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Young breast cancer patient grateful to be cancer-free

Move-in day is exciting for any new college student, but for Ashlie Gauthier, the day marked the beginning of two major life events: she was embarking on an exciting study abroad program in Brighton, England, and it was the day she discovered a lump in her breast.

“I told my mom about it right then and she urged me to go get it checked out,” Gauthier said. But after waiting two months to get into a breast clinic in England and then another two months to learn the results, it was January and the once small lump had grown to a 3 ½-inch tumor.

With growing concern, Gauthier made the decision to move home, near Louisville, Ky., for treatment. There, she underwent multiple biopsies until finally receiving a diagnosis. She had a high-grade malignant phyllodes tumor, a rare and aggressive type of cancer that occurs in the breast. This cancer does not arise in the same cell type that makes up a typical breast cancer. It starts in the stromal, or supporting cells, in the breast tissue and thus behaves more like a sarcoma, a cancer of connective tissue and bone. Doctors in Louisville immediately pointed Gauthier to Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine because of Siteman’s experience with this type of cancer, which accounts for less than 1 percent of all breast tumors.

Gauthier drove to St. Louis with her parents, not knowing what to expect. They met with Washington University medical oncologist Angela Hirbe, MD, PhD, who strongly encouraged a very specific treatment plan.

“We were completely shocked and had not expected Dr. Hirbe to recommend a mastectomy, chemotherapy and radiation,” Gauthier said. “But looking back, I am so glad she was direct and firm in advising me. It gave me confidence in her expertise and care – and best of all it worked.”

Hirbe, who also is an assistant professor of medicine at the School of Medicine, said, “Gauthier is young, and this is a rare and aggressive cancer. Multimodality therapy with an experienced and knowledgeable team is key to good outcomes. That is why being treated at a cancer center such as Siteman is so important.”

After surgery, Gauthier was treated with chemotherapy in Louisville. However, she returned to Siteman for her radiation therapy, under the care of Imran Zoberi, MD, at Siteman’s S. Lee Kling Proton Therapy Center.

“Because of the type of tumor she had, we wanted to administer radiation after her mastectomy to reduce the risk of recurrence,” said Zoberi, who also is a professor of radiation oncology at the School of Medicine. “The competing issue in our minds was to minimize radiation to adjacent parts of her body. She is a young, college-age woman with many decades to live, so we were concerned about reducing the risk of a radiation-induced cancer. Proton therapy offered a way to treat exactly what we wanted to treat with minimal radiation exposure to other parts of her body.”

Both standard radiation therapy and proton therapy work on the same principle, by aiming a high dose of radiation towards a tumor, which damages cells’ fragile DNA. Unable to cope with this assault, the cancer cells ultimately die. A major advantage of proton therapy treatment is that protons slowly deposit their energy as they travel towards the cancerous tumor and deposit the majority of the radiation dose directly in the tumor, then stop. Radiation travels no farther through the body. Less radiation is delivered as the proton beam enters the body, and little to no radiation is delivered after it hits the tumor. This results in fewer healthy tissues and organs receiving unnecessary radiation.

Today, Gauthier is back home and feeling optimistic. She volunteers at a local elementary school, has gotten engaged and is planning her return to England to continue her studies.

“I am so grateful I was encouraged to go to Siteman,” she said. “I know I was in the best hands, and I am now cancer-free!”