Chrissie’s cancer: What you can learn from tennis legend’s diagnosis

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Chris Evert is both tennis royalty and on the short list —perhaps even at the top — of South Florida’s most accomplished born-and-bred athletes.

For us native South Floridians, “Chrissie,” who was born in Fort Lauderdale and now lives and runs her Evert Tennis Academy in Boca Raton, has been a constant in our lives — and on the world stage — for more than 50 years, since making her Wimbledon debut at 16.

Last month, a couple of days prior to the start of the just-completed Australian Open, Evert disclosed, via an article on espn.com written by her good friend and ESPN broadcasting partner Chris McKendry, that she had been diagnosed in December with Stage 1C ovarian cancer and was set to begin chemotherapy.

In this 2019 photo, Chris Evert speaks during the induction ceremony at the International Tennis Hall of Fame in Newport, R.I. Last month, the 67-year-old tennis legend and Boca Raton resident revealed she was diagnosed with early-stage of ovarian cancer and was undergoing chemotherapy treatment.
In this 2019 photo, Chris Evert speaks during the induction ceremony at the International Tennis Hall of Fame in Newport, R.I. Last month, the 67-year-old tennis legend and Boca Raton resident revealed she was diagnosed with early-stage of ovarian cancer and was undergoing chemotherapy treatment.

The cancer, which is considered early stage, had been discovered following a preventive hysterectomy.

The 67-year-old tennis legend had watched her younger sister (and fellow former professional tennis player), Jeanne Evert Dubin, be diagnosed with ovarian cancer in 2017 and ultimately succumb to the disease at age 62 in 2020.

McEndry wrote in the ESPN article that Jeanne had “tested negative for harmful [pathogenic] variants of the BRCA1 gene, which can be markers for susceptibility to certain cancers... most notably breast and ovarian cancers.”

Thus, other family members were not encouraged to have their genetic markers tested.

As genetic testing has progressed, however, Jeanne’s genetic variants were reinterpreted to be pathogenic.

When Evert was told this, wrote McEndry, “Chrissie immediately sent her blood for genetic testing. It revealed that she, too, had a pathogenic variant of the BRCA1 gene. Following discussions with her doctor, Chrissie had a hysterectomy in early December.”

“We thought we were being proactive,” said Evert, whose hysterectomy was performed by Dr. Joel Cardenas of Cleveland Clinic Weston.

Shortly after the surgery, Cardenas told Evert that “the pathology revealed malignant cells and a tumor originating in the left fallopian tube.”

Evert had to undergo another procedure to determine whether or not the malignant cells had spread to her lymph nodes.

They had not — which meant Evert was among the fortunate minority of women whose ovarian cancer is discovered in its earliest stages.

Evert, who is still extremely fit and active, had not experienced a single symptom of her cancer and said the diagnosis put her “in a daze. I just couldn't believe it. I had been working out, doing CrossFit, playing tennis. I didn't feel anything different."

As Cardenas noted “70% to 80% of ovarian cancer is diagnosed at Stage 3 or 4. Three months or so from now, she'd be Stage 3 or 4. If nothing is done, it reaches the abdomen."

The reason why Evert chose to share so much of her private medical information, she told McEndry, is to help others and bring awareness to these forms of cancer.

“More people need to hear stories like these!" Evert said to McEndry. "It's the stark reality! We need to have these conversations. Ovarian cancer is a very deadly disease. Any information is power. Be your own advocate. Know your family's history. Have total awareness of your body, follow your gut and be aware of changes. Don't try to be a crusader and think this will pass."

In the spirit of Evert’s message to her tens of millions of fans, we asked another Cleveland Clinic Weston physician, gynecologic oncologist Dr. Adria Suarez-Mora, to give us a quick primer on what people need to know about ovarian cancer.

Cleveland Clinic Weston gynecologic oncologist Dr. Adria Suarez-Mora.
Cleveland Clinic Weston gynecologic oncologist Dr. Adria Suarez-Mora.

How is ovarian cancer usually discovered — and why is it usually at a later stage?

