How having a stroke saved this woman's life

Susan Caluori says a stroke saved her life. 

The 60-year-old Montreal woman had just run a half marathon in December 2015 when her husband noticed the left side of her face was drooping. She wanted to keep watching TV, but he insisted they go to the hospital.

The doctors there treated her for a stroke, the facial droop, and she was discharged a week later.

A couple of weeks passed, and she returned to the emergency department after becoming confused and disoriented and experiencing speech difficulties. It was then that doctors performed a series of tests that led them to identify a blood clot in one of her heart valves. With the help of a biopsy, they found the cause of the clot was a dangerous form of ovarian cancer.

"The empress of subterfuge," her doctors called the cancer masquerading as a stroke.

It turns out that it was the malignancy in her Fallopian tubes that was the source behind her drooping face and the mixed-up words that her kids had been teasing her about for two months prior to her emergency room visit.

"The stroke saved my life. Yes, I have repercussions because of the strokes, but you know what, I'm alive because of them. If not [for them], they would have never have found the cancer," Caluori said.

Caluori's presentation was so rare that her medical team wrote up the case report in a medical journal last year. 

"What alerted us to her having ovarian cancer is nothing in her abdomen or pelvis," said Dr. Ziggy Zeng, a gynecological oncologist at the McGill University Health Centre. "The disease is so cunning it presented itself with a clot."

The ovarian cancer caused Caluori's blood to produce a clot that triggered the strokes, Zeng said.

Once properly diagnosed, Caluori's cancer was treated with chemotherapy and surgery, and she's now in remission.

Specialized Pap brush samples fluid

Caluori's case inspired physicians to try to find a way to expose the hidden cancer and have written up their research in this week's edition of the Science Translational Medicine journal. 

Medical researchers at McGill collaborated with others in the U.S., Denmark and Sweden to try to find a way to detect ovarian cancer before it starts manifesting as stroke. To do so, they're experimenting with using a special Pap brush to sample fluid and test it for genetic mutations associated with the disease.

High-grade serous carcinoma, or Type 2 ovarian cancer, like Caluori's accounts for up to 90 per cent of ovarian cancer deaths. 

Current tests to detect it, such as transvaginal ultrasound or a blood test called CA125, are unable to spot the cancer early enough.

Another of Caluori's physicians, Dr. Lucy Gilbert of the Research Institute of McGill University Health Centre, said ovarian cancer often starts in the Fallopian tubes as a few mutated cells. The problem is, it spreads menacingly into the ovaries or abdomen before a detectable lump forms.

"If you wait for the cancer cells to reach the cervix, it may be too late," Gilbert says. "So, by going into the uterus, we are more likely to detect the cancer cells because we're going closer to the origin."

Conventional Pap tests aren't sensitive enough to distinguish ovarian cancer from other gynecological issues, such as fibroids and benign tumours.

Look cancer in the eyes

"It's a bit like identifying something by its contours or by looking at something literally into its eyes and recognizing it," Gilbert said. "We're going after the very thing that causes cancer, the mutation that causes cancer, so we can identify it much earlier."

Gilbert said women in the McGill study reported it was more painful than a conventional Pap, though only for a few seconds.

At the Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire, Dr. Gilbert Welch is a professor of medicine who keeps a close eye on the limitations of tests to detect cancer.

"This isn't ready for prime time," Welch cautioned.

Welch said it'll take a decade to follow thousands of patients to find out whether screening for ovarian cancer with a liquid biopsy works.

From a patient's perspective, Caluori welcomes the latest research into early detection. "Boy, if they could find something without having the stroke, do it. "

Because of the stroke, the formerly bilingual Caluori lost her French language skills. With determination and stroke rehabilitation, she was able to regain her driving skills and get back her licence.

'Life follows a really weird way'

But she's had to give up her work as a real estate agent. "She was a vibrant and highly functional professional woman," said Zeng.

"It's a tragedy. We've done a lot in terms of treating her disease, and she's done a lot in terms of recovering from stroke …but it would also have been nice for her to be healthy and be able to maintain that other part of her life."

Caluori calls the cancer "a little blip" in her life. She keeps her family close and said she often daydreams of the beach and palm trees to cope with ongoing challenges such as short-term memory loss. 

And her reaction to being a medical journal celebrity?

"I would like it if it was in Glamour or in Style, one of the fashion magazines, because it would be more fun. But I think it's interesting because it's such as rare thing to happen," she said. "Life follows a really weird way."