When Sarah Joanis found out she was pregnant, she was so thrilled -- and surprised -- that she took 12 home pregnancy tests in a row and photographed the positive results. Just to make sure.
Three months later, however, Sarah and her husband, Kevin, received another shock: The Plainfield woman's ovarian cancer had returned. She was 29 years old.
One of every 1,000 pregnant women in the U.S. has cancer, a relatively rare but stark convergence of life and death. For these women, treatment is possible. But it comes with a host of terrifying decisions for the family.
Do you start chemotherapy, which could harm the fetus? Or do you delay treatment, risking the mother's life?
Sarah desperately wanted her baby. Kevin wanted to grow old with his wife even more. Ultimately, after many heart-wrenching conversations, they agreed Sarah and their unborn baby would go through her chemotherapy and ovarian surgery together.
Statistically, Sarah was an unlikely candidate for epithelial ovarian cancer. She was 26 and working as an engineer for Ford Motor Co. in Detroit when she was diagnosed with a disease that typically targets women over 55. She had no family history of ovarian cancer.
But on Super Bowl Sunday in 2006, Sarah woke up with a sharp abdominal pain that turned out to be a cancerous tumor. Doctors were able to successfully remove the growth, along with her left fallopian tube. Because Sarah was young and wanted children -- and everything else looked good -- she did not undergo chemotherapy, which could have damaged her fertility.
The cancer scare gave Sarah a new outlook on life, and for the next two years she seized her moments. An ambitious and independent woman, she finished her MBA at the University of Chicago by commuting from Michigan on weekends, married her soul mate, went sky-diving, traveled to Hawaii and moved back to the Chicago area, where she had grown up.
For months the couple tried to get pregnant, but a reproductive endocrinologist told them that Sarah's one fallopian tube was blocked and that in-vitro fertilization was their only option. To their astonishment, pregnancy happened naturally, prompting Kevin to rush out and buy a dozen pregnancy tests at Costco for confirmation.
Then, on April 4, 2008, during a routine pregnancy ultrasound, her doctor found more cancer. This time it had spread across the pelvic region.
"I was supposed to be OK," Joanis wrote on her blog, "I Want to Breathe" (sarahjoanis.blogspot.com), which chronicles her fight with cancer. "I was supposed to go on with life with one less fallopian tube. Big deal. But here I am now. Standing at the start of what is going to be the longest and hardest journey of my life."
Treatment began with a risky surgery to remove her left ovary, which had been engulfed by the tumor. Doctors worried that if the uterus were stimulated during the operation it might contract, triggering premature labor at 28 weeks.
Sarah, who had convinced herself Natalie would be born that day, was shaking before surgery began. Kevin was stoic and strong for his wife but broke down privately afterward. Even her gynecological oncologist, Sudarshan Sharma of Adventist Hinsdale Hospital, felt anxious. "Cancer surgeries are full of surprises," Sharma said.
For three days after the procedure, Sarah experienced violent contractions, but she hung on to her pregnancy. Her doctors remained concerned. "My heart was breaking during the surgery," said Sarah's OB-GYN, Julie Jensen of Edward Hospital in Naperville, who held the uterus -- and felt Natalie kicking -- throughout the operation. "We knew it was likely her only biological child."
Then came another agonizing decision: Whether to start chemotherapy.
For years, the medical professional has wrestled with how to treat pregnant cancer patients, and whether women with cancer should even continue their pregnancies. The fear was that chemotherapy -- drugs that kill off fast-growing cells -- would damage the unborn child or that pregnancy itself might exacerbate the condition.
But research has since shown that some forms of chemotherapy are safer than others. While children exposed to the powerful drugs in utero have a higher risk of stillbirth, birth defects, low birth weight and other complications, the risks decline after the first trimester when most of the major organs have developed.
Still, there is no long-term data on how chemotherapy can affect a fetus' brain development or whether a child exposed in utero will have increased susceptibility to cardiac problems, fertility problems and secondary cancer, issues that still weigh on Sarah and Kevin.
Moreover, going through chemo while pregnant creates its own set of challenges. The fatigue was so punishing that Sarah slept 18 hours a day. When she was awake she vomited and her muscles ached, making it almost impossible to walk up the stairs. The fear of what the drugs were doing to the baby was constant.
When Natalie was delivered early by Caesarean section on Aug. 8, weighing just 5 pounds but otherwise healthy, "an instant calmness came over me," Sarah said. "You're here now," she told her daughter. "Everything I do is for you."
That meant aggressively treating the cancer with more surgery and chemo. After Natalie's birth, Sarah had a hysterectomy, in case the cancer had spread to other organs. It had. Pathology results showed stage IIIC cancer -- it was found in a lymph node -- which has a five-year survival rate of 30 percent.
As a new mom dealing with postpartum hormonal changes, sleep deprivation and a colicky baby, Sarah weathered four more grueling rounds of chemo. This time the side effects were so debilitating that she was unable to take care of -- or even hold -- her new baby. "Cancer is sucking the life out of me," she wrote on her blog.
But by Christmas, four months after Natalie's birth, there was no sign of cancer in her body.
Cancer's threat still looms large. It's why Kevin's heart still jumps when Sarah calls after her regular doctor visit. It's why, as Sarah wrote, she wonders every day whether she will be able to watch her "little angel grow up and do wonderful things in the world."
But cancer also is why the words "Miracles. Believe in them" are painted on the wall in gold letters over Natalie's crib.
Source
