At the age of 27, Nadia Le Tiec was on a tear.
Intelligent, articulate and driven, she was working for the tourism board in her native Jersey, making good use of the first-class honours degree in marketing management and branding she had earned five years earlier at the University of Gloucestershire.
Three or four times a week, she would rise at 6am to do boxing classes, a regime that earned her the affectionate nickname ‘the healthy one’ among her friends. Whatever she did, she did whole-heartedly.
Then, in spring 2022, something strange happened: Nadia’s hair began to thin and fall out. She booked an appointment with her GP, who ordered a blood test. When the results came back, he declared: ‘Your bloods are disgustingly good, I’ve got no concerns about you.’
But still something wasn’t right. Nadia began getting intermittent pains in her side, just below the ribcage. She assumed it was just a stitch, or something she had eaten. Just to be sure, though, she returned to the doctor’s surgery. Physical examinations and an ultrasound scan revealed nothing.
So Nadia began pursuing other avenues. She sought the advice of a nutritionist. She began experimenting with her diet. And then she just got on with life. That November, she handed in her notice – ‘I fancied a change,’ she says – and then joined her parents on a family holiday to Barbados.
‘It’s somewhere we go around the same time every year, it’s like a second home to me,’ says Nadia. ‘I grew up going there, my parents went there on their honeymoon, and they just kept going there, so eventually they brought me along. It was like an annual tradition. It’s somewhere I feel relaxed.’
As she eased into the holiday and the stresses of working life receded, Nadia began listening to her body more attentively. Despite adjusting her diet, she was suffering from inexplicable bloating. Then she found a hard lump on the side of her pelvis. Nadia spent the flight home frantically Googling her symptoms.
Mr John Butler, a consultant gynaecological oncology surgeon at the Royal Marsden Hospital, performed an 11-hour operation on Nadia Le Tiec after she was diagnosed with ovarian cancer
Images created using a technique called hyperpolarised carbon-13 imaging allow doctors to distinguish between different subtypes of ovarian cancer, aiding treatment
Professor Kevin Brindle (seated, right) of the University of Cambridge, seen here with his lab group, has devised an imaging technique that allows rapid assessment of ovarian cancer
On 29 November 2022, after visiting a different doctor, she was diagnosed with ovarian cancer after a mass ‘the size of a grapefruit’ was discovered on her ovaries. In an instant, her world turned on a dime.
‘I remember not being able to speak, I was just so shocked,’ recalls Nadia. ‘I didn’t have any words. I didn’t even cry until after about five minutes.
‘My first thought was, “How long do I have?” You just literally start thinking about death. But I didn’t ask; I didn’t really want to hear what they had to say. I was too scared to ask any questions.’
Twenty days later, Nadia underwent an 11-hour operation at the Royal Marsden hospital in Chelsea, south-west London.
‘I probably wasn’t taking notice as much as I should have done,’ she says. ‘But saying that, ovarian cancer is so hard to detect, unfortunately, at the early stages.
‘The symptoms are very vague: things like acid reflux, bloating, feeling full quickly.
‘At the time, I didn’t really think much of it. I thought I’d probably eaten too much fatty food, or I’d eaten too quickly. But looking back, I realise I had symptoms. I just didn’t think they could be associated with such a serious diagnosis, especially at 27.’
While unusual, given her age – half of all cases in the UK are among women over the age of 65 – Nadia’s story is far from unique. Roughly 7,500 new cases of ovarian cancer are diagnosed in the UK each year, approximately two-thirds of which are for the most aggressive form of the disease, called high-grade serous ovarian cancer.
Nadia Le Tiec has spoken publicly to raise awareness about the risk ovarian cancer can pose to young women
‘We can potentially predict which drug night be better for the patient and also detect within a matter of days whether a tumour is responding to treatment,’ says Professor Kevin Brindle
Nadia Le Tiec is seen alongside John Butler and Tamara Beckwith Veroni, right, and Josephine Daniel, founders of the Lady Garden Foundation, a women’s health charity
The cure rate for all forms of the disease is low. Ovarian cancer claims the lives of more than 4,000 women a year, according to Cancer Research UK, with only 35% of women in England surviving for 10 years following diagnosis.
