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The Deadly Whisper of
Ovarian Cancer
By: Jane E. Brody
New York Times, October 2, 2001
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.
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