When Abbi was planning her wedding, the last thing she expected was a diagnosis of cervical cancer.
She had a wedding to plan - her own. But in April of 2012, Abbi Coulter received news from her gynecologist that a routine pap test, a procedure in which cells are scraped from the cervix and looked at under a microscope, detected abnormal cells, and the weeks leading up to that wedding found her faced with a frighteningly different set of decisions to make.
After their initial findings, Abbi's gynecologist followed up with more extensive tests, including a colposcopy, a procedure to examine an illuminated, magnified view of the cervix; and a biopsy to take a small sampling of cervical tissue followed by Loop Electrosurgical Excision Procedure (LEEP) which uses a thin, low-voltage electrified wire loop to remove abnormal cervical cells. By May, they confirmed the diagnosis: cervical cancer.
Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. It is usually a slow-growing cancer that may not have any symptoms, but can be detected with a regular Pap test. Cervical cancer is almost always caused by the human papillomavirus (HPV) infection. Approximately 12,500 new cases of cervical cancer are diagnosed each year in the United States.
Abbi and her doctors now would need to determine the best treatment approach—with the added consideration that she was a young woman of childbearing age.
"To be honest, when I was diagnosed, I wasn't thinking about the implications this would have on child-bearing," Abbi says. "I was terrified and just wanted the cancer taken out of me as soon as possible. If they had told me I needed a hysterectomy I would have done it, no question."
The first step was a referral to gynecologic oncologist Konstantin Zakashansky, MD, at The Mount Sinai Hospital in New York City. Dr. Zakashansky is a physician surgeon who specializes in diagnosing and treating cancers that are located on a woman's reproductive organs and one of nine specialists in Mount Sinai's Division of Gynecologic Oncology. Founded in 1967 before the discipline even received official designation as a subspecialty of The American Board of Obstetrics and Gynecology, the division treats more gynecologic cancers – the most common type of cancer in women after breast, lung and colon cancers - than any other center in New York.
"Dr. Zakashansky was phenomenal," Abbi said. "From the first meeting, he immediately put us at ease by being calm and explaining all the facts and next steps with us."
At Mount Sinai, Abbi underwent additional testing that confirmed the cancer had spread into her lymphatic vessels. Dr. Zakashansky discussed treatment options with Abbi.
"For invasive cancer, the definitive treatment is hysterectomy, radical hysterectomy, with removal of the lymph nodes in the pelvis to be sure the cancer didn't spread or radiation therapy," Dr. Zakashansky explains. "But Abbi was young, just getting married, and had no children, so we looked at a fertility sparing approach."
Abbi adds, "My gynecologist and Dr. Zakashansky explained to me how they wanted to ensure I could still bear children, whether it meant not needing to have as severe a surgery or freezing (my) eggs."
Once they discussed her options, Dr. Zakashansky and Abbi concluded the optimal treatment approach would be a cold knife cone procedure, a surgery to remove a portion of the cervix and affected areas only in combination with laparoscopic evaluation of the pelvic lymph nodes. This type of surgery is a fertility preserving surgical alternative to a radical hysterectomy – removal of the uterus, fallopian tubes, cervix and ovaries - and applicable in selected younger women with early cervical cancer. The surgery date was set for June 1—the day Abbi was getting married. Because she wanted to avoid the added stress of having to postpone her wedding, Abbi asked to reschedule her surgery, and Dr. Zakashansky agreed to move the procedure to the following week.
Prior to her surgery, the Mount Sinai gynecologic oncology team performed tests to ensure that Abbi did not have any evidence of cancer outside of the cervix using PET scan which produces 3-dimensional, color images of the pelvis "to be sure nothing else was left behind."
Dr. Zakashansky explains that the team conducted laparoscopy, a minimally-invasive surgery using small incisions in the abdomen and pelvis to confirm that there was no evidence of microscopic cancer in the lymph nodes, which could have been missed with the PET scan.
"Dr. Zakashansky didn't waste time in getting all tests completed, providing results and updates, and performing the surgery," she said. "Time seems to go slowly when you get diagnosed with cancer, so the proactive/efficient approach was appreciated."
Abbi's case is an example of the kind of patient-centered treatment approach taken at Mount Sinai Hospital.
"At one time there used to be one approach for every patient, but that's changed. We now have the ability to tailor the approach to the patient," says Dr. Zakashansky. "I urge all women between the ages of 21 and 65 to get an annual pap test in conjunction with testing for HPV to screen for cervical cancer. It is one of the most reliable and effective screening tests available and we know it saves lives."
For now, Abbi Williams is happily married and looking forward to a long life with her new husband, which includes children one day. "I cannot thank Dr. Zakashansky enough for giving me back my future," she said.