The patient: Larisa*, 15, a high school student in Ukraine
The symptoms: Cough, abdominal pain
The doctor: Dr. Cynthia Herzog, deputy division head, University of Texas MD Anderson Cancer Center in Houston, Texas
When Larisa began experiencing pain in her abdomen, pain that would come and go, the teenager’s concerned parents brought her to their family doctor, who referred her to a gynecologist.
After an ultrasound detected a mass in Larisa’s pelvis, an oncologist took a biopsy. A week later, the results came back positive for a germ-cell tumor, a type of cancer that occurs in the reproductive cells of the ovaries or testicles—and is one of the most common cancers in teens. Further testing showed that the disease had already spread to the lymph nodes around Larisa’s spinal cord. Plus, find out what happened when one woman’s “tiredness” turned out to be a condition linked to cancer.
Rather than seek treatment for their daughter near home, Larisa’s parents headed overseas to the MD Anderson Cancer Center in Houston, Texas, where Larisa became one of their many international patients.
By the time Dr. Cynthia Herzog, who treats pediatric patients, saw Larisa, the teen was also complaining of a cough whenever she lay down to sleep. A pathologist verified the initial diagnosis, and Herzog put Larisa on the standard chemotherapy regimen for a germ-cell tumor. When that caused inflammation in the teen’s bowel, as well as diarrhea and vomiting, she was switched to an alternative, and successful, course of drugs.
Three months later, a surgeon removed Larisa’s shrunken ovarian mass and a number of the affected lymph nodes and confirmed that the tumors were dead. New ones could always develop, but the prognosis was good. “Even with metastatic disease, the long-term survival rate is 50 percent, which is fairly high,” Herzog says.
When Larisa arrived ten weeks later for her first post-surgery scan, she mentioned that her cough had returned. Test results explained why that might be: The disease had grown in the lymph nodes around her heart. Learn about some cancers that are notoriously difficult to detect.
Surprised by the about-face in her condition after treatment had proved so effective, Herzog wanted to perform a biopsy of the chest mass, but Larisa’s parents refused. Their daughter’s cough would make it difficult to lie down for the procedure, and she would have to be anesthetized. Larisa had already gone through so much, so they chose to continue the chemotherapy instead. After one cycle, however, scans revealed that the chest mass remained unaffected.
“It’s very odd for the disease to come back and not respond to treatment,” says Herzog. “That’s when we said that we really need a biopsy to see exactly what we’re dealing with before continuing.”
A few days later, Herzog got one of the biggest surprises of her 33-year career. The hospital’s pathologists informed her that Larisa had a separate primary cancer—a lymphoma. The doctor’s shock is understandable: A girl Larisa’s age has approximately a one in 100,000 chance of getting either one of those cancers, putting the odds of having both at one in ten billion. “It’s the only time I’ve ever seen it,” Herzog says.
Treating lymphoma is a longer process than for a germ-cell tumor—the standard regimen lasts a year and a half. Larisa and her family lived in Houston for most of that time, before moving back home to Ukraine for the remaining treatments.
Larisa’s last course of chemo ended four years ago. She now returns to MD Anderson for follow-up scans once a year and so far remains cancer-free. The 21-year-old is living much like she did before her symptoms first appeared, with one notable change: She’s now planning to pursue a career in health care. Next, check out these 30 simple ways you can prevent cancer.
*Patient’s name and some details have been changed to protect privacy