It does not help that the symptoms are so indistinct as to be easily missed. The most common include a swollen stomach or bloating – ‘Quite a common thing for a woman,’ Nadia points out – as well as pain or tenderness in the pelvic area, loss of appetite, feeling full quickly, and an urgent need to urinate.
Diagnosis can be similarly challenging, partly due to the vague nature of the indicators, but also because the ovaries lie deep within the abdomen, making it difficult for doctors to feel tumours during a physical examination.
About 90% of ovarian cancers begin in epithelial cells surrounding the outer surface of the ovaries. This single layer of cells, known as the ovarian surface epithelium, is essentially designed to protect the ovaries from disease. But when the cells malfunction, tumours can develop that may be classified as benign, borderline or malignant.
A blood test that measures levels of a protein called CA-125 can help to diagnose ovarian cancer, but it is regarded as unreliable, since a high reading can also can also be indicative of other conditions such as endometriosis, fibroids and even pregnancy.
There is no national screening test for the disease, with diagnosis dependent on methods including ultrasound, transvaginal and abdominal scans. Tellingly, the analysis of Nadia’s blood ordered when she first visited her GP did not include a test for CA-125.
‘I feel like there should definitely be some sort of early screening detection,’ says Nadia. ‘There isn’t really anything like a smear test to detect it at an early stage, like you have for cervical cancer.
‘Something that would detect it earlier would save peoples’ lives. It’s catching it at a late stage that makes it harder to treat. Unfortunately, mine was [found to be] stage 4 when I had the surgery.’
The Royal Marsden hospital in Chelsea, south-west London, where Nadia underwent an 11-hour operation in December 2022
Professor Susana Banerjee, seen here at a charity event in 2018, led a study involving 115 patients with ovarian cancer that showed combining two drugs can shrink tumours
Research has shown, however, that existing methods are not effective in detecting ovarian cancer early enough to impact survival rates. And while efforts are afoot to address that shortfall, the emphasis in the meantime falls on treatment.
That too is a complex area, not least because ovarian cancer patients often have multiple tumours spread throughout the abdomen. It is impossible to take tissue samples, or biopsies, of all of them, yet distinguishing between different forms of the disease is crucial, since the effectiveness of drug treatment varies according to the tumour subtype.
In an effort to tackle this problem, researchers at the University of Cambridge have developed a new way of imaging the metabolism of cancer tumours which can differentiate between distinct strains of the disease. The method not only enables the best treatment pathway to be identified, but also allows doctors to see whether the administered drugs are working within 48 hours.
‘There are multiple tumour types and they have different responses to treatment,’ explains Professor Kevin Brindle, a Cambridge biochemist and senior group leader at the Cancer Research UK Cambridge Institute. ‘The challenge in clinical oncology today is to match the patient to the drug.
‘Not only can we potentially predict which drug night be better for the patient, but we can also detect very quickly, within a matter of days, whether that tumour is indeed responding to treatment.’
The technique, known as hyperpolarised carbon-13 imaging, involves magnifying the sensitivity of magnetic resonance images more than 10,000-fold, which in turn enables scientists to monitor the metabolism of a solution injected into patients.
The solution contains a form of pyruvate, a naturally occurring molecule that plays a key role in cellular metabolism and energy production, labelled with an isotope of carbon 13.
‘This technique massively increases MRI sensitivity,’ says Brindle, whose work focused on high grade serous ovarian cancer. ‘So for the first time, we have the capability to image where this molecule was in the body after we injected it, but most importantly we can monitor its conversion into other molecules.
‘It’s mainly converted into a molecule called lactate, and tumours are full of lactate, so they tend to light up when you inject this polarised pyruvate.
