During one of Bethany Hart’s early examinations while pregnant, she underwent a routine Pap smear and learned the results were abnormal. At the time, the then-30-year-old was about 10 weeks along, and the nurse reassured Hart that she was probably OK.
“I remember hanging up and having this nagging feeling, like, ‘Well that’s strange. That’s never happened to me before,’” Hart, now 36, of Noblesville, Indiana, recalls to TODAY.com. “I called a couple of my girlfriends, and I think two of the first three I talked to all said, ‘We had that before, too, and it was nothing.’”
When Hart was 16 weeks pregnant, her doctor preformed a colposcopy, a test that allows a closer look at the cervical cells. After that, her doctor recommended she see an oncologist. She soon learned she had a rare, aggressive cervical cancer.
“The oncologist looked at me and said, ‘It’s cancer,’” Hart says. “That is where our entire world got turned upside down out of nowhere.”
Cervical cancer and pregnancy
Prior to her abnormal Pap smear, Hart had always had normal results from the test, which screens for changes in the cells of the cervix. At first, it seemed like she’d be able to carry the pregnancy, her first, to term, but when she learned her cervical cancer was small cell, a rare and aggressive type, everything became uncertain.
Hart experienced no symptoms or warning signs, like many patients with this type of cancer. Her doctor described the condition to her as “exploding tumors,” which perfectly captures her own story, she says. Hart visited the OB-GYN regularly during the early weeks of her pregnancy, and “there was never any sign of trouble,” she recalls. But by week 16, “they could see that tumor very clearly and know it was dangerous. It just came out of nowhere.”
Hart’s cancer was stage 1. As doctors were trying to plan her treatment, which needed to be aggressive to beat the intensity of the cancer, Hart tragically lost her pregnancy at 19 weeks.
“There was just no ability to process what was happening,” Hart says. “You’re so entrenched in the fight for your life and dealing with the physical side effects from the treatment.”
Treatment was intense and included a radical hysterectomy, 28 rounds of external radiation concurrently with five rounds of chemotherapy, and three final rounds of internal radiation.
Hart recalls her doctor telling her that the treatment strategy was “throwing the kitchen sink” at her. “I knew going into it that I was going to almost go to the brink of death to be saved from the cancer,” she says.
Small or large cell cervical cancer
According to MD Anderson Cancer Center, small or large cell cervical cancer is rare, accounting for about 100 of the nearly 11,000 cases of cervical cancer a year — less than 1%. It is aggressive and has few, if any, symptoms.
“Most cervical cancers don’t have symptoms,” Dr. Meera Ravindranathan, a medical director at OncoHealth, a group that supports people with cancer diagnoses, tells TODAY.com. “Oftentimes when you have symptoms, it’s more advanced cancer.”
Symptoms of cervical cancer can include:
- Bleeding between periods
- Bleeding after sex
- An unusual discharge
People often experience these symptoms for other reasons, making it difficult to know when to talk to a doctor. But Ravindranathan says it’s important to tell your doctor about bleeding and discharge so that they can rule out cervical cancer.
“There’s shame and embarrassment about talking about women’s bodies,” Ravindranathan says. “It is very important that women have a relationship with their doctors where they feel comfortable and have the confidence to talk about their bodies, especially younger women.”
Screening can lead to earlier diagnosis of cervical cancer. The American Cancer Society recommends cervical cancer screening from ages 25 to 65 with one of three options: a primary human papillomavirus (HPV) test every five years, a Pap by itself every 3 years or a test that combines HPV and a Pap every five years, TODAY.com previously reported.
HPV is a “ubiquitous virus,” causing most cases of cervical cancer, Ravindranathan says. Most people contract it through bodily fluids, Dr. Marshall Posner, co-leader of the Cancer Clinical Investigation Program at the Tisch Cancer Institute at Mount Sinai, previously told TODAY.com. For most people, the body is able to clear the HPV so the virus is no longer active in their system. But for a small portion of people, the virus gets reactivated and can cause cancer; it’s not know why.
“Some people get a persistent infection in those cells in the cervix, and then the virus sits there long enough to make those cells pre-cancerous,” Ravindranathan says. “If we don’t detect those pre-cancerous cells or the HPV infection by a Pap smear, the pre-cancerous cells then develop into cancer. The one thing to remember, though, is that process takes about 10 to 15 years.”
HPV causes more than 95% of cervical cancer, according to the World Health Organization, but the type of cancer that Hart had — small cell cervical cancer — has no definitive link to HPV. “The cause is not fully understood,” MD Anderson noted.
These types of cancer have “a natural propensity to grow quickly and spread, and no matter how quickly we catch it, we always use chemotherapy and radiation because we know that it’s highly aggressive,” Ravindranathan says, adding that surgery may also precede the chemo.
Creating a legacy
After treatment ended, Hart faced the grief of losing her daughter, Hallie. She and her husband had just purchased a house and fixed up a nursery, which became a constant memory of their loss.
“Every time I walk past her room, it’s just this reminder,” she says. “To lose your daughter, to have to face cancer, to have to face the fact that we’ll never have a biological family all at once — those are three very big life events in and of themselves. But all three of them happening together were extraordinary.”
In 2018, Hart started the Hallie Strong Foundation to honor the daughter she lost. She sends fun, comfortable socks to cancer patients.
“Socks are just a very real need. Hospitals are awful. They’re so sterile, and a lot of times when you’re in the hospital, socks are the only thing of your own that you can wear,” she says. “We purposely do something to create this constant reminder that anytime they’re worn, that you’re not alone, and there’s this legacy of a little girl who lost her life because of a cancer diagnosis.”
Hart has been cancer-free, but because of how aggressive this cancer can be, she still worries about recurrence.
“There’s always this little (fear) forever in the back of my mind,” she says. “As a cancer survivor, it’s hard to know when it’s a cough because you have a sinus infection or it’s a cough because is that lung cancer? I think I forever will look at life through that lens.”
Thanks to adoption, she and her husband have two boys now, ages 3 and 1, who are her “saving grace.” She serves as a peer mentor with Iris by OncoHealth, an oncology-focused app, and shares her experiences to help others feel less alone.
“No matter your diagnosis, no matter what type of cancer it is, it is impossibly hard,” Hart says. “Sharing your story just opens the door to somebody going through it now to say, ‘Hey, what you’re feeling … it’s totally normal. We all get it.’ And the more you open up and let people in, the better you’re going to be able to survive.”