Ovarian Cancer: Detecting the Silent Killer

By Heather C. Guidone

Called the "silent killer", ovarian cancer has claimed the lives of hundreds of thousands of women, including funny ladies Gilda Radner and Madeline Kahn, best known for their comedic television and film roles. Each of them hoped that their celebrity status would bring awareness to the disease and help others; their legacies live on through such organizations as Gilda´s Club, founded by Joanna Bull, and the Ovarian Cancer National Alliance, founded by the leaders of seven ovarian cancer groups.

According to the American Cancer Society, ovarian cancer accounts for 4% of all cancers among women, and ranks 5th as a cause of their deaths from cancer. The Society estimates that there will be 23,400 new cases diagnosed and 13,900 deaths from the disease this year alone. This rate has barely improved over the last 50 years.(1)

Ovarian cancer comes from cells of the ovary that grow and divide uncontrollably. These cells may grow to form a tumor on the ovary, and may spread to other parts of the body. There are different types of tumors that can start in the ovaries. Some are benign (non-cancerous); others are malignant (cancerous). Although ovarian cancer can spread throughout the entire body, in most cases it stays in the abdomen and affects organs such as the intestines, liver, and stomach.(2)

Early diagnosis is crucial: the 5-year survival rate for Stage I patients is nearly 90%; 70% for Stage II patients. Unfortunately, almost 70% of
women with ovarian cancer are not diagnosed until the disease is in advanced Stages (III-IV), and the 5-year survival rate for those women
is only 15-20%. (3)

Ovarian Cancer Symptoms & Risk Factors

While varying from patient to patient, common symptoms of ovarian cancer include abdominal pressure, bloating or discomfort; nausea, indigestion or gas; urinary frequency; constipation or diarrhea; abnormal vaginal bleeding; unusual fatigue; and unexplained weight gain or loss. Symptoms are often associated with the location of the tumor and its impact on the surrounding organs. Symptoms can mimic other conditions such as irritable bowel syndrome, endometriosis, ovarian cysts, etc. Women who are concerned about symptoms they may be experiencing should see their gynecologist.

While all women are at risk for ovarian cancer, studies by the National Cancer Institute show that the following factors may elevate risk: personal or family history of ovarian, breast, or colon cancer; increasing age (56% of women diagnosed with ovarian cancer are older than age 65); and childbearing status (women who have never had children are more likely to develop ovarian cancer than those who have). Use of fertility drugs or hormone replacement therapy (HRT) after menopause may also cause a slightly increased risk. Researchers are studying these possible links, as well as performing further investigation into the role genetics play and potential environmental causes of the disease. (4)

Some studies have shown that breastfeeding and taking oral contraceptives may decrease a woman´s likelihood of developing ovarian cancer. Women who have had a tubal ligation or hysterectomy (removal of uterus) also have a lower risk of developing the disease. In addition, researchers suggest that reducing the amount of fat in the diet may also lower a woman´s risk of developing ovarian cancer. Women who are at high risk for ovarian cancer due to a family history of the disease may consider having their ovaries removed before the cancer develops, through a surgical procedure called a prophylactic oophorectomy. (5)

Diagnosing Ovarian Cancer

Ovarian cancer may be diagnosed through a series of exams and tests, such as a pelvic exam; an ultrasound; a CA-125 assay (a blood test used to measure the level of CA-125, a tumor marker that is often found in higher-than-normal amounts in the blood of women with ovarian cancer); a lower GI series or barium enema (a series of x-rays of the colon and rectum); a CT Scan; and a surgical biopsy, in which tissue is removed for examination under a microscope.

According to the National Ovarian Cancer Resource Center, the 3 main types of tumors are:

  • Epithelial: epithelial ovarian tumors develop from the cells that cover the outer surface of the ovary. Most epithelial ovarian tumors are benign. Cancerous epithelial tumors are carcinomas. These are the most common and most deadly of all types of ovarian cancers, and epithelial ovarian carcinomas account for 85% of all ovarian cancers. Although most epithelial ovarian cancers occur in women who do not have a family history of the disease, about 5-10% of women with ovarian epithelial cancer have other family members who have also had the same kind of cancer.

  • Germ Cell: ovarian germ cell tumors develop from the cells that produce the ova (eggs). Most germ cell tumors are benign, although some are cancerous and may be life threatening. Germ cell malignancies occur most often in teenagers and women in their twenties. An estimated 90% of patients with ovarian germ cell malignancies can be cured and their fertility preserved.

  • Ovarian: stromal tumors develop from connective tissue cells that hold the ovary together and from those that produce the female hormones (estrogen and progesterone). These tumors are quite rare and are usually considered low-grade cancers, with approximately 70% presenting as stage I disease.

"Stage" of disease is ascertained during surgery and is based on how far the tumor has spread. With Stage I, growth of the cancer is limited to one or both ovaries. With Stage II, growth of the cancer involves one or both ovaries, with pelvic extension. With Stage III, growth of the cancer involves one or both ovaries, the cancer has spread beyond the pelvis to the lining of the abdomen, and/or the cancer has spread to lymph nodes. Stage IV is the most advanced, in which growth of the cancer involves one or both ovaries and distant, lymphatic spread has occurred.

Treatment Options

Treatment options and patient outcomes depend on the type of cancer and how far it has spread before it is diagnosed. Treatments include:

  • Radical surgery, in which the ovaries, fallopian tubes, uterus and cervix are usually removed, through an operation known as hysterectomy with bilateral salpingo-oophorectomy. Often, the surgeon will also remove the omentum (the thin tissue covering the stomach and large intestine) and lymph nodes (small organs located along the channels of the lymphatic system) in the abdomen. If the cancer has spread, the surgeon usually removes as much of the cancer as possible in a procedure called tumor debulking. Tumor debulking reduces the amount of cancer that will have to be treated later with chemotherapy or radiation therapy.

  • Chemotherapy is the use of drugs to kill cancer cells ("chemical therapy"). Chemotherapy may be given to destroy any cancerous cells that may remain after surgery, to control tumor growth, and/or to relieve symptoms of the disease. After chemotherapy is completed, a second-look surgery may be performed to examine the abdomen directly. The surgeon may remove fluid and tissue samples to see whether the drugs have been successful in eradicating the disease.

  • Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill the cancer cells.

Side effects of these treatments range from surgical pain and induction of surgical menopause to nausea and vomiting, loss of appetite, diarrhea, fatigue, numbness and tingling in hands or feet, headaches and hair loss.

Follow-up care after treatment for ovarian cancer is important and should include regular checkups, complete with physical and pelvic exams, Pap tests, a urinalysis, a CBC (complete blood count) and a CA-125 assay.

Ovarian cancer is curable if diagnosed and treated early!! Be aware of symptoms and request tests of your doctor that may save your life.

Where to find help:

1) American Cancer Society
2) Gilda Radner Familial Ovarian Cancer Registry
3) "What Is Ovarian Cancer?" by the National Ovarian Cancer Resource Center
4) & 5): "Ovarian Cancer," by the National Cancer Institute. NIH Publication No. 00-1561

Heather C. Guidone is a freelance writer and researcher with a special interest in women's health. She has served as the Director of Operations and an Executive Board Member of the Endometriosis Research Center, a 501(c)3 non-profit organization for education, research facilitation and support since the organization was founded. She is a member of the American Medical Writer's Association and the World Endometriosis Society. Heather resides outside NYC with her family. For more information, visit: www.hcgresources.com/endoindex.html



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