Metastatic Non-HPV Cervical Carcinoma: Micaela’s Story

Micaela is a very bright, active teenager with a promising future ahead of her. She has non-HPV metastatic cervical cancer, which is very rare at her age. Her cancer progressed rapidly after surgery and chemotherapy, but she subsequently has had a dramatic response to radiation followed by immunotherapy. Her symptoms have resolved and she has returned to her normal life.

Micaela, 15, was referred to Children’s Hospital of Philadelphia (CHOP) with a large pelvic mass that appeared to be arising from her cervix. A biopsy performed at an outside hospital was non-diagnostic. At CHOP, Micaela was seen by a multidisciplinary team including Frank Balis, MD, a solid tumor expert and Director of Clinical Cancer Research, and Thomas Kolon, MD, an attending pediatric urologist.

A rare diagnosis

Dr. Kolon performed a repeat biopsy to get an adequate tissue sample from the mass to make a diagnosis, and the specimen was reviewed by pathologists at CHOP, Penn Medicine and experts at other hospitals. The tumor was an undifferentiated carcinoma that was arising from the cervix, which is a common site of cancer in women but very rare in adolescents.

Micaela was referred to a Penn Medicine team led by gynecologic oncologist Robert Burger, MD, for surgery in March 2017, and the tumor and involved lymph nodes were successfully removed. After recovering from surgery, Micaela started on a standard chemotherapy regimen, but after one cycle she developed back pain and blockage of her kidneys. An ultrasound revealed that the mass had grown back even larger than the original one. Micaela’s medical team recommended radiation therapy, which successfully eradicated the mass, but Micaela’s health saga continued. Her team found that there were metastases in her liver, lung and abdomen. Her parents, Richard and Lily, were devastated.

“I told her that there were a lot of very smart people with decades of experience and the latest technologies and advancements who were doing everything they could to help her get well as soon as possible,” remembers Richard.

Responding to immunotherapy

After discussions about treatment options, Micaela’s medical team and her parents elected to initiate a form of immunotherapy, and she started this therapy, named nivolumab, in June 2017. A repeat scan in August found that the metastases were dramatically smaller. More importantly, Micaela’s symptoms were improving, and she was feeling stronger every week. As Micaela’s medical journey progresses, immunotherapy continues to be her treatment. She receives an infusion every two weeks under the care of Dr. Balis.

“Dr. Balis deserves so much kudos. You can just see the love and exceptional level of care,” says Richard. “We appreciate how CHOP is a leader in innovation. The fact that they’re willing to try new approaches probably saved her life.”

A bright and active teenager, Micaela excels at school, and she loves horseback riding and fencing. She plays the piano and sings, has performed in the school musical every year, and was the stage manager for the annual middle school play, Romeo and Juliet. “It has been a long journey, but I’m feeling great now,” she says.

In addition, Micaela has discovered a strong passion for medicine. She has ambitions to become a pediatric cardiothoracic surgeon. Micaela has connected with CHOP’s cardiothoracic surgery team and has shadowed three surgeries, one of them an open-heart surgery on a 5-day-old boy. She also will become a Junior EMT next year.

Presented by Chapman Auto StoresMicaela’s family is grateful to the entire team at CHOP. “Everyone is incredible,” says Richard. “The nursing staff is just amazing — they’ve done guided meditation to help Micaela reduce stress and used to come in at night to play Uno with her if she couldn’t sleep. The child life specialists, social workers, the chaplain — we’re thankful for everyone who has cared for our family.”