Dr. Tessa Maria Kleyn
End Cervical Cancer
How my story begins: I began having very light vaginal bleeding after sex periodically in the few months before my initial diagnosis. In April 2009, we went to a GYN who did a Pap test and colposcopy, but not a biopsy. I will never forget his statement: "I don't think this looks as bad as the Pap said it would be. I don't think we need to biopsy it. Don't worry, cervical cancer doesn't sneak up on anyone." He was wrong, but I didn't know that then.
My husband and I planned to travel outside of the country for two months during the summer between college and medical school. That June (2009), I started noticing light vaginal bleeding during exercise (while jogging and on the elliptical). As soon as we returned stateside, I found a new GYN who was able to see me right away. This GYN did a colposcopy and a biopsy which returned positive for invasive squamous cell cervical cancer with adenocarcinoma in situ. She called me personally, on my first day of medical school orientation in August 2009, to deliver the news.
Life before my diagnosis: I was a happy, care-free college student who had just been accepted to medical school alongside my husband. I'd had a few LSIL Paps over the past ten years but I felt like and believed that I was in good health. We loved to waterski! I had just been married for one year when I was first diagnosed with 1b1 cervical cancer.
How I felt after diagnosis: After the diagnosis, I felt anger, shame, frustration and sadness. I underwent an abdominal radical trachelectomy in August 2009. I wanted to get the cancer out of my body and move on with my life.
My treatment: After the trachelectomy in 2009 and subsequent PET/CT and GYN exam surveillance, I was cleared with no evidence of disease sometime around 2013/2014. I graduated medical school in 2013 and matched into a challenging five year residency in Pediatrics, Child and Adolescent Psychiatry and Adult Psychiatry.
Not quite six months after my graduation from this residency, nearly 10 years after my original diagnosis - I was diagnosed with suspected perforated diverticulitis and a psoas muscle abscess. In truth, I had developed a recurrence of cervical cancer, now metastatic, to my left psoas muscle. There, it had formed a necrotic tumor cavity and eaten through my sigmoid colon, perforating it, in turn causing an abscess in the psoas muscle on which it lay.
In February 2019, I underwent a left hemicolectomy and I awoke from that surgery with a new reality. Given the residual tumor in my psoas muscle and the presence of an ongoing psoas abscess, I was referred to the GYN/ONC team at MD Anderson. In April 2019, I started a six cycle regimen of chemotherapy and immunotherapy: Carbo/Taxol/Avastin.
I had the privilege of being told that the follow up PET/CT in September 2019 showed no evidence of disease. I had a wonderful three months with my family and friends. I returned to MD Anderson for follow up scans in December 2019 and was diagnosed with a single liver metastasis that was amenable to surgical resection which was performed just before the new year.
How I felt after treatment: After the first surgical treatment in 2009, I felt ashamed. There is such a stigma around cervical cancer and HPV. I felt like a dirty person. I felt like a bad person. I felt like a fraud. I had only been married for one year and I felt like a bad wife. I felt like a failure- though the surgery I underwent was intended to be fertility sparing, I never got pregnant. I wanted the cancer and everything associated with it to be gone. I wanted it all to go away, the whole thing, forever, and never come back again.
I struggled with the sequelae of the initial surgery, especially the effects such a grueling surgery had on my physical body and my sexuality. I was depressed and I struggled to deal with my depression. I struggled to talk about my feelings. I eventually sought help in the form of both pharmacologic therapy and later talk therapy to process what I had gone through.
Now that so much time has passed, even though the diagnosis of the recurrence was crushing, I have somehow felt better prepared to navigate it and have again sought help as needed with both the physical and emotional sequelae of this disease.
What I did to help myself: I'll be very transparent with you all: to help myself, I had to accept help. I had periods of time during which I took antidepressants (in conjunction with therapy) to get me through serious depressive episodes. I sometimes still need to take anti-anxiety medication to make it through scans and procedures. I have continued to participate in treatment because I've made the choice that it is the right path for me. I maintain an active prayer life and surround myself with my support system and prayer warriors. I've sought to walk with God closer than ever before.
I've reached out through social media groups to feel in-touch with other cancer survivors. I'm sharing my story here today, which is cathartic in a way - I feel it's me leaving a mark, checking in and saying "I was here. I am here."
I tend to be very intellectually-minded and read a lot, but I am now more careful about what I read. Initially, I was pouring over journal articles and research regarding cervical cancer, but falling down that rabbit hole was never very helpful. I now stick to minimal journal searching and spend my time instead on reading books or articles that are thoughtful, inspirational and educational because those are the things that speak to me.
Where I am today: Follow-up scans in February 2020 indicated a new liver metastasis and a possible pelvic metastasis in the area of prior involvement at my left psoas. I am awaiting biopsy of that pelvic site and (since the tumor was PDL-1 positive) we plan to start Keytruda in March 2020. I have a rock solid support system (thank you God, thank you husband, thank you family, thank you friends and thank you Cervivor!). I am still here. I am still fighting!
What I want other women to know: If you have been diagnosed with HPV, if you are facing cervical cancer, know that it is not your fault. Know that you are NO LESS of a person, a wife, a girlfriend, fiancée, sister, friend, mother, student, etc. You are NOT alone. You are not dirty, you are not a fraud nor are you a bad wife/spouse/significant other/person. Please seek out emotional support if you are struggling. I found solace and emotional healing in therapy of my own, having been in therapy with a few different, kind and effective types of providers over the years.
Find your tribe- the "I'm a Cervivor" group on Facebook is a great place to start when looking for people who have been through what you are going through. Rely on your support system - your family, your friends, your local church - they will want to be there for you. Let people know how they can help you and help yourself by accepting help when you need it.
How I will try to help others: In part, all of this experience led me to specialize in two fields in medicine, Pediatrics and Psychiatry, in which I felt like I could do "the most good" for the most vulnerable and most underserved populations. As a physician, I strongly believe in preventive medicine and as appropriate, I have counseled my patients and their parents, educating them about HPV as well as other STIs and promoting the HPV vaccination series. I use my own personal story, when appropriate, to help illustrate the realness of and to put a face to cervical cancer. The CDC puts it best in stating "HPV vaccination is cancer prevention." While I am unable to practice medicine as I am fighting my own personal war against this disease, I continue to advocate for HPV vaccination and education on various platforms of social media and will continue to correct misinformation when it comes across my feed (so to speak) both on screen and in real life.
Any additional information you'd like to share: When navigating the healthcare system, remember that you are the authority over your own body. You know your body best. If you feel like something is not right, it is absolutely your responsibility to advocate for yourself to get the care you need and deserve. Never give up on this. If you need help finding strength to do this, reach out to us. Other Cervivors are here for you, rallying for you.
The picture of me above was taken by my husband on my 39th birthday while we were celebrating the brief but beautiful time I had no evidence of disease. Thank you for reading my story. I hope it helps you and I wish you the very best in your journey.