A nurse who went to the doctor for symptoms of fatigue in 2013 said she realized it was probably something more than vitamin D deficiency when she started coughing up blood. But Karie Fisher, of Colorado, wasn’t expecting to learn that she was facing stage 4 esophageal cancer, an illness which accounts for just 1 percent of all cancers diagnosed in the U.S.

“I lived in a very rural area at the time, so [esophageal cancer] wasn’t on anybody’s radar,” Fisher, who was 43 at the time of her diagnosis, told Fox News. “I spit up a little bit of blood at one point and I knew that was not good, so I went to the ER and ended up being life-flighted to Denver.”

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Fisher said she was hospitalized for 10 days in Denver, and on the eighth day, she learned of her diagnosis and that the cancer had spread to her liver. She was reportedly told she was terminal, which is when she found Dr. Toufic Kachaamy at the Cancer Treatment Centers of America in Phoenix.

Kachaamy said Fisher wasn’t the typical esophageal cancer patient he encounters, as some risk factors include being over aged 50, experiencing prolonged or uncontrollable heartburn, being male, and having a family history of the illness. Fisher did say that she was overweight at the time of her diagnosis, which is one of the risk factors, though not a major one.

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“Half the people who are diagnosed with esophageal cancer do not have heartburn,” Kachaamy told Fox News. “So that fact that you don’t have heartburn does not mean you are not at risk.”

Most patients are diagnosed after an endoscopy and biopsy, Kachaamy explained, but added that screening for esophageal cancer remains controversial. He said patients with multiple risk factors and those who have been diagnosed with Barrett’s esophagus, which is when the lining of the esophagus changes, are ones who are monitored more actively. However, for patients like Fisher, that means that the cancer is not found until it has reached advanced stages.

Fisher began treatment with traditional chemotherapy and radiation for several years, but there was no change to her tumor. Kachaamy presented another option, truFreeze, which was spray cryotherapy targeted at the tumor in her throat. After three treatments, Kachaamy said Fisher’s tumor began responding, and eventually, it was small enough to be surgically removed.

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Fisher, who has been in remission for five years, said patients don’t know enough about options like cryotherapy.

“Dr. Kachaamy was very cutting-edge for me and worked really hard … and he brought in spray cryotherapy for palliative reasons, to help shrink the tumor so I could swallow, so it was about nutrition at that time and quality of life,” she said. “That was one of the things I think that a lot of people aren’t aware of — they traditionally go chemo and radiation but there are some other treatment options out there that I think [are] important for people to know about.”