Angel Gnau

February 2014

I am a four-time ovarian cancer survivor.

My journey with ovarian cancer began in March of 2006. Though, looking back, I realize now that it had started much earlier than that. For about six months leading up to March 2006, I had a constant, dull pain in my lower left side. I also had ongoing issues of unexplained bloating, nausea and fatigue for almost a year prior to that time.

I had mentioned these symptoms to my primary care doctor on more than one occasion. I have a history of Irritable Bowel Syndrome (IBS) and life-long gastrointestinal issues, and that is what I was treated for.

One day at work, I ate about two bites of my lunch and suddenly felt sick. I tried to continue working, but the pain got worse, so I decided to go home. A co-worker asked me if I was okay as she saw me leaving and I said, “No, I am in extreme pain.” She asked if I could come into her office and all I wanted to do was go home! She proceeded to ask about my symptoms and when I told her, she said, “Oh, Angel that sounds like ovarian cancer to me.” I said to her, “Now you are just scaring me!”

I saw my primary care doctor the next day. He still tried treating me for gastrointestinal problems. I was given Zelnorm, which just made me sicker. The pain didn’t go away. I felt bloated, gassy, fatigued and could no longer tolerate food. After the third appointment, looking like I was eight months pregnant and still with no diagnosis, I insisted on further tests.

I finally got an appointment for an ultrasound. When the technician performed the ultrasound of my lower left abdomen, where I had complained of the pain, her eyes suddenly got a little bigger. She excused herself and moments later the doctor came in and said he wanted to do a CT scan. After the scan, he came in and said, “You have a myriad of things going on in there.” It turned out that I had a tumor the size of a large orange on my left ovary. I was shocked when he said I may have ovarian cancer. I had to wait all weekend wondering if I had cancer.

I was referred to a gynecologic oncologist on Monday and a week later had debulking surgery. I was diagnosed with Stage IIB, Grade 3 epithelial ovarian cancer, with a 15cm tumor on the left ovary and some cancer cells on the right ovary as well. I started chemotherapy with Carboplatin and Paclitaxel on April 10th, 2006. I had five out of the scheduled six rounds, as my white blood count dropped and would not come back up. I felt the sixth round could kill me, or seriously damage my bone marrow.

Following treatment, I had no evidence of disease for almost five years. I truly thought I was cured. My doctor had even said so!

I had my first recurrence in January 2011. I had started bleeding heavily vaginally, yet I had been in Menopause since about 2002. After approximately a month of tests including a laparoscopic biopsy surgery, my gynecologic oncologist confirmed that it was, indeed, ovarian cancer recurrence. I had a 3 cm tumor on the left vaginal cuff and metastasis to the bladder and sigmoid colon.

Surgery was not an option at that point, as I would lose part of my colon and bladder. I started a second round of chemotherapy with Carboplatin and Paclitaxel. On the third infusion, I had a severe allergic reaction to the Carboplatin. My doctor switched me to Cisplatin for the last three rounds of chemo, which I finished in June 2011.

A PET scan on June 28 showed no evidence of disease. I was ecstatic to say the least!

My joy was short-lived. After about two and one half months, the cancer returned, this time on top of the bladder. I had five weeks of daily Intensity Modulated Radiation Therapy (IMRT) which targets the tumor area, supposedly causing less damage to surrounding tissue and organs than conventional radiation. I finished radiation treatments on November 30, 2011.

I began to experience symptoms again in September 2012 and received a diagnosis in January 2013 after almost four months of tests and procedures. The cancer had invaded the sigmoid colon, with the tumor protruding through the vaginal wall, causing bleeding and a discharge that I have to this day. The doctor originally thought the discharge was from the cancer, but now believes it is from radiation damage which refuses to heal.

At this point in my 7-year journey with ovarian cancer, I chose to seek a new medical team. My original doctor had provided me with excellent care, but I needed a fresh perspective to guide me through the rest of my treatments.

In May 2013, I had a partial pelvic exenteration surgery, where 12 inches of sigmoid colon was removed, along with part of the vagina, rectum and pelvic tissue, along with a 5.5 cm tumor. I ended up with a colostomy. Though I was not happy with this situation, I learned quickly how to cope with this new development and did very well.

I had reversal surgery in July 2013. My doctor wanted me to start chemotherapy again (Doxil) but I was adamant to have the reversal surgery done first. I started chemotherapy on August 14, finishing the Doxil treatment on December 4, 2013. After a CT scan on December 12 showed no evidence of disease, I was considered to be in remission, though I don’t really believe the cancer is completely gone.

It is so important for patients and their doctors to be vigilant, monitoring blood work and any symptoms that arise. This disease is insidious and smart. It can morph from one thing into another and become resistant to drugs.

I try to live my life as normally as possible. I am passionate about advocacy and raising awareness regarding ovarian cancer. I volunteer with two wonderful organizations: Breast Friends, a non-profit women’s cancer support group in Portland, Oregon, where I am the Ovarian Cancer Liaison; and the Ovarian Cancer Alliance of Oregon and SW Washington, a partner member of the Ovarian Cancer National Alliance (OCNA).

I joined the Survivors Teaching Students® program sponsored by OCNA, giving presentations to 3rd year medical students and to nursing school students on the often-vague symptoms of ovarian cancer in the hope that women can get diagnosed at earlier stages. We don’t have a reliable screening tool for ovarian cancer, yet we desperately need one.

I feel one of the most important things we have as cancer patients, is hope. I never want to lose that hope. My best inspiration came from a volunteer at the hospital right after my surgery in 2006. Before she left, she said, “Oh, by the way, I am an 18-year survivor of ovarian cancer.” I almost cried. I told her, “Thank you, that is what I really needed to hear right now.” I wanted to know that I could survive this cancer.

Editor’s Note: Angel is 58 years old and lives in Portland, Oregon with her husband of 36 years, Michael. They have a son, James (30), who lives just a few miles away. James had his own experience with cancer, being diagnosed with Neuroblastoma at eight months of age. Luckily, he responded to surgery and chemotherapy and has been cancer-free since. Being so young, he does not remember any of it.

Angel was the first recipient of the “Angel Award” inspired by her volunteer work at Breast Friends, the women’s cancer support organization where she is a volunteer and Ovarian Cancer Liaison. The award was presented at the Survivor Luncheon held in October 2013 and will be presented annually to “Breast Friend’s outstanding volunteer and community advocate”

Angel is a life-long horse lover, retired horse trainer and runs her business, Pacific Equine Appraisal & Consultation from her home. She is also a published writer of horse-related articles.