A Missed Diagnosis Leads Cervical Cancer Patient to Seek Lifesaving Care at Miami Cancer Institute

The first time Maria Cristina Squilloni was diagnosed with cervical cancer was in February 2020.  The then-47-year-old wife and mother, a relationship manager with the global travel technology company Amadeus, underwent a radical hysterectomy a month later. Since then, she had been following up with her gynecologic oncologist, affiliated with another South Florida health system.

At one of her follow-up appointments, Mrs. Squilloni told her oncologist she wasn’t feeling well and thought there was something going on “down there” again. Upon examination, the doctor noted what he thought was a small cyst in her vagina. “He didn’t seem too concerned about it and suggested we monitor it,” she recalls.

Two months later, the cyst had grown larger and was causing increasing pressure on her bladder. “It was uncomfortable and making me have to urinate frequently and urgently,” says Mrs. Squilloni, who was born in Italy but lives in Bay Harbor Islands with her husband and seven-year-old son. To complicate matters, they would be leaving soon to visit her family in Italy for three months.

Mrs. Squilloni’s oncologist again seemed unconcerned and even dismissive, suggesting it could be a side-effect of her surgery a few months earlier. Just to be sure, however, she underwent a Pap smear and a biopsy of the cyst shortly before leaving. The Pap smear results came back and showed nothing abnormal, and Mrs. Squilloni flew to Italy as planned. She had no sooner settled in with her family there, however, when she received a call from her oncologist back home. The results of her biopsy had come back and showed that she had recurrence of her cervical cancer in the vagina.

Given her symptoms, Mrs. Squilloni was shocked but not entirely surprised. She asked if she should come back before her planned return in late August and start treatment now. “He told me not to worry and said he would see me as soon as I got back,” she recalls. However, as Mrs. Squilloni would discover later, her oncologist left out one important detail in their conversation.

Once the leading cause of cancer death for U.S. women

Cervical cancer used to be the leading cause of cancer death for women in the U.S., according to the American Society of Clinical Oncology (ASCO). This year, an estimated 14,100 U.S. women and more than 600,000 women worldwide will be diagnosed with invasive cervical cancer, ASCO says.

Over the past 40 years, however, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly, according to ASCO – thanks in large part to an increase in screenings such as Pap smears and prevention strategies such as the HPV vaccine, which can prevent cervical cancer when administered before patients are exposed to the virus.

A diagnosis of cancer gets even worse

Over the summer in Italy, Mrs. Squilloni’s symptoms continued to worsen, with increasing bladder pressure along with vaginal pain and intermittent vaginal spotting. As soon as she returned to Miami in August, she went to see her oncologist in Broward. He performed an exam which showed that the cancerous mass in Mrs. Squilloni’s vaginal area had grown to five centimeters. He recommended that she start radiation therapy immediately and scheduled a consultation for her with a radiologist at a nearby hospital.

During her appointment, the radiologist reviewed her CT scan and report, which Mrs. Squilloni herself hadn’t even seen yet. He pointed to several spots on her scan and told her she had metastatic cancer – the cervical cancer had metastasized to her lung. “He said to me, ‘I’m sorry, but this is not for me to treat. You’re going to need chemotherapy,’”she recalls. “I just broke down and started crying uncontrollably.”

Once she had recovered from the initial shock of what proved to be a far more serious diagnosis, Mrs. Squilloni realized she would need much better cancer care than what she had received so far. Indeed, her life depended on it. “By then, I was just feeling so sick and so emotionally devastated,” she says. “I was in fear for my life, I didn’t know what to expect and I just wanted to make sure I got the very best care.”

Choosing the “hometown” cancer center for her care

Mrs. Squilloni researched leading cancer centers around the country and decided on Miami Cancer Institute, which is part of Baptist Health. The fact that it is her “hometown” cancer center was just one of many factors in her decision.

“I had read lots of really good reviews online from patients who had been treated there, including a lot of international patients,” Mrs. Squilloni says. And she remembers being so impressed when she visited Miami Cancer Institute for the first time. “Here was this beautiful, massive building dedicated solely to treating cancer, with all of these support services available to patients.”

Mrs. Squilloni entrusted her care to Eleftheria Kalogera, M.D., a gynecologic oncologist at Miami Cancer Institute, whom she saw for the first time last September. “I had a gut feeling about her. She’s a very empathic doctor, which is why I felt so comfortable with her,” says Mrs. Squilloni. “She’s very calm and she explains things very well. She’s also very up-front and honest. She won’t give you false hope, but she will give you hope based on reality.”

Dr. Kalogera recalls her first encounter with her patient. “I saw Mrs. Squilloni three weeks after she had received clinical confirmation of recurrent metastatic cervical cancer that had spread to her lung,” she says. This meant that she would need aggressive systemic treatment, which Dr. Kalogera recommended they begin immediately. Mrs. Squilloni agreed. “I knew my body was strong and could withstand it.”

Adding an immunotherapy drug to her treatment plan

After her first treatment, Mrs. Squilloni had been doing some research on cervical cancer therapies and learned that immunotherapy was proving to be an effective treatment for certain kinds of patients with specific types of cancer. Coincidentally, Dr. Kalogera says, a new study that had just been published in a prestigious medical journal showed that patients with recurrent metastatic cervical cancer had better outcomes with the addition of a novel type of immunotherapy.

