Conquering the Big C
Inside TV star Fran Drescher's battle to beat cancer.
From the book Cancer Schmancer by Fran Drescher.
Copyright (C) 2002 by Fran Drescher.
Reprinted by permission of Warner Books, Inc, New York, NY.
All rights reserved.
June 12, 2000: A Diagnosis
When the phone rang I was in the bathroom. It was my gynecologist—Doctor #8—calling. I went into my bedroom to grab a pen and paper. I’d learned from experience: When speaking with a doctor about anything that concerns you, get in the habit of taking notes.
“Oh, hi,” I said cheerfully.
“I got the results back from your tests…”
“You have adenocarcinoma. I’m very surprised myself.”
“What’s that?” I asked, still not really understanding.
I immediately burst into tears. She was saying I had cancer. Me. In that instant, my whole world came crashing down.
My legs got so weak I dropped onto the bed. I don’t want to die. There must be some mistake. But it was me she was telling this to. They were my tests that showed these results. My body’s turned on me. It’s trying to destroy me. Dear God, why? Did I do something to deserve this?
Through my fears and tears the doctor got my attention. “Fran, it’s in a very early stage. And uterine cancer is very slow growing and much less invasive than other women’s cancers.”
Nothing seemed to be working in my brain. I couldn’t think, couldn’t recognize this horror. I didn’t know what to do. I began to panic.
“What happens now?” I asked.
“You’ll need surgery, at least a partial hysterectomy,” she answered. A hyster-WHAT? Growing up, my mom talked about relatives who’d had that surgery, and she said they were never the same.
Oh my God, I don’t want to become some kind of a freak. Will I still feel like a woman? Who will love me? Will anybody love me? A flood of questions ran through my head, but what came out were deep, guttural sobs.
“They may be able to save your ovaries, but that’s up to the surgeon. I’ve made an appointment with a specialist. She’s on the board at Cedars [Cancer Center], considered one of the best nationwide, and she’s very compassionate.”
My hand was shaking as I tried to write everything down. “When?” I asked.
“Friday. That’s when she sees new patients.”
This is only Monday, what do I do between now and then?
Just the week before, my mother had undergone a D&C [dilation & curettage; scraping the uterine wall] for a polyp in her uterus and she was fine. No cancer, no hysterectomy, just a few snips on a benign growth as an outpatient and boom, good as new. That’s what I’d been expecting, too. But she’d passed her test and I’d failed mine.
I have cancer? This doesn’t make sense. I’m the strong one, the healthy one. Good peasant stock, that’s what I’m made of! Cancer center? Where all those really sick people go?
June 16, 2000: The Triple C Ranch
My boyfriend John took out his pad and pen to take notes, titling the page “Sweetie’s Visit to the Triple C Ranch” (for “Cedars Cancer Center”). The first and most shocking statement Doctor #9 made was how terrible it was that it had taken this long to diagnose me. She could not understand why none of the previous doctors thought to do a D&C. She added that, based on my menstrual history, I was probably suffering from something called luteal phase defect. Luteal WHAT? I had a defect that no one knew about?
Probably from as early as my very first period, she theorized, I’d always run low on progesterone, and if there’s one thing the uterus hates more than anything, it’s what’s called unopposed estrogen. That’s when you have too much, or even normal amounts of, estrogen, but it’s not balanced or countered by the appropriate amounts of progesterone. I’d always had extremely short cycles—19 to 24 days, tops—and the one and only time I accidentally got pregnant, I began to miscarry immediately. At the time I didn’t dwell on the implications of my inability to carry the pregnancy forward. Had I seriously tried to have a baby in my 20s or even my 30s, I might have been diagnosed with the hormone imbalance years before, because I probably wouldn’t have been able to go full term. Instead, the condition caused the glands in my uterine wall to rebel and grow a malignant ball the size of a walnut.
I felt anger toward the medical community and the doctors I’d seen prior to Doctor #9, including Doctor #8. Even though she ultimately was the one who diagnosed me, she should have given me the D&C right away. Why didn’t she test me for uterine cancer before treating me for a perimenopausal condition I didn’t have? Why assume it’s one thing when you haven’t ruled out another?
June 19, 2000: “Now I’m Concerned”
When Doctor #9 called there was no small talk, no pussyfooting around, no soft-pedaling. She came right out and said “The second biopsy shows a more advanced cancer than the first.”
“What do you mean, ‘more advanced’?” I said.
She explained that a more extensive scraping of the uterine tissue indicated not only cells that were grades of one and two, but also threes and fours.
My head was whirling. Thank God for my sister Nadine. The request she made for a second biopsy might have seemed like overkill at the time, but proved to be one of the single greatest pieces of advice I’d received throughout this whole unfortunate mess. “What does that mean exactly?” I asked, always trying to understand and write down everything she said.
