“I don’t take ‘no’ for an answer!”
Alisa Secaida, a 39-year-old mother of two living in La Verne, California, calls herself “relentless.” Especially when it comes to managing her cancer care. She will stand up and fight to be heard, even if some doctors get annoyed, even angry about it.
“Be proactive,” she says. “Don’t worry about upsetting doctors.”
And that’s why, as she approached her 40th birthday – a milestone she was not sure she would reach – Secaida chose to undergo surgery and radiation for Stage 4B lung cancer, despite being told her disease had been controlled, even eliminated by the medications she’d been taking.
Secaida is among the rising number of women under 50 who receive a cancer diagnosis each year. The incidence of cancer in women has surged to 82% higher than in men of the same age group. These women are increasingly becoming their own health advocates, determined to take control of their cancer journeys.
Early Lung Cancer Symptoms
It was late December of 2020 when Secaida knew something was wrong. She was coughing. She felt fatigued. Breathing became difficult. Her chest felt tight and her shoulder ached. One local doctor suspected asthma and gave her an inhaler. Her symptoms worsened. A second doctor blamed “long COVID” and told her to ease up on her schedule. “They said I was working too much,” she recalled ruefully.
With doctors dismissing her distress, Secaida took matters into her own hands, cashing in a discount voucher to pay for her own computed tomography (CT) scan. The test detected a mass in the upper left lung.
Concerned about her condition, Secaida requested a referral to a lung specialist. Unfortunately, her doctor responded with unexpected frustration, seeming to take her request personally. Despite this challenging interaction, Secaida persisted, and after her husband advocated firmly on her behalf, the doctor eventually provided the needed referral. At the pulmonologist Secaida had a positron emission tomography (PET) scan, which is more able than a CT to spot cancerous cells. She expected to get the results in a few days. The doctor phoned as Secaida was driving home. “Something’s wrong,” he said. “And it looks like cancer.”
Impossible, she thought. She didn’t smoke. No one in her family, including several smokers, had ever had lung cancer. And she was only 35. Doesn’t lung cancer strike older people?
Although overall lung cancer rates have declined sharply, and patients under 45 make up a tiny fraction of total cases, a significant number of younger people are diagnosed each year. Most tend to be women, many have never smoked, and their malignancies are often detected at a late stage, after symptoms develop.
For Secaida the next step should have been an immediate biopsy but here again she had to fight. Several doctors refused to perform the procedure, claiming it was too risky. While it is true that a lung biopsy can occasionally cause chest infections or collapse the lung, there is no other way to accurately measure a tumor’s stage, a critical element in determining treatment.
It took a few weeks, but Secaida did get her biopsy, and was told, “You need to see an oncologist.”
Finding the Right Care Team
Secaida headed straight for City of Hope, a short distance from her home.
“I was in tears, I was shaking,” she recalled.
Her diagnosis was serious. Secaida had stage 4B non-small cell lung cancer. A cancerous lesion had developed on her brain as well.
Ravi Salgia, M.D., professor and chair of the Department of Medical Oncology & Therapeutics Research, and the Arthur & Rosalie Kaplan Chair in Medical Oncology, started Secaida on Keytruda (pembrolizumab), a monoclonal antibody that stimulates the immune system to destroy cancer cells, plus the chemotherapy drugs carboplatin and pemetrexed.
In the meantime, radiologist Arya Amini, M.D. used stereotactic radiosurgery (SRS) to pinpoint and destroy Secaida’s brain lesion.
By July of 2022 Secaida was designated as NED: no evidence of disease, a welcome development.
But there was a problem. Ten rounds of Keytruda left Secaida with liver toxicity, pointing out the unfortunate reality of cancer treatment.
“Every therapy can have toxicity,” said Dr. Salgia.
A course of steroids took care of the liver problem, but in January of 2023 the cancer returned.
However, along with it came a pleasant surprise.
Genetic testing revealed that Secaida's tumor was ALK-positive (anaplastic lymphoma kinase) and could be treated with targeted therapies specifically designed for it.
New drugs known as tyrosine kinase inhibitors (TKI) work especially well on ALK-positive cancer. Secaida began taking one of them, alectinib, which did the job, putting her cancer under control.
For more than a year afterwards, Secaida felt joy and relief each time a follow-up scan showed no sign of disease. But a disturbing thought lurked in her mind. What if it comes back one day?
“It was like living with a loaded gun to my head,” she said. Her concerns escalated when later scans began to show the tumor again, but not consistently. Sometimes it was visible, sometimes not.
She was told not to worry, that the mass almost certainly was “dead” with no active cancer cells. Staying on her TKI treatment would be more than enough. Secaida didn’t think so.
“I knew it was there, and I was determined to stay ahead of it,” she said, adding that many of her fellow patients taking TKIs had seen their cancers begin to progress anew after a while. She didn’t want that to happen to her.
A Quest for New Treatments
In the spring of 2024 Secaida heard about a webinar that claimed there was evidence that Stage 4 patients could be treated with surgery, which would enable them to live longer.
“I started on a quest for surgery,” she asserted. Her quest took her to several institutions but eventually brought her back to City of Hope.
Secaida’s City of Hope physicians investigated and ultimately agreed with her, scheduling Secaida for surgery with Jae Y. Kim, M.D., chief of the Division of Thoracic Surgery in the Department of Surgery.
Her procedure took place on February 3, 2025. Dr. Kim removed the upper left lobe of Secaida’s lung, plus some lymph nodes. Pathology reports then proved Secaida was right. Her primary tumor was still active, and cancer cells were detected in the lymph nodes. She is now getting intensity-modulated radiation therapy (IMRT) to eradicate any remaining malignant cells.
Secaida knows her “go-go-go” insistence on getting properly tested, ignoring the doctors who belittled her symptoms, made a profound difference. So did choosing City of Hope.
“City of Hope gets it,” Secaida said. “I was never shut down. They just asked for more information, and they were definitely open-minded about everything, making me part of the team and not just a statistic.”
She also says City of Hope “gets” the unique needs of young women with cancer, and more institutions need to do the same.
Secaida's experience highlights a gap in cancer care that needs to be addressed for younger female patients nationwide.
That’s why City of Hope is partnering with the American Cancer Society, Together for Supportive Care, Tigerlily Foundation and others to highlight this issue and push for necessary changes.
“Because most cancer patients are older, doctors tend to focus on quality of life,” she said. “But we’re young. We want more time. I want to see my kids graduate. So, we’re willing to take chances, and handle the risks and side effects to get (that extra time).”
Dr. Salgia agrees.
“We have to empower each and every one of our patients,” he said. “Alisa is phenomenal in her outreach and ability to understand her disease and know what is going on.”
“We have to continue to spread the message. Lung cancer is also a woman’s cancer. It is also happening in the young person. Let us continue to educate and spread the message.”
Secaida is spreading a message too.
“I hope more females start to push,” for second opinions and treatment options, and never to meekly accept things at face value, she said. “Because, looking at my friends with cancer, the ones who lived past their prognosis, every one of them had pushed back.”