Franchesca's Story Undifferentiated Pleomorphic Sarcoma

Head shot of Franchesca Manuco against a brick wall

It started with nosebleeds in the fall of 2016, which weren’t unusual for Franchesca Namuco. What was unusual was the duration—sometimes they lasted well over 45 minutes.

One time, she went to an ER near her dorm and a doctor placed packing up her nose, which Franchesca then walked around with for the rest of the week. 

When the nosebleeds persisted, an otolaryngologist scoped Franchesca’s nose and discovered a mass that a biopsy showed to be cancerous. Undifferentiated pleomorphic sarcoma, to be more specific. It usually develops in the arms or legs. Franchesca’s had formed in her sinus. 

The location was rare. Her age—she was 20 at the time and a college junior—made her case even rarer. She was referred to Penn Medicine oncologist Arthur P. Staddon, MD.

“Immediately, Dr. Staddon had a game plan. He was telling me what type of chemotherapy and radiation I may have to get,” Franchesca says. “It was still so new to me, so it was comforting to know that they had it all figured out and were ready to move right away.”

Accepting a New Reality

Franchesca Manuco smiling while in hospital bed

Franchesca was having a hard time grasping that she had cancer, even though she was suddenly withdrawing from school and scheduling her first cycle of chemotherapy. She cut off her long hair in anticipation of losing it and then shaved her head completely after her first cycle. 

Still, it wasn’t until her third cycle of chemotherapy that Franchesca began to feel like she had anything more than the flu. She began to sleep most of the day every day—and realize “OK, I’m sick. It took a while, but I know it’s serious now.”

Franchesca would undergo six cycles of chemotherapy, with each one lasting three weeks. Her final cycle was in March 2017. “It was the longest stretch of my life,” she says. Making matters worse, she turned 21 that February. With her doctors’ and nurses’ reassurance, she went out to dinner and had a drink. “It was a small victory,” she says.

The news at virtually every checkpoint was also very encouraging. Franchesca underwent chemotherapy in advance of surgery in the hope that it would shrink the tumor and enable its extraction to be less invasive. The scans after the third cycle indicated it was working.

By the time she had surgery in April, “there was no active tumor. So she had a complete response to chemotherapy,” says Lee Hartner, MD, Clinical Director of Sarcoma Medical Oncology at Penn. In other words, all the cells in Franchesca’s tumor were dead.

“That’s unusual with just chemotherapy,” Dr. Hartner says.

The tumor’s location, however, made it difficult to remove additional surrounding tissue  as a precaution. “Which increases the risk of a recurrence after surgery, even if you don’t see any active cancer,” Dr. Hartner says.  In June, a couple months after her surgery, Franchesca started undergoing proton therapy. 

Returning to Normal

As the summer wore on, Franchesca says she began to see a light at the end of her tunnel. And almost as soon as she did, she set a goal for herself: Go back to school. Her doctors were hesitant at first—proton therapy was going to run until the beginning of August—but she continued to ask. The day Franchesca finally got their approval, she left the hospital, drove straight to school, and registered for the fall semester.

Photo of Franchesca Manuco ringing the bell

She had to take a few classes the following summer, but she was able to participate in commencement last May. Today, Franchesca’s working in a microbiology lab and entertaining the possibility of applying to medical school. She’s still trying to come to terms with her whirlwind year first though.

“It’s still weird to think about it. I’m the same person, but my outlook is different now,” she says. “Before, I wasn’t negative exactly, but I didn’t try to be positive. Now, I try to make everything upbeat.”

She also talks openly about her cancer, even jokes about it. “I know that sounds a little messed up, but it’s my way of dealing with it,” she says. “And there’s no reason to be upset about it.”

The scans she continues to get are a reminder every few months not to be upset about it. She found her way through. And with every passing day, the chance of a recurrence grows a little less.

“Probably at least three-quarters of the people who are going to recur with sarcoma are going to do so within the first two years,” Dr. Hartner says. “So, at this point, Franchesca’s risk is low, and it’ll continue to get lower.”