Primer on ovarian cancer

[Guest guest]

Greetings:

Nearly three years ago I lost my sister to ovarian cancer, largely

because she did not have the information she needed to recognize the early

warning signs. About 10 years earlier I lost my cousin Pat to the same

disease and we now suspect that my paternal grandmother died of the same

disease in the early 1950s, despite a diagnosis of stomach cancer. Upon

reading this excellent summary by Jane Brody from the New York Times I felt

compelled to pass this on to the women on my email list and to several other

listserves.

In health and love of life,

Lighthall

California Institute for Rural Studies

October 2, 2001

The Deadly Whisper of Ovarian Cancer

By JANE E. BRODY

In 1958, as I was turning 17 and my brother 13, our mother died of

ovarian cancer. She was only

49 and, until the miserable year that followed the diagnosis, she had

never had anything more

serious than a cold. She missed many good years as a wife, mother, friend

and beloved elementary

schoolteacher.

Similar tragedies still occur for far too many women who develop ovarian

cancer, the fourth leading

cause of cancer deaths among American women, after lung, breast and colon

cancer. Progress

against this disease has been painfully slow, largely because ovarian cancer

is hard to find in its early,

curable stages, before it has spread beyond its point of origin.

The disease has long been called a " silent killer " because it occurs in an

organ deep in the pelvis and

produces only vague, easily dismissed symptoms, if any symptoms at all,

before it reaches a more

advanced stage. And there is no simple early detection method that could be

used for screening, as

there is for breast cancer (mammography) and cervical cancer (the Pap

smear).

But those intent on improving women's chances of surviving ovarian cancer

insist that it be silent no

more. They want to alert women to the most common symptoms and urge them to

see a doctor

without delay and insist on a thorough medical work-up. Many women

experiencing these admittedly

vague and easily misattributed symptoms either ignore them or, if they do

consult a doctor, are given

a cursory checkup and receive a misdiagnosis like irritable bowel syndrome.

Symptoms to Heed

Ovarian cancer " whispers . . . so listen, " says a brochure from the National

Ovarian Cancer Coalition

(headquarters in Boca Raton, Fla., toll-free phone number (888) OVARIAN, Web

site

www.ovarian .org, and e-mail address NOCC@ovarian .org).

The whispers to heed include any of the following symptoms that are

persistent and unusual to you:

pelvic or abdominal pressure, pain, bloating, swelling or discomfort;

gastrointestinal upsets like gas,

nausea and indigestion; frequent or urgent urination in absence of an

infection; unexplained changes in

bowel habits; unexplained weight loss or gain; pain during intercourse,

continuing unexplained fatigue

or shortness of breath. If you develop any of these symptoms, make sure your

doctor takes them

seriously.

Once a year, women 35 or older should have a checkup in which a doctor

manually examines the

vagina and rectum simultaneously, to detect abnormal ovarian swelling or

tenderness. Starting at age

25, women known to be at high risk of developing ovarian cancer are advised

to have a transvaginal

sonogram twice a year, which can reveal the size and shape of the ovaries,

and a blood test for a

substance called CA-125, a tumor marker that is often increased in women

with ovarian cancer.

All three of these exams should be done if a woman develops any of the

" whispering " symptoms of

ovarian cancer. If there is even the slightest suspicion of cancer, a woman

would be wise to consult a

gynecological oncologist; a referral list is available from the

Gynecological Cancer Foundation at

(800) 444-4441. And any woman interested in taking part in a trial of early

detection methods for

ovarian cancer can call the National Cancer Institute's Cancer Information

Service at (800)

4-CANCER (422-6237).

Statistics and Risk Factors

Ovarian cancer can occur at any age, but often afflicts women in midlife,

when symptoms can be

mistaken for incipient menopause. Over the course of a lifetime, one in 55

women will develop the

disease. Each year, more than 23,000 cases are diagnosed and more than

14,000 women die of the

disease, making it the deadliest gynecological cancer.

The survival statistics for the various stages of ovarian cancer speak to

the importance of a quick

response to early symptoms. When the disease is detected and properly

treated while it is still totally

confined to the ovary in which it arose, more than 90 percent of women can

expect to be cured.

Unfortunately, only about 25 percent of cases are now diagnosed at such an

early stage.

Once the cancer has spread to nearby areas of the pelvis, the five-year

survival rate drops, ranging

from 60 percent to 80 percent, and if it has spread beyond the pelvis, the

survival rate is only 10

percent to 20 percent. Over all, when all stages are considered, only 35

percent to 47 percent of

women with ovarian cancer can expect to live five years, whereas the

five-year survival rate for all

cases of breast cancer is now 85 percent.

A number of factors in addition to the degree of spread influence a woman's

survival chances. These

include the tumor grade, which is a measure of how abnormal the cancer cells

are, and the cell type

(some types are more responsive to treatment than others). Women who have a

mutation in the

tumor suppressor gene BRCA1 are thought to have a better than average chance

of beating the

disease.

Certain factors also increase a woman's risk of developing ovarian cancer.

These include a family

history of the disease in one or more first-degree relatives (mother,

sister, daughter, aunt or

grandmother from either side of the family).

A family history of cancers of the breast, colon, rectum, endometrium or

pancreas may also increase

a woman's risk. Women who carry a mutation in either BRCA1 or BRCA2 have an

increased risk of

developing ovarian cancer as well as breast cancer, and sometimes choose to

have preventive

surgery to remove the breasts or ovaries, or both. A woman can inherit such

mutations from her

mother or father.

Another important risk factor is the number of times a woman has ovulated.

Starting to menstruate

before the age of 12, never giving birth to children and starting menopause

after 50 all increase a

woman's risk. There is also evidence that prolonged use of fertility drugs,

which stimulate ovulation,

may predispose a woman to ovarian cancer, although infertility itself may

account for all or part of

any increase in risk.

On the other hand, bearing several children, especially starting before age

30, breast-feeding and

taking birth control pills, both of which suppress ovulation, are

protective. The pill reduces a woman's

lifetime risk by 10 percent for each year of use.

A Mainstay Treatment

Surgery is necessary to make an accurate diagnosis, and it is the mainstay

of treatment. Typically, if

cancer is present, the surgeon will remove the uterus and fallopian tubes as

well as both ovaries.

Then, depending on the stage of the disease, a woman will usually be advised

to take cancer- killing

drugs, most often a combination of carboplatin or cisplatin and paclitaxel

(Taxol), given on an

outpatient basis every three weeks for a total of six treatments. More than

two-thirds of ovarian

cancers respond to this chemotherapy regimen.

A woman's CA-125 levels will be monitored to assess her response to

treatment.

Chemotherapy is a nonspecific approach to killing cancer cells. It harms

healthy cells as well, leading

to unpleasant side effects, including nausea and vomiting, hair loss, low

blood counts, fatigue, weight

loss or gain and allergic reactions. Though doctors now have ways to

counteract some of the side

effects, the search is on for less toxic treatments. New approaches now

being tested include

monoclonal antibodies, which are tailor-made to attack cancer cells and

spare healthy ones.

Copyright 2001 The New York Times Company | Privacy

Information

Lighthall Ph.D.

Executive Director

California Institute for Rural Studies

P.O. Box 2143 (U.S. Mail)

221 G Street, Suite 204

, CA 95616

Tel: (530)756-6555

Fax: (530)756-7429

dlighthall@...