Most patients present with Stage 3 and 4 ovarian cancer (70-80%) and typical symptoms include abdominal distention or bloating, abdominal or pelvic pain, urinary frequency or urgency, difficulty eating, nausea, or feeling full easily, and sometimes vaginal bleeding.

Patients most frequently experience abdominal (77%), gastrointestinal (70%) pain (58%), constitutional (50%), urinary (34%), and pelvic (26%). These symptoms are very nonspecific and vague, which can lead to a delay in diagnosis while workup for other causes is being completed.

Another reason ovarian cancer is detected at a later stage is because most ovarian cancers are an aggressive subtype that tends to spread easily, even when there is only a small cyst or mass in the ovary, or prior to any symptoms being present. So it becomes difficult to detect in early stages. Early stages of ovarian cancer (1 or 2) may not have signs or symptoms at all. That’s why some call it the “silent killer.”

Ovarian cancer is usually discovered when imaging studies show a mass in one or both ovaries or evidence of spread of the ovarian cancer to other organs. Other tests such as a tumor marker called CA125 can be helpful.

What do the different 'stages' mean?

The stage of the cancer tells us where it is located, including if it has spread from the ovary or fallopian tube to other places in the body. It is typically given after surgery is performed for ovarian cancer, but imaging tests can be helpful in giving us an idea of the stage. For example, Stage 1 means the cancer is limited to the ovaries (one or both) or fallopian tube(s). Stage 2 is when the ovarian cancer spreads to pelvis, Stage 3 is when the tumor has spread to the abdomen and/or lymph nodes.

What is the chance that a BRCA-positive patient who is asymptomatic and has both a normal blood test and normal ultrasound could still have incidental ovarian cancer?

Very early-stage ovarian cancer patients may be asymptomatic with a normal workup (blood test and imaging studies). The risk of finding occult ovarian cancer when surgery is done for risk-reducing purposes in high-risk patients with BRCA is about 5% to 10%.

(In the ESPN story, McEndry wrote that Evert had “reminded me that her annual exams, including tests for the amount of cancer antigen 125 protein in her blood, her ultrasounds and MRI with contrast were all negative.”)

How does the stage at which ovarian cancer is discovered influence how it will be treated — and what are the various treatment protocols?

Most patients with ovarian cancer need a combination of surgery and chemotherapy. For a tumor that can be resected, surgery is performed, followed by chemotherapy. When the tumor is not resectable or has spread to the chest, chemotherapy is given first, followed by surgery and then additional chemotherapy.

Even with early-stage cancers, if they are of the aggressive subtypes, patients will also require chemotherapy after surgery. Some less aggressive ovarian cancers can be treated with surgery alone. Treatment plans are tailored to the patient’s specific cancer.

What does the general public need to understand about the BRCA1 gene and its various mutations?

Patients with a pathogenic variant (mutation) in the BRCA gene have increased risks of several types of cancer. For example, patients with the BRCA1 pathogenic variant have more than 60% risk of breast cancer and 39% to 58% risk of ovarian cancer.

In addition, there can also be increased risk of pancreatic cancer, prostate cancer, and melanoma. Breast cancers can also present in both males and females. Therefore, people of both genders can be affected by a BRCA pathogenic variant.

How do you recommend people use genetic testing for cancer-associated genes and their various mutations?

Early detection of gynecologic cancers is one of the best ways to improve your outcomes from these potentially deadly diseases.

For ovarian cancer, screening and prevention is difficult due to our available technologies for screening and because of the biology of ovarian cancer which has a tendency to spread early. This is why we focus on identifying high-risk individuals and genetic testing when appropriate. This allows us to take steps even before cancer is detected and focus on prevention.

Our prevention strategies are proven to help high-risk women live longer and prevent ovarian cancer. We discuss strategies such as regular pelvic ultrasounds, lab tests for the tumor marker CA125, and eventually surgery to remove the ovaries.

Being proactive and educated about your health and family history can be very powerful when it comes to ovarian cancer prevention.

This article originally appeared on Palm Beach Post: chris evert cancer diagnosis