Doctor and patient discussed the idea, and Miami Cancer Institute’s multi-disciplinary tumor review board agreed that in Mrs. Squilloni’s case, the addition of the immunotherapy would indeed be beneficial. Dr. Kalogera adjusted her patient’s treatment plan to include this immunotherapy drug in addition to her standard chemotherapy for a total of six rounds which were then followed by two rounds of immunotherapy alone. Mrs. Squilloni had the option to  remain on the immunotherapy treatment, which she has decided to postpone for now.

Mrs. Squilloni’s final treatment was March 30^th and she has now been proclaimed disease-free. “It’s not often we have a new medication at our disposal to add to our standard treatments that is capable of offering improved outcomes for patients right at the start of their treatment,” Dr. Kalogera says.

An integrative, naturalistic approach to her treatment

As for Mrs. Squilloni, she’s elated to hear the words “disease-free” but says it’s difficult to be too happy because she doesn’t know how long it’s going to last. “I know that with metastatic cancer, chemotherapy alone may not be the solution,” she says. “So, on top of my medical treatment, I’ve also completely changed my lifestyle to reduce the toxic burden chemotherapy has placed on my body. I’ve changed how I live, what I eat and drink and which supplements I take.”

Mrs. Squilloni traveled to Germany recently to spend a few weeks at an integrative health clinic there. “I wanted to make sure my body is physically able to fight off a recurrence if my cancer does come back,” she says, adding that Dr. Kalogera was very open to accommodating her “integrative, naturalistic” approach to her cancer treatment, which encompasses diet, exercise, acupuncture and massage.

“Everything is interconnected – what you’re feeding yourself is what you’re feeding your cells,” says Mrs. Squilloni. “I’m living a healthier life and I’ve stopped eating carbs, meats, sugar and dairy. Now, I’m basically vegetarian and eating all-organic fruits and vegetables. I’ve even installed a water filter on my tap.”

Dr. Kalogera says that Mrs. Squilloni was willing to do everything it took to treat her cancer but wasn’t 100-percent convinced that Western medicine was the best approach for her treatment. Eventually, her initial reluctance gave way to acceptance and trust as she developed a closer relationship with Dr. Kalogera and learned everything Miami Cancer Institute has to offer.

“It was a big shift for her. My philosophy is to try and understand what my patients value and determine if our treatment recommendations are in line with their philosophy,” Dr. Kalogera says. “I like to be open to other approaches to health. We’ve definitely learned from each other.”

Being a cancer survivor in a pandemic has been challenging but Mrs. Squilloni says she spends a lot of time outdoors going to the beach, visiting parks and enjoying time with family and friends. “Having survived a life-threatening condition, I value more than before how I spend my time and I’m more careful about doing only the things I really want to do,” she says.

A show of support from a young neighbor

For some cancer patients, hair loss during treatment is not uncommon, and Mrs. Squilloni lost her hair shortly before hosting her son’s seventh birthday party. “I spent a lot of money on a wig made with real hair and I wore it at the party and one other time,” she says. “It was scratchy and itchy, I never knew if it was positioned right and I just didn’t feel like myself when I wore it.” So for now, Mrs. Squilloni chooses to go wigless, wearing a scarf only when it’s cold.

Bald women tend to stand out in a crowd, and that’s how Mrs. Squilloni’s cancer battle came to the attention of her 13-year-old neighbor, Nell, who has never had a haircut in her lifetime and has long hair down to her ankles. “It’s usually done in beautiful braids,” according to Mrs. Squilloni, who has always admired the incredible patience it must take for Nell and her parents to braid her hair regularly.

Soon, however, as a tribute to her neighbor’s status as a cancer survivor, young Nell plans to cut off all her hair and donate it to Locks of Love, which for the past 25 years has been providing high quality hair prosthetics to financially disadvantaged pediatric cancer patients.

Mrs. Squilloni says it was Nell’s decision to cut her ankle-length hair that gave her the courage to share the story of her cancer journey with Resource readers. “She’s such a beautiful girl, with such beautiful, long hair,” she says. “And to cut it all off in my honor? That’s such a powerful gesture.”

In the meantime, Mrs. Squilloni is spending the summer with her family in her hometown of Formia, a small costal village halfway between Naples and Rome, where she’ll celebrate her 50^th birthday. “How long I stay depends on what Dr. Kalogera has to say.”

According to Dr. Kalogera, Mrs. Squilloni is doing very well and should be able to enjoy her summer in Italy with a close follow-up shortly after she returns. “For someone with recurrent metastatic cancer, Mrs. Squilloni had an intensive and quick response to treatment,” she says. “It’s been very gratifying to know that we could help her feel better. She’s been an extremely rewarding patient to care for.”

Dr. Kalogera adds that all women should be vigilant for cervical cancer. “Getting your annual exams and following your gynecologist’s recommendations for PAP smears is critical,” she says, as is getting the HPV vaccine, which she says both boys and girls should get as early as nine years of age. “And, of course, always see your doctor if you have any unusual symptoms. Being able to catch cancer early leads to better outcomes.”