chance of survival have optimal tumor debulking surgery. The goal is to eliminate all visible disease.”

Janet’s operation therefore included exploratory abdominal surgery, a total hysterectomy, left ovary removal, bilateral pelvic and paraaortic (heart-adjacent) lymph node dissection, omentectomy (removal of a layer of connective fatty tissue over the abdominal organs), splenectomy (spleen removal), removal of the pancreas’ bottom half, as well as extraction of sizable masses on her right kidney and diaphragm.

Dr. Chapman-Davis served as Janet’s primary surgeon, aided by surgical oncologist Dr. Martin Goodman—an expert in upper abdominal surgery. “We often work together for ovarian cancer debulking,” explains Chapman-Davis, to offer patients the best possible surgical outcome. These procedures are further aided by the chief resident and other members of the gynecologic oncology team.

Following a week of post-op hospitalization, “I came home with 45 staples,” says Janet, “from the bottom of my stomach to just under my ribs. I stayed with those staples for quite a while—they were my friends, keeping me together.” She laughs.

Though she jokes about it now, Janet was always aware of the gravity of her situation. She admits that the palpable embrace of her family—husband, three children, and five grandchildren—kept her thoughts and focus buoyant throughout her ordeal. “I never felt so loved,” she says, “The love that I felt…” her voice breaks, overcome with emotion, “…that got me through.” Her children began planning a family trip to Tuscany amid Janet’s cancer therapy—something fabulous to focus on. 

Aside from a smaller surgery to remove a urethra polyp five weeks later, Janet proudly, gratefully asserts, “I’ve been clean ever since [the debulking surgery].” This is partly thanks to Dr. Chapman-Davis’ subsequent order of another big chemotherapy series combined with  a regular series of peg-filgrastim shots to keep up her white blood cell count.

By July 2014, Chapman-Davis declared Janet in remission, and as promised, Janet and her family spent 12 “heavenly” days in Tuscany that September—so energized, she recalls, “one day, we walked well over 6 miles.”

Besting the Odds

“They kinda look at me like I’m a little miracle,” she says of her medical team at Tufts. “What are you gonna do? I feel like I’m a little special,” she laughs. 

“Janet is doing really well,” agrees Dr. Chapman-Davis, pointing out the American Cancer Society’s 2015 statistics expecting fewer than 44% of those diagnosed with ovarian cancer to survive. “It is the 5th leading cause of cancer death among women,” and the overall survival rate for Stage IV cancer five years out is 15-20%.

In a true mark of success, Janet’s follow-up visits are now less frequent due to her remarkable progress—port flushes every 6 weeks (her intravenous port remains in case further chemotherapy is necessary), and full exams including blood work with Dr. Chapman-Davis every 12 weeks. This schedule will continue for two years, widening to a 6-month frequency until year five, and annually thereafter.

Ever-buoyant Janet has made these follow-ups something to look forward to. “We [Luco and I] go earlier than we have to be, because we have a little date of coffee and a muffin before my visit,” she says. “The people in the cafeteria know me now.”

Reflecting on her experience, Janet exudes endless praise. “I’m very, very happy with Tufts. I love them. I love them all,” she says of her oncologic team, citing plans to host Dr. Chapman-Davis and Rachel Soffer for dinner—a small token of her gratitude. At this point, “they’re like family. I love everything about the hospital. It is absolutely wonderful.”

Janet looks to the future as a realist and optimist. “There’s a possibility that it [the cancer] will come back, and I know that,” says Janet. And yet, “I’m never down. I have too much fun every day. My husband and I have a wonderful schedule. We get out, we keep busy, we go for walks; we go for coffee. I love it. I’m taking advantage of every day.”