“Well, before, it appeared to be what I think of as a baby cancer, where the cells are just beginning to turn, but to now find cells that are grades three and four—I gotta be honest with you, Fran, now I’m concerned.”
I’ll never forget those three words: now I’m concerned. A malignant tumor can have cells in it varying in grades from one through four (four being the worst). Which grade of cells dominates determines what grade the tumor is. If it’s a grade-four tumor, suffice it to say, you’re in pretty bad shape.
“I’m going to want to do a radical hysterectomy. That means you’ll have to lose your ovaries and I won’t be able to perform the surgery laparoscopically or vaginally; we’ll have to cut into the abdomen.”
She still thought surgery would essentially cure me, since uterine cancer is pretty noninvasive and slow growing. In that respect I was lucky. Even though as a young, thin woman I was atypical for uterine cancer (it mostly affects postmenopausal or obese women), out of all the gynecological cancers I could have gotten, this was the best—“best” meaning least likely to spread if caught early. There I was, finally too young and thin for something, and I get it anyway.
“But,” she explained, “with all cancers, we never know what stage it’s at until the surrounding tissue and lymph nodes are removed and biopsied. How deep and how far-reaching the cancer has gone will determine what stage of the disease you have.”
Meanwhile, I’d read somewhere that uterine cancer was the only gynecological cancer with a mortality rate that was on the rise, in part due to late diagnosis.
June 21, 2000: The Surgery
I noticed a huge round patch stuck to my right breast. Doctor #9 took a look at the patch and explained that it was an estrogen patch to prevent me from going into what’s called surgical menopause. In that instant, I thought about the radical effect on my body of suddenly yanking out every major female-hormone-producing organ. In fact, that’s what having a complete hysterectomy amounted to.
But for some reason I remembered that hormone patches should be placed on fatty tissue between the waist and the thigh, but never the breast. “Now they’re going to give me breast cancer, too,” I thought. Doctor #9 casually explained that the post-op nurse must have mistakenly placed the patch there because that’s where they often put the nitroglycerin patch on heart patients.
When I asked her why something on my right side seemed to be hurting more than my left, she told me the pain I was feeling might be due to the appendectomy. “WHAT APPENDECTOMY?” I exclaimed.
“You were at risk of it getting infected and we don’t want to have to cut into your abdomen again,” she responded. But why didn’t we discuss all this before? Shouldn’t I have known that standard procedure called for my appendix to be removed along with the hysterectomy? Even though her reasons made sense, the bottom line was, she forgot to mention it. It may not have been a big deal to her, but this was my body, my reproductive organs and my appendix. It was a big deal to me.
July 9, 2000: Radiation Treatment?
I hated the way my body looked after the surgery; so swollen and bruised, it didn’t even look like my shape. I worried I’d be stuck forever with this matronly, misshapen, ugly, bruised body. I didn’t want my boyfriend John to see what I looked like. As I stared in my completely mirrored bathroom, lit by a skylight, no less, I saw my flesh was shades of green and purple in spots. Every ripple, every bulge, everything looked worse in those mirrors under the cold, harsh shaft of light from above.
Doctor #9 took some tissue samples for a biopsy and then blurted out, “I’ve been giving it some thought, and I think you should consider radiation treatment.” What did she just say? Did she just use the R word?
My heart sank as this emotional roller coaster continued. “You said everyone thought I was clean and no post-op treatment was necessary,” I insisted. Why had she said one thing and then taken it back? What had changed?
“I know,” she said, “but I just wasn’t completely comfortable so I called a colleague of mine in Wisconsin who specializes in uterine cancer. Wisconsin is the fattest state in the union, and because of all the obesity in women there they have an extremely high number of cases. Women who carry a lot of fat release higher levels of estrogen. And we all know unopposed estrogen is one of the causes of uterine cancer.”
“This colleague said he recommends radiation on all his patients. If you received the radiation, it would bring your percentage of non-recurrence up from 95 to 98 percent. If it were me, I’d do whatever it takes to better my odds.” If it were me? But it wasn’t her, it was me. I felt like vomiting. Less than a week ago, she’d told me I was essentially cured, and I hated that she was taking it back. I hated the very idea of radiation. I wanted to know all the implications. What were the side effects, how long did the treatment take, and why did I need it?
“It’s really up to you,” she said. “If there’s recurrence, it would most likely be in the vaginal cuff, so that’s the only place we’d radiate.” What the hell was this woman saying? I didn’t even know I had a vaginal cuff!
Then the radiologist entered and everything he said filled me with revulsion. The radiation procedure would occur every other week for six treatments. The first time would take the longest, maybe three hours total, and thereafter about 45 minutes. I’d need another X-ray to determine the exact location of my bladder, my bowels, and the vaginal cuff, all three of which are extremely close together. Something would be inserted into my rectum, something else up my urethra to the bladder, and then the radiating wand would be inserted into my vagina. This type of radiation is called brachytherapy.
