Preserving the Dream of Motherhood When Treating Gynecological Cancer

When Adriana Velasco looks at her son’s sweet face, she is filled with love — and also with gratitude. If she hadn’t had trouble conceiving him, she might not have discovered she had endometrial cancer.

Ms. Velasco is also thankful for the fertility-sparing treatment she received at Baptist Health Miami Cancer Institute, which preserved her uterus so she could get pregnant and deliver her baby. She was determined not to allow cancer to derail her dream of having a child.

“I don’t give up easily; I work hard for anything I want to accomplish in life,” Ms. Velasco says. “I can be stubborn sometimes, but I feel that this could be a good thing because I stick to my beliefs and my goals.”

Ms. Velasco, who is Venezuelan-born and moved to the United States as a teen, never imagined she’d have trouble starting a family. But a year of trying did not result in a successful pregnancy. Concerned, she and her husband sought the guidance of a fertility specialist. The problem appeared to be related to a polyp, which was detected in her uterus and removed. The couple was optimistic.

And then the pathology report came back: cancer. Endometrial adenocarcinoma, to be exact.

It was a stunning diagnosis for Ms. Velasco, who was only 37 years old at the time. According to the American Cancer Society, the average age of women diagnosed with endometrial cancer is 60. It's uncommon in women under 45.

Treatment for endometrial cancer usually involves the removal of the uterus, fallopian tubes and ovaries, but Ms. Velasco wanted to retain the possibility of carrying a child. She turned to John Diaz, M.D., chief of gynecologic oncology at Miami Cancer Institute, who carefully guided her through hormone treatment instead. “Dr. Diaz understood my desire to become a mother,” Ms. Velasco recalls.

John Diaz, M.D., chief of gynecologic oncology at Baptist Health Miami Cancer Institute

For young women diagnosed with uterine cancer who want to have children, surgery is sometimes postponed while progestin therapy is used to treat the cancer, Dr. Diaz explains. This can cause the cancer to shrink or even go away for some time, giving the woman a chance to get pregnant. In Ms. Velasco’s case, they also inserted an intrauterine device to deliver progestin directly into her uterus in addition to oral medicine.

When two follow-up biopsies over six months showed no signs of cancer, Ms. Velasco got the go-ahead from Dr. Diaz to resume fertility treatment. It was not easy, but it was a big step toward achieving her dream.

“We got her into remission,” Dr. Diaz says. “She was able to preserve her uterus and ultimately to have a beautiful baby.”

As part of her continuing treatment, Ms. Velasco underwent a robotic-assisted hysterectomy earlier this year so that her cancer would not have a chance to spread. It was performed by Dr. Diaz, who is also director of robotic surgery at Baptist Health and an internationally recognized expert in the field. He continues to monitor her closely. “He is very caring and compassionate,” Ms. Velasco says.

Endometrial cancer, or uterine cancer, is the most common gynecologic cancer in the United States. For reasons not fully understood, the disease is rising across all age groups, including women under 50, Dr. Diaz says.

According to the American Cancer Society, uterine cancer is the only cancer type for which survival has fallen in the past four decades. The disease will kill some 13,000 women in the U.S. this year, surpassing ovarian cancer to become the deadliest gynecologic cancer.

Treatment of gynecologic cancer has become increasingly sophisticated and requires a dedicated team of specialists focused solely on these particular cancers, Dr. Diaz points says. Seeking treatment at a high-volume center like Miami Cancer Institute is key.

“A gynecologic oncology team at Miami Cancer Institute includes your surgeon, medical oncologist, radiation oncologist, pathologist, geneticist and many others, some of whom you never see,” Dr. Diaz says. “Every one of them is focused on treating gynecologic cancers.”

Treatment guidelines for uterine cancer are complex with many inflection points that offer different options, Dr. Diaz adds. “It takes a great deal of highly specialized knowledge — as well as a clear understanding of each patient’s risk factors for recurrence — to know exactly how to utilize all of the available options for the best possible outcome.”

Although most common in post-menopausal women, endometrial cancer can affect any woman, Dr. Diaz notes. There is no screening for the disease, so it’s important to be aware of possible signs, which include vaginal bleeding or discharge not related to your period; vaginal bleeding after menopause; difficult or painful urination; pain during sexual intercourse, or pain in the pelvic area.

“Endometrial cancer is actually the most curable of all gynecologic cancers but you have to recognize its symptoms,” Dr. Diaz says. “The sooner we know if it’s cancer, the sooner we can start treating it.”

At the time, Ms. Velasco did not take note of a possible symptom, she says. “The only thing I noticed after the fact was that my periods were more abundant than before, but I thought it was a normal thing since my periods had always been irregular,” she says.

As one would expect after so many tribulations, Ms. Velasco considers her son, who is now 2, the center of her world. She loves to play with him, take him on walks and just watch him grow. She credits Miami Cancer Institute, and especially Dr. Diaz, for opening the door on the future she envisioned.

“His team of doctors, nurses and assistants helped me throughout this process,” she says. “I was able to win this battle against cancer, accomplish my greatest desire and get the most valuable gift of my life — my son.”