Like many people, Karen Lagasse has never been a big fan of the dentist. But she’ll always be thankful for a 2013 tooth extraction for paving the way to a life-saving discovery.
Noticing Lagasse’s elevated blood pressure, her dentist asked when she had last visited the doctor. Lagasse admitted it had been a few years, but promised to make an appointment. She did, and a physical exam a few months later revealed Stage II cervical cancer.
Lagasse, then 57, was shocked. She felt fine and had none of the well-known indicators of cervical cancer, such as vaginal bleeding or pelvic pain, though. Cervical cancer can often develop without these clues — making it all the more important to get Pap or HPV screening tests at appropriate intervals.
Radiation and chemotherapy in the Gynecologic Oncology Program at Dana-Farber put the cancer into remission. And while it has since metastasized to numerous parts of her body, Lagasse credits the personalized treatment she’s received from her multidisciplinary team at Dana-Farber for allowing her to continue working, leading an active social life, and making regular visits to her four grandchildren.
“Cancer tests what you can go through,” says Lagasse. “Throughout my time at Dana-Farber, I’ve always felt very strongly that whatever happens next, my team will know what to do. That’s the trust I have in them.”
Appreciating her options
A lifelong New Hampshire resident, Lagasse initially sought out an oncologist close to home after her cervical cancer diagnosis. She was put off, though, by what she describes as the doctor’s failure to involve her in decision-making around her care.
“At our first visit, the doctor gave me a PET scan,” Lagasse explains. “Then, when I showed up for my second visit, she already had an entire treatment plan put together for me, including a radical hysterectomy. That didn’t give me a good feeling. I felt like I wasn’t being given any other option.”
Traveling to Boston, Lagasse met with surgical oncologist Ross Berkowitz, MD, at Dana-Farber Brigham Cancer Center for a second opinion. Berkowitz conducted additional testing, including a CAT scan and a cervical cone biopsy to remove and analyze a portion of Lagasse’s cervical tissue. He then presented her with an alternative treatment.
“One of the lymph nodes outside my uterus was enlarged, and Dr. Berkowitz explained that there was a chance it was cancerous,” says Lagasse. “He said I could still undergo a radical hysterectomy, but if the lymph node was cancerous, I would then need radiation and chemotherapy. That would pose a lot more risk than if I just did radiation and chemo without removing many of my organs beforehand.”
Emboldened by the thorough, caring way that Berkowitz outlined her choices, Lagasse decided to forgo the radical hysterectomy. In January and February of 2014 she underwent six weeks of daily radiation, Monday through Friday, along with one weekly chemotherapy infusion. On snowy days, the drives down from New Hampshire could take up to three hours each way, but a rotating group of family and friends made sure Lagasse never missed a treatment and was home each night.
“I’m so grateful for all the love and support people showed me throughout all of this,” Lagasse says.
The regimen put Lagasse into remission, and spared her major surgery. For three years, PET scans every six months at Dana-Farber showed no sign of cancer.
Moving past metastases
Then, in the winter of 2017, Lagasse’s annual mammogram back in New Hampshire revealed a lump in one of her breasts. Doctors there suspected breast cancer, and took a biopsy, but after nearly 10 days and examination in three labs it was revealed to be cervical cancer that had metastasized to her breast. Lagasse immediately reached out to Berkowitz for guidance, and he recommended she return to Dana-Farber and be seen by his colleague Susanna Campos, MD, MPH, clinical director of Gynecologic Oncology.
As she had with Berkowitz, Lagasse established a strong rapport with Campos and confidence in her expertise. After a lumpectomy, she started a regimen of chemotherapy and additional surgery in April 2017 — the beginning of a four-year odyssey in which she would go in and out of remission numerous times as the cancer metastasized from her breast and lymph nodes to her liver, the outside her liver, a node by her pancreas, and then four nodes in her back and spine.
“I don’t think I was ever off of chemo for more than 90 days before I started another regimen,” Lagasse says of this period. “It seemed like it was constant. I would go into remission, then I’d have a PET scan three months later and the cancer would be back.”
The treatment led to numerous side effects including severe fatigue and neuropathy in her hands. Because she went through much of this roller-coaster during the COVID-19 pandemic, when Lagasse was isolated from all but her closest family, she had few outlets to deal with her anxiety. She never lost hope, however, because of the faith she had in her team.
“Since I started down this road with Dr. Campos, she’s assured me that there are more and more options becoming available,” says Lagasse. “She always gives me all the information I need, and lets me help decide what to try next.”
The decisions have become much easier since April 2021, when the cervical cancer stopped its travels throughout Lagasse’s body. She’s had clean PET scans ever since, and while she says the waiting between scans remains daunting, she’s been thrilled to regain much of her old energy. She’s back to hiking, gardening, and dining out with friends.
“Karen is doing exceptionally well,” says Campos. “Over several years her PET scans and MRIs have revealed no evidence of cancer. Her success today came with hard work and a belief that the treatment of cervical cancer would continue to evolve. And indeed it has. Immunotherapy is now incorporated in the management of locally advanced cervical cancer, and immunotherapy is part of a four-drug regimen for recurrent disease. In addition, novel agents called antibody drug conjugates have paved the way for the future success of patients.”
Lagasse is doing so well, in fact, that her PET scans have now been moved up to once every six months. After her next one, in September, she plans a trip to see her son, daughter, and their families in Minnesota for Grandparents Day.
“If the cancer metastasizes again, Dr. Campos will know what to do,” Lagasse says.
About the Medical Reviewer
Dr. Campos received her MD from Georgetown University in 1992, and then completed residency training at Georgetown Medical Center. Between 1995 and 1998, she completed a fellowship in hematology-oncology at Brigham and Women's Hospital, in Boston, and in 2000 received her MPH from Harvard Medical School. She serves on committees for the American Society of Clinical Oncology, the Gynecological Oncology Group, and the National Comprehensive Cancer Network. She is board-certified in internal medicine, oncology, and hematology.