Poor women, I thought. Is there no attention paid toward making all this stuff less humiliating? The radiologist kept talking percentages. Ninety-five percent, 97 percent, first-year recurrence, third-year recurrence, blah, blah, blah. Although only one in 10 women actually needs this radiation to prevent recurrence, many doctors make it standard procedure. Nine women in 10 are getting radiation for nothing.
July 10-17, 2000: Surfing the Web
The day after my first post-op exam, Operation Brachytherapy began! I wasn’t ready for the amount of energy I needed to pull off this research campaign, but what choice did I have? John immediately began surfing the Internet to find websites on everything. I lay in bed printing out gynecology pages from my WebTV. The goal was to gather enough knowledge so we could make an informed decision. Within no time we had hospitals, numbers, e-mail addresses, fax lines, you name it.
Meanwhile, fresh samples from tissue removed during my surgery had been transported to Johns Hopkins (in Maryland) so that a uterine cancer pathologist could make his own determination. When Doctor #9 had asked if I wanted, at my own expense, to get a second opinion, I’d emphatically said yes, and appreciated the suggestion. Why shouldn’t another expert look at it? Believe me, I felt better when the Hopkins report turned out to be exactly the same as the Cedars.
The stuff on the Internet really educated us on the many different studies that had been done over the years regarding treatments for every different grade and stage of uterine cancer. There was no time to lose. Over the next few days I started a file on all the information we’d gathered regarding my cancer. I went from feeling helpless to feeling empowered. In that sense the radiation treatment dilemma had its positive side. Not only did I familiarize myself with a battery of specialists who are at the top of their fields, I also gained knowledge about my disease that I’d never have obtained otherwise. It was a revelation how much info there is waiting to tap into. I’ll never again get treated for even a hangnail without reading every piece of information available on the Internet.
The more I read, the less I thought the radiation was for me. The side effects seemed severe, and the only part of my body where it might inhibit recurrence was the vaginal cuff, where the radiation would be focused. Even that wasn’t a guarantee, which was galling. Another major turnoff was that if cancer did show up somewhere else down the road, radiation was likely to be less effective the second time around.
I finally spoke with the doctor in Wisconsin whose comments had opened this whole can of worms, and was sure glad I did, because it cleared up a lot of confusion. He explained that follow-up appointments with your physician are key to early detection of recurrence. Many of his patients lived on farms, however—some as far as 300 miles away—and almost none of the women continued with their follow-up examinations after their release from the hospital. Because of this, he radiated all his patients as a precautionary treatment—not so much for the nine out of 10 who’d never experience recurrence, but for the one in 10 who would.
In my case, he felt I was not a candidate as long as I was diligent about going for my checkups every three months. What a relief! Two doctors at Sloan-Kettering in New York each read my pathology reports and said adamantly that they wouldn’t suggest radiation for a stage-one/grade-two patient, but each reiterated the importance of follow-up exams.
I didn’t know what to do. If I didn’t do the radiation, I’d have to make peace with that choice and never look back with regrets, no matter what happened down the road. I wondered if I could do that. What if a year from now they found something? Would I beat myself up that I hadn’t received the radiation? On the other hand, if I got another cancer (God forbid), I could always seek radiation treatment then. Perhaps I should take my chances now?
I don’t know exactly when it hit me, but I suddenly felt that 5 percent recurrence was something I could live with because there was 95 percent non-recurrence on my side. Those are better odds than a motorist faces driving on the freeway, in L.A. at least! If the odds weren’t so stacked in my favor, I’m sure I would have thought differently. But over and over again the doctors agreed that I would not be making a mistake either way.
They removed my ovaries, my tubes, my uterus, my cervix, my omentum, my appendix, and 40 lymph glands, and everything but the tumor itself came back negative from both pathology reports. I mean, my own body didn’t seem to know it had cancer. Not from the blood tests at least.
So based on days of research and networking I was able to make an informed decision not to move forward with the brachytherapy. I feel like my cancer is gone and won’t return. I did what was right for me. And whatever happens, I know there’s no turning back.
October 2000: On Pins and Needles
The hysterectomy helps take care of the cancer problem but creates a whole new set of hormonal and reproductive issues that are permanent and irreversible. Maybe I should have considered joining a support group, but first I’d need to accept what happened and not try to deny it. Regardless, somehow the voices of women who’d been through it before managed to enter my life with some sage advice anyway. My friend Rachael’s mom, for one, turned me on to what I now consider a must-read for us all: the Harvard Women’s Health Watch newsletter.
Curiously, the name of one acupuncturist kept coming up as someone worth going to. He was a medical doctor who practiced acupuncture, herb therapy and nutrition. I swear, there must have been five different people with no connection to each other who referred me to this man.