‘You see a lot of this labelled lactate appear in the tumour. That lactate labelling is very much related to how fast a tumour is growing and consuming glucose.’
Clinical trials of the technique are ongoing at about 20 sites worldwide, and while it is expensive – the polarisation hardware costs over £1 million – it can also be used to investigate other forms of cancer, including breast, prostate and brain tumours.
No less promising is recent research into low-grade serous ovarian cancer, the rare type with which Nadia was diagnosed – and one that rarely responds to traditional treatments like chemotherapy and anti-oestrogen therapy.
Led by Professor Susana Banerjee, a consultant medical oncologist at the Royal Marsden NHS Foundation Trust, a study involving 115 patients with the disease demonstrated that a combination of two drugs can shrink tumours and even stop the growth of cancer cells.
‘What we showed was that more substantial shrinkage occurred in around one in three women in the trial,’ says Banerjee, who is also a professor in women’s cancers at the Institute of Cancer Research.
‘But [the figure for] any amount of shrinkage was over 80%. We haven’t seen results like that so far in the trial of other treatments for this rare cancer, so it’s really encouraging.’
Particularly promising, says Banerjee, is that the combination of avutometinib and defactinib – drugs designed to block signals that encourage tumour growth – was well tolerated by patients, with only one in 10 women abandoning treatment due to side-effects.
‘To put that into context, more than three out of 10 stop treatment with our current treatments such as chemotherapy,’ says Banerjee, who is hopeful that the drug combination will change the global approach to a disease that disproportionately affects younger women.
The results of the study, entitled Ramp 201, were especially encouraging for women with a mutation in a gene called KRAS, which is present in one in three women with low-grade serous ovarian cancer.
Among such patients, tumours shrank in 44% of cases, offering hope of similar breakthroughs in the treatment of other cancers where the KRAS mutation is relevant, including lung and pancreatic cancer.
There is also work underway to create an ovarian cancer vaccine.
With the help of Cancer Research UK funding worth up to £600,000, Professor Ahmed Ahmed of the Nuffield Department of Women’s and Reproductive Health at the University of Oxford is working on just such a measure.
‘Teaching the immune system to recognise the very early signs of cancer is a tough challenge,’ says Ahmed, who is working on a vaccine that would attack proteins linked to the early development of the disease.
‘But we now have highly sophisticated tools which give us real insights into how the immune system recognises ovarian cancer.
‘OvarianVax could offer the solution to prevent cancer, firstly in women at high risk but also more widely if trials prove successful.’
For Nadia, however, as for so many other women diagnosed with the disease, surgery was the only option.
Though life-changing, It did not come a moment too soon.
‘Not until they went in to do the surgery did they realise it was stage 4,’ says Nadia, who underwent a hysterectomy and had her colon and parts of her liver and spleen removed.
‘I only had a couple of weeks, if that. They said I wouldn’t have made it to the new year.’
Despite all that she has been through, Nadia remains upbeat and determined to raise awareness about the risk ovarian cancer poses to younger women.
She says she is encouraged by the growing body of research into the disease.
‘I’m really interested in all these things that are happening now,’ says Nadia. ‘I’m feeling really hopeful for my future.
‘I do a lot of travelling, I’ve got some exciting plans for the new year and I’m actually going back to Barbados next year.
‘I haven’t been to any of the other Caribbean islands, so we’re going on a cruise, and we’re going to Malaysia in February.
‘I’m also spending lots of time with family and friends.
‘I’m just so grateful that I’m still here and able to live my life to the full.’
And her message to other young women who might discover similar symptoms to the ones she encountered?
‘If in doubt, there’s no point in taking chances,’ says Nadia. ‘If there’s anything out of the norm for you, get it checked out.
‘It’s about not being complacent – and not thinking that you’re too young to get something like this.
‘Cancer doesn’t discriminate. It can happen to anyone, at any age.’
