Diagnosis Of Rare Cancer Led To Lifesaving Surgery and Access to Clinical Trial Treatment at UT Southwestern

With the expertise of Jayanthi Lea, M.D., a patient with low-grade serous ovarian carcinoma is now in remission.

Alaine Hardesty knew something was wrong as she became progressively unwell, experiencing loss of appetite, overwhelming fatigue, and debilitating fluid retention that left her legs swollen and abdomen distended.

Despite visiting multiple physicians over a period of six months, she received no answers. The lack of definitive results from an echocardiogram, colonoscopy, pap smear, and enterovaginal ultrasound left her puzzled.

“I went from traveling, coaching volleyball, and making the most of life to the confines of a chair, unable to move,” Ms. Hardesty says. “After visiting multiple specialists without a diagnosis, I was eventually referred to UT Southwestern.”

At Harold C. Simmons Comprehensive Cancer Center, she met with Jayanthi Lea, M.D., Professor of Obstetrics and Gynecology and Chief of the Division of Gynecologic Oncology. “A CT scan showed evidence of metastatic disease,” says Dr. Lea, who ordered a CA-125 blood test and performed surgery that then led to a diagnosis of low-grade serous carcinoma (LGSC).

According to Dr. Lea, LGSC is a rare subtype of ovarian carcinoma that has a specific molecular profile, arising de novo or after a serous borderline tumor. The median age at diagnosis for LGSC is 45 years old. Ms. Hardesty was 58 at the time of treatment.

“Distinguishing between LGSC and other histological subtypes of ovarian carcinoma is paramount,” Dr. Lea explains. “The treatments are markedly different. We opt for upfront surgery in LGSC whenever possible, as the response to chemotherapy is inferior to that of other subtypes. LGSCs are also highly sensitive to aromatase inhibitors.”

A Complex Procedure

With a presumed diagnosis of ovarian cancer, Dr. Lea devised a plan for surgery. The procedure would be complex and best handled by a specialized group of gynecologic cancer experts.

“The procedure was lengthy, lasting 5 to 6 hours, but we achieved our goal of removing the cancer and draining her fluid,” Dr. Lea says.

Ms. Hardesty had a strong postoperative recovery, and despite her cancer being diagnosed at an advanced stage, she was able to achieve an excellent outcome that would not have been possible without the right diagnosis and treatment. This story could have easily gone a different direction, Ms. Hardesty says. “Not only did the surgery remove my cancer, but I also dropped 70 pounds in five hours because they drained 23 liters of fluid from my body. I couldn’t believe it.”

Testing a Novel Therapy

The second part of Ms. Hardesty’s treatment involved chemotherapy to prevent a recurrence. Patients at UT Southwestern often have the opportunity to join clinical trials that enable access to treatments not yet widely available. Ms. Hardesty was eligible for a clinical trial where she would be randomized to receive either the standard chemotherapy or a new adjuvant therapy with the goal of lowering the risk that the cancer would come back.

“Clinical trials play a crucial role in advancing the understanding and treatment of ovarian cancer. This clinical trial was testing an aromatase inhibitor,” Dr. Lea explains. “In the phase III randomized trial, letrozole was compared to standard chemotherapy in women with advanced stage LGSC.  It has distinct advantages compared to chemo like no hair loss, no myelosuppression, and no fatigue.” 

Ms. Hardesty joined the clinical trial and received the new agent. Now two and a half years since the surgery, she has regained her quality of life and is once again traveling and coaching volleyball.

“I’m happy to report that I’m in remission and feeling great,” she says. “I'm going off on adventures, making the most of life, and relishing in every moment.”