BY JAMIE LOBER
Who Is at Risk?
About 3% of all new cancers found in women each year are ovarian cancers. Women of any age can have cancer of the ovary, but the risk increases with age. The most common type occurs most often in women between the ages of 50 and 75 years. Half of all ovarian cancers are found in women older than 63 years. Cancer of the ovary is much less common in women younger than 40 years. It occurs more often in white women than in women of other races.
Ovarian cancer is a gynecologic condition that women need to take seriously. “What happens is the cells of the ovary change and become abnormal. They grow abnormally and usually you will see a cyst or a mass on the ovary,” said Dr. Victoria Shirley, obstetrician/gynecologist at Middle Georgia Ob-Gyn. Regardless of your age, it is important to pay attention to your body. “Women who are menopausal and have ovarian cysts need to be concerned and make sure they discuss it with their doctor,” said Dr. Shirley.
Unfortunately, ovarian cancer can affect anybody. “For the average population that does not have any family history or risk factors, there is a 1 in 70 chance of a woman developing ovarian cancer,” said Dr. Sharmila Makhija, director of gynecologic oncology at Emory University Hospital in Atlanta.
Unlike other gynecologic diseases, ovarian cancer does not have explicit symptoms. “A lot of patients who are diagnosed say they just do not feel right and it is hard to find out why,” said Shirley.
According to the American College of Obstetricians and Gynecologists, symptoms can include:
R Pain or pressure in the pelvic area or back
R Indigestion, gas, and bloating that cannot be explained
R Abnormal vaginal bleeding
R Pain or swelling of the abdomen
R Increase in abdominal size
R Increased feeling to urinate or changes in bowel habits
R Feeling tired
R Weight loss
Even though these symptoms don’t seem severe, you should discuss them with your doctor.
Ovarian cancer is complex in the sense that many symptoms mimic gastrointestinal problems, irritable bowel syndrome or menopause. “Everybody in the United States probably has some of the symptoms,” said Doug Barron, executive director of the Georgia Ovarian Cancer Alliance. The difference is that in ovarian cancer, symptoms persist for an extended period of time and treatment does not help. “The average age of diagnosis is 63 years-old and that is the tail end of the generation that has been told that the doctor knows everything and is the smartest person in the world. If the doctor says something and you are not getting any better, question him and do not just go along with it,” said Barron.
If you do not feel right or believe your doctor is not paying attention to you, do not be afraid to seek a second opinion. “Odds are you are not going to have ovarian cancer but as a woman, if you feel something is not right, it is important to voice your concerns and opinions and get things looked at further,” said Makhija. It used to be said that ovarian cancer is a silent killer. Now, doctors emphasize that it whispers, and you have to be in tune to your body well enough to listen for the symptoms.
As of yet, there is no definitive screening test. “The pelvic exam, ultrasound, and CA125 blood test are not 100 percent but a combination gives a better idea,” said Makhija. The pap smear does not indicate anything about ovarian cancer and the annual gynecologic examination does not provide much information either. Every gynecologist has a different way of going about ruling out ovarian cancer. “A lot of times doctors suggest a combination pelvic and rectal exam and a transvaginal ultrasound,” said Barron.
Prognosis is very good if you are diagnosed in stage 1. Women usually have a surgery to get the visible cancer out followed by chemotherapy. Doctors are treating it like a chronic illness such as diabetes or high blood pressure. “We are treating it in the same mindset such that we are trying to make sure it does not come back, but it may come back. You may have to get more chemotherapy just like if you had a flare-up of diabetes and need to have more insulin or start back up on insulin,” said Makhija. Because of this mindset, women are living longer. “We are improving things with the current treatment modalities and there is hope,” said Makhija.
Of course, as in all cancers, late diagnosis decreases survivability. “If you are diagnosed, you need to know all of your options and garner as much information as possible so you can make an intelligent decision along with your doctor on what the best plan of action and course of treatment would be,” said Barron. According to the Ovarian Cancer National Alliance, treatment options may include:
1 Surgically removing visible tumors
1 Chemotherapy to kill cancer peritoneal chemotherapy
1 Radiation therapy to kill cancer cells in the pelvic area
Few variables are within your control. “Women who take birth control pills can reduce their risk; eating healthy, exercising, and breastfeeding all help and childbearing is a good thing,” said Shirley. Being health-conscious and caring for your body is another great defense. “It has been suggested that talcum powder applied directly to the genital area or on sanitary napkins may be carcinogenic to the ovaries,” said Elissa McCrary, Central Georgia regional communications director for American Cancer Society. Studies hint that medication can be an ally when used wisely. Both aspirin and acetaminophen have been shown to reduce the risk but information is not consistent. Tubal ligation and hysterectomy are also noted as beneficial from a preventative standpoint. “The theory is that some cancer-causing substances may enter the body through the vagina and pass through the uterus and fallopian tubes to reach the ovaries,” said McCrary.
Women with a personal or family history of other cancers especially breast cancer are at higher risk. “With the obesity epidemic, more women are