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When a rare cervical cancer struck visual artist Krista Machovina, her care team from USC Verdugo Hills Hospital needed to write a new playbook.

Krista Machovina figured that one bout with cancer was more than enough. Having survived thyroid cancer in her twenties, the Los Angeles-based studio artist figured that by the summer of 2020, she鈥檇 met her cancer quota.

But life sometimes operates by a different accounting scheme. So, when the stomach pains that hit Krista that August turned out to be cervical cancer, 鈥淚 thought, 鈥楢re you kidding me?鈥欌�� she says. 鈥溾�楧id I not learn the lessons the first time? Why am I here again?鈥欌��

Making matters worse, she continues, 鈥淭his one was really scary.鈥� Indeed, her cervical cancer was so rare and aggressive that the medical field hadn鈥檛 yet established a standard for its treatment.

Rare form of cervical cancer

Krista was already a Keck Medicine patient at the time of her diagnosis, and when the decision came to refer her to a specialist, her physician sent her to Marcia Ciccone, MD, a Keck Medicine gynecologic oncologist who practices at .

It didn鈥檛 take Dr. Ciccone long to realize that she had a tough case on her hands.

鈥淢ost cervical cancer is caused by HPV, or human papilloma virus,鈥� Dr. Ciccone says. 鈥淏ut Krista鈥檚 cervical cancer was not.鈥�

In fact, the cells in Krista鈥檚 tumor exhibited a completely different histology, or cell structure, than those of HPV-related cervical tumors. 鈥淲hen you looked at Krista鈥檚 tumor under the microscope,鈥� Dr. Ciccone says, 鈥渋t actually had these little 鈥榮ignet rings鈥� on the cells that made them look like the cells in gastric tumors that secrete mucin.鈥�

This morphology characterizes what鈥檚 known as primary signet ring cell carcinoma of the cervix (PSRCCR), a very rare cervical cancer that microscopically resembles gastric tumors 鈥� but that also has a poor prognosis and a record of resistance to standard cancer treatments like chemotherapy and radiation.

To put the cancer鈥檚 rarity into perspective, consider that the American Cancer Society鈥檚 estimate for the number of US patients diagnosed with invasive cervical cancer in 2024 was 13,820; meanwhile, the largest case series on Krista鈥檚 cancer at the time topped out at 23 cases.

So if Dr. Ciccone was hoping to base Krista鈥檚 treatment on past precedent, she鈥檇 have to pivot. 鈥淯nfortunately,鈥� she says, 鈥渢here aren鈥檛 enough patients or data out there to say what you should or shouldn鈥檛 do.鈥�

That left Dr. Ciccone with a conundrum: Krista had a diagnosed cervical cancer, but one that neither looked nor responded to treatment like one.

Yet within that conundrum, Dr. Ciccone also saw a hint at a solution. As she puts it, 鈥淢aybe histology matters when you鈥檙e talking about how a cancer will behave. So if this looks like a gastric cancer, maybe it behaves like a gastric cancer, responds like one 鈥� and maybe we shouldn鈥檛 treat it like a cervical cancer.鈥�

Protocol for treating unconventional cancer

In the absence of time-tested options, Dr. Ciccone hastens to add, 鈥淚 didn鈥檛 make any decisions in a vacuum.鈥� Being part of an academic health system like Keck Medicine, she didn鈥檛 have to.

As Dr. Ciccone explains, 鈥淲hen a patient presents with something rare, you want to compile the knowledge and experience of all the minds you have access to.鈥�

She took Krista鈥檚 case to what鈥檚 known as 鈥渢umor board鈥�: a gathering of medical professionals from multiple disciplines designed to discuss and make determinations about complex cancer cases.

鈥淭he radiologists are there, the pathologists are there, the radiation oncologists, GYN-oncologists 鈥� we鈥檙e all there to discuss everything in detail, put all the pieces together and come up with a plan,鈥� Dr. Ciccone says.

Together, Dr. Ciccone and her colleagues developed an innovative approach.

鈥淭here鈥檇 been several instances in the case reports of combining a cervical-cancer treatment with a gastric-cancer protocol,鈥� Dr. Ciccone says.

They decided not just to sensitize Krista鈥檚 tumor to radiation with cisplatin鈥攁 traditional cervical-cancer chemotherapy drug鈥攂ut to also add to that regimen 5-fluorouracil, a chemotherapy agent often used to treat gastrointestinal cancers but also known for its use as a radiosensitizer with prior history of use in cervical cancer.

After radiation and chemotherapy came surgery 鈥� another somewhat unconventional move.

鈥淔or most cervical cancers, even when it鈥檚 more advanced or a larger tumor, radiation can cure you,鈥� Dr. Ciccone says. 鈥淏ut knowing that this cancer might not respond fully to radiation, we planned to remove the uterus and cervix following chemotherapy and radiation to make sure we cleared out all of the tumor that was there.鈥�

This proved to be an important step, as they did find more tumor during surgery.

Moreover, knowing that tumors like Krista鈥檚 sometimes migrate from the stomach or large bowel, her care team performed a colon resection along with the hysterectomy. 鈥淣ot being sure if this was coming from the stomach or maybe the colon,鈥� Dr. Ciccone says, 鈥渄oing the colon surgery helped us answer that question.鈥�

鈥淔ortunately.鈥� Dr. Ciccone reports, 鈥渢he intestine wasn鈥檛 involved.鈥�

Managing expectations for rare cancer treatment

According to Dr. Ciccone, managing expectations is always hard when treating 鈥� and battling 鈥� cancer. But it鈥檚 even harder when that cancer is so rare that you don鈥檛 even know what to expect.

Yet that鈥檚 the case with almost any cancer, she argues. 鈥淐ancers even within the same cell type behave differently,鈥� she says. 鈥淵ou never know when you鈥檙e going to have that patient who responds really well.鈥�

And Krista turned out to be just that. Four years on, regular scans and routine monitoring continue to confirm that Krista is in remission.

And she鈥檚 back at work, returning to the studio, mounting solo shows and creating art 鈥� albeit with a fresh perspective.

鈥淢y work has shifted,鈥� she says. 鈥淎nd people have noticed it. They鈥檒l say, 鈥楾here鈥檚 something different here.鈥� And I鈥檒l think, 鈥榃ell, it鈥檚 because I鈥檝e had a near-death experience! I didn鈥檛 quite see the light in the tunnel, but it happened.鈥欌��

Her experience has only redoubled her commitment to art, and her choice to make it her career.

鈥淲hen you realize your life is finite, it reminds you that you鈥檇 better make it palatable,鈥� she says. 鈥淪o if anything, I鈥檓 more fiercely convinced that I am gonna do this. This is what I鈥檝e chosen to do.鈥�

Among the art she鈥檚 made since returning to the studio is a mixed-media work titled 鈥淧laying the Hand You鈥檙e Dealt.鈥� As Krista says, 鈥淐ancer was the hand I was dealt, and it didn鈥檛 make sense.鈥�

But that hand also hid some aces. 鈥淚 landed an ace of a doctor,鈥� she says, 鈥渁nd this teaching hospital 鈥� which I love.鈥�

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