Jacqueline “Jackie” Modia – wife, mother, bank branch manager and South Miami resident – did everything right when it came to her health. Annual visits to her gynecologist. Pap smear and HPV test every year. As a woman in her 30s, she knew the risks of cervical cancer and the importance of annual screenings and early detection. So she was concerned but not panicked when her Pap smear last year was flagged as irregular.
Mrs. Modia’s gynecologist recommended further testing and referred her to John Paul Diaz, M.D., chief of gynecologic oncology at Miami Cancer Institute. Dr. Diaz recommended a colposcopy, a quick procedure in which a special microscope affords a close-up view of cells on the patient’s cervix. A mild solution of acetic acid applied before the exam dries out the cervix and makes any pre-cancerous cells appear whiter than surrounding healthy cells.
A colposcopic-directed biopsy of some suspect cells revealed high-grade cervical dysplasia which, according to Dr. Diaz, could possibly become cancerous. Although Mrs. Modia had experienced no symptoms, he thought the results were concerning enough to warrant an even closer look. He performed a conization, an outpatient procedure in which the abnormal, precancerous cells are removed from the cervix.
“It’s essentially a larger biopsy of the cervix,” Dr. Diaz says. “We remove a cone-shape section of the abnormal tissue, as well as a small amount of normal tissue, so that only normal tissue remains.” The specimen obtained from Mrs. Modia’s cervix was found to contain squamous cell carcinoma.
“There are two types of cells on the cervix,” Dr. Diaz explains. “Squamous cells are found on the outside of the cervix, while glandular cells are on the inside of the cervix and therefore more difficult to detect.” When those cells grow and multiply in an unusual manner, they become cancerous, he says.
In Mrs. Modia’s case, Dr. Diaz says, hers was stage 1 cancer, meaning it had not yet spread beyond the cervix. “For a younger, low-risk patient with stage 1 cancer, surgery is preferred over radiation, because it provides better quality-of-life outcomes,” he says. For advanced cancer, he adds, surgery is not an option, and radiation therapy or chemotherapy – or sometimes a combination of both – is required.
Dr. Diaz performed a Loop Electrosurgical Excision Procedure (LEEP) on Mrs. Modia, which uses a low-voltage electrified wire to remove abnormal tissue identified in the colposcopy. “LEEP allows us to remove abnormal cells from the cervix and obtain an accurate diagnosis of the cervical pathology,” he says. At the same time, he adds, LEEP cauterizes the surrounding tissue, which aids in healing and effectively eliminates any remnant cancer cells.
To ensure that Mrs. Modia’s cancer wouldn’t spread beyond her cervix, Dr. Diaz recommended that she also consider a radical hysterectomy – a difficult decision for any woman, especially one still in her 30s. She took his advice and had her surgery in April. “Given her age, we decided to leave her ovaries so that she wouldn’t go into menopause prematurely,” Dr. Diaz says.
At the same time, Dr. Diaz performed a sentinel lymph node biopsy, a surgical procedure used to determine whether cancer has spread beyond a primary tumor into the patient’s lymphatic system. “Sentinel lymph node biopsy is our preferred approach, over the traditional lymph node dissection, because it provides a tailored approach to patients with improved detection and less morbidity,” says Dr. Diaz. “Fortunately, our evaluation of Mrs. Modia’s sentinel lymph nodes showed no spread.”
Today, according to Dr. Diaz, Mrs. Modia remains “NED” (No Evidence of Disease) and has an excellent prognosis. “Hopefully, she should be cured,” he says. He will continue to see her every three months for the next two years, then every six months until she hits the five-year mark. “After that,” he says, “she can go back to routine annual surveillance by her gynecologist.”
Mrs. Modia says she feels fine now and has no limitations in her daily life. “Everything is back to normal.” She realizes, however, that her cancer journey could have been much more difficult. “My best friend died of cancer eight years ago when she was 30, and I couldn’t stop thinking about that. Fortunately, my cancer was detected early enough.”
Dr. Diaz says Mrs. Modia’s case is a perfect example of the importance of screening and early detection. “This is how it’s supposed to work – screening, early intervention and treatment,” he says. “Mrs. Modia did everything she was supposed to do with her annual exams and screenings, and we were able to catch her cancer while it was still highly treatable and curable.”
As for Mrs. Modia, she says she is grateful for Dr. Diaz and the team at Miami Cancer Institute. “Every time I go there, everyone is so warm and welcoming, and his office staff is so responsive,” she says. “And Dr. Diaz – he makes you feel at ease and explains everything so well.”
Mrs. Modia is justifiably proud to count herself as a cancer survivor. “I’m happy that I beat cancer because a lot of people don’t get that opportunity,” she says, adding that early detection saved her life. “Make sure you keep up with your screenings and exams. And if you are diagnosed, don’t lose hope – cervical cancer is curable.”