My friend Kathryn’s boyfriend, Ray, came home with a note from a coworker who’d read about my illness. She explained that she’d had the same surgery as mine and hadn’t begun to feel well internally until she went through her treatment with Doctor #11. Well, I don’t need to get hit over the head with a hammer to wake up, so I called his office in Santa Monica and made an appointment in the hope he’d be able to speed up my recovery. I was ready to start enjoying life again.
When I visited Doctor #11, everything about him was calming. He seemed extremely compassionate as I talked about my cancer and the surgery. Once I finished talking, he told me to stop eating nightshade vegetables. I’d never heard of nightshade vegetables, but they sounded awful, and I was sure I’d never eaten anything like that. Well, it turns out they’re tomatoes, potatoes, peppers and eggplants, all of which I managed to eat plenty of. I love Italian food. Need I say more?
“These vegetables do most of their growing at night, hence the name nightshade vegetables,” he explained. “And they’re considered inflammatories. If you have arthritis or any kind of inflammation, be it post-operative or a simple sprain, you should avoid these foods.” Who knew?
He also took me off all starches like pasta and white rice and suggested I eat brown rice instead. “No pasta?” I exclaimed. “But I love pasta. I eat it almost every day!”
“Too hard to digest. No dairy, no sugar, nothing raw like salads, and very little animal protein,” he rattled off. This guy is nuts.
“How ‘bout fruits?” I asked, hopefully.
“No fruit. Except for apples,” he replied. Oy. How is this man going to make me feel any better when I’m starving to death? “And here’s a special tea that you have to brew and drink after every meal,” he said, handing me a bag of twigs and bark that looked like it came from his driveway. Am I supposed to drink this stuff or use it as fertilizer?
“Oh well, I guess I have nothing to lose,” I said, acquiescing. I’d spent four months feeling lousy, and I was desperate. He promised he’d make me feel much better in six to eight weeks if I were to come for treatment every week and follow his nutritional guides.
He began to stick the acupuncture needles into me quickly, precisely, and, most important, painlessly. Now, I’d never been into acupuncture. The one time I’d tried it in the past, it hurt. This doctor was part of a Chinese family who’d been practicing for generations and he made the experience most pleasant. He inserted a few needles in each calf, in my abdomen, my chest, my head, and my hands. “Don’t move,” he instructed, as he turned on a heat lamp and let its warmth penetrate my stomach. Oh, did I ever enjoy that.
I listened to Doctor #11’s words as if they were gospel. By the time my treatment ended, I was sold—hook, line and sinker. An absolute skeptic in the beginning, I would up falling in love. I was buying the CDs that always wafted over the sound system, the herbs and, per the doctor’s instructions, I tried to take brisk walks every day. Soon enough, I began to feel better. Acupuncture had turned out to be a good thing now that I’d found the right physician, and in combination with walking, diet and herbs it became the formula that put my recovery on the right path.
Don’t let what happened to me happen to you! I’m not a doctor (and no, I’ve never played one on TV, either), nor do I claim to have all the answers, but I do think you can learn from my experience.
Over a two-year period I saw seven different doctors in search of a diagnosis for my symptoms. I fell through the cracks every step of the way. It didn’t matter that I was “The Nanny” and everyone loved the show. I didn’t know what to ask for, and I wasn’t offered all available tests that could have diagnosed me. So for two years I walked around with a progressively worsening cancer and none of these doctors, not one, offered me the simple test that ultimately detected it. Maybe they thought I was too young for uterine cancer, but just ripe for a perimenopausal hormone imbalance. Please, I could not accept I was beginning my menopause at the very moment I was single and entering my sexual peak! No way. And thank God I didn’t, because nothing could have been further from the truth.
We need to educate ourselves about our bodies. Women need to understand gynecological cancers and the tests that can help detect them. Let me sound the alarm. We have to take control of the situation, become educated consumers, network among ourselves, and gain information and insight into getting diagnosed and getting treatment. Someone gimme a podium!
If my story makes you understand one thing, I hope it’s that you are never passive when it comes to your health. Open a mouth! Assume that doctors, being human, are fallible, and remember that nobody knows your body the way you do. Don’t be an ostrich, either. A problem doesn’t go away simply because you choose to ignore it. I promise you, the day will come when you can ignore it no more. Trust me, early detection is crucial.
Although getting cancer was probably the worst thing that’s ever happened to me (did I say “probably”?), there have been so many wonderful silver linings, too. Often, the truly great and valuable lessons we learn in life are learned through pain. That’s why they call it “growing pains.” It’s all about yin and yang. And that’s not something you order off column A at your local Chinese restaurant. They’re the positives and negatives of life. One doesn’t exist without the other. How you experience your pain, what you learn from it, and how you live through it—that’s what makes all the difference.