Charlotte Elwood will never let anyone tell her anything is impossible. When the Boise, Idaho resident was diagnosed in 1997 with a rare form of ovarian cancer called germ cell granulosa — despite having no ovaries after a hysterectomy — she was told she would have six months to live. Elwood, 54 years old at the time, did not accept that.

Her local oncologist found a treatment that had only been used for testicular cancer before, but her body responded well to it, and it gave Elwood two cancer-free years.

Unfortunately, Elwood's ovarian cancer metastasised to her liver after that. And it continued to recur after additional rounds of chemotherapy and radiation. Even after an experimental type of radiation, it still came back.

At one point, one of her metastatic tumours grew to the size of a football.

In 2015, when “it reared its ugly head again,” she was told she was out of options, and that radiation was off the table because she had received as much conventional radiation as her liver could tolerate.

Elwood pressed her oncologist for other options. He mentioned proton therapy but cautioned her that they would likely not take her because she was too sick. Elwood insisted on an appointment and was referred to Fred Hutch Cancer Center radiation oncologist, Smith Apisarnthanarax, MD.

Proton therapy can sometimes be used to treat cancer when all other options for radiation are exhausted, because proton radiation can be delivered very precisely, within millimetres, sparing healthy tissue from receiving further radiation exposure. Healthy tissue can only receive a finite dose of radiation before the risks outweigh the benefits.

“Charlotte had a large tumour burden in her liver and her liver had already received two prior courses of radiation,” said Apisarnthanarax. “This was a particularly difficult case, but I felt that proton therapy would allow us to deliver meaningful doses of radiation to her liver recurrence in the safest way possible.”

Apisarnthanarax and the team at Fred Hutch Cancer Center – Proton Therapy made sure that proton therapy would be a suitable option for Elwood, as they do for all prospective patients.

“It took them a while to decide if proton therapy was right for me,” said Elwood. “I had to do all kinds of tests. I think Dr Apisarnthanarax — I will never forget his name! — thought my case would be challenging.”

Because she knew protons were her last viable option, Elwood leaned into her faith, her source of strength. She visualised Jesus next to her during treatments, which gave her comfort.

“I am so thankful for Dr. Apisarnthanarax. He is so caring, such an amazing man. I have a lot of admiration for him,” said Elwood.

Elwood expressed a lot of enthusiasm about the staff, as well, saying they made her feel warm and uplifted.

“I felt the staff’s warm welcome the moment I walked in,” said Elwood.  “Sometimes, the places you go for something serious like cancer can feel stifling. That was not the case here. The people are the best part of the experience.”

While she and her husband, Larry, stayed in Seattle during the months of her treatment; Larry’s employer in the hospitality industry gave them a discount on a room. They explored all of Seattle’s many parks and even found a local church to attend.

After they returned to Idaho, Elwood expected the cancer to return at the two-year mark, which for her had been the norm. While she did stay in the clear for the first four or five years, she developed a potentially unrelated tumour on her back. She had six-hour microwave-ablation surgery to remove the tumour which she described as “very painful.” Since then, she has been cancer-free.

At her 10th anniversary since having proton therapy, Elwood wrote Apisarnthanarax a card to thank him and update him on her life. She is now 82.

“I was quite pleasantly shocked to receive this kind and thoughtful note from Charlotte,” said Apisarnthanarax. “It made my day to find out that she was not only cancer-free but that she was living life to the fullest without any complications from her treatments — which was her number one priority.”

Elwood advises others to know all their treatment options and to be their self-advocate.

“If proton therapy is offered to you, take it,” she said. “Advocate for yourself, if not. That’s what I did, and it paid off.”