Helen Foster

Helen Foster was sixty-one when she noticed her trousers were becoming uncomfortably tight despite no change in diet or weight. She attributed it to bloating, perhaps irritable bowel syndrome, and ignored it for two months. When she finally saw her GP, a CA-125 blood test and urgent CT scan produced results that led to a same-week referral to the gynaecological oncology service at Silvaris Cancer Institute in San Diego. The news was devastating: advanced ovarian cancer with widespread peritoneal spread. Helen, a retired headteacher and grandmother of four, sat in the clinic room with her daughter and made a decision that she has held to ever since: she would fight.

Her gynaecological oncologist was among the most respected surgeons in the field of cytoreductive surgery, and her confidence in his technical ability was established at their first meeting. He explained that the goal of the initial operation was to remove as much tumour as possible — that achieving complete macroscopic clearance was the single most important predictor of survival in her situation, and that it was a goal he was determined to reach. He was also honest about the scope of the surgery: it would involve the uterus, both ovaries and tubes, the omentum, the appendix, and sections of peritoneum — a six to eight hour procedure requiring several days of post-operative recovery. 'He told me what it would cost me physically,' Helen says. 'He also told me what it would give me. I chose it without hesitation.'

The surgery achieved complete macroscopic clearance — no visible tumour remaining at the end of the procedure. Helen woke in intensive care, sore and weak but aware that this was the best possible outcome from the operation. Recovery took six weeks before she was well enough to begin chemotherapy. Six cycles of carboplatin and paclitaxel followed, administered every three weeks on a day-case basis. The oncology nursing team managed her through the side effects — significant hair loss, peripheral neuropathy in her hands and feet, fatigue — with practical interventions and unwavering warmth. 'They treated me like a person, not a protocol,' Helen says. 'Every cycle, every nurse knew my name and asked about my grandchildren.'

Germline genetic testing identified a BRCA1 pathogenic variant — a hereditary mutation that explained her cancer and had significant implications for her daughters. Helen's oncologist and a specialist genetic counsellor arranged a family meeting to discuss cascade testing, and both of Helen's daughters underwent genetic testing. One tested negative; one carried the same variant and has since undergone risk-reducing surgery. 'That might be the most important thing that came out of my diagnosis,' Helen says. 'My daughter got tested in time. That is everything.' Olaparib maintenance therapy was commenced after chemotherapy, targeting the BRCA1 vulnerability in any remaining cancer cells.

Three years after her diagnosis, Helen's CA-125 remains normal and her surveillance scans show no evidence of recurrence. She has outlived the statistics she was given at diagnosis and attributes her outcome to the quality of the surgical clearance and the comprehensive maintenance therapy programme. She volunteers weekly at the cancer institute's patient support service, offering conversation and tea to women who have just received their diagnoses. 'I remember sitting where they are sitting,' she says. 'The fear is physical. It is real. What helped me was someone telling me truthfully that this was possible to survive, and showing me — by being alive — that it was.' She is that person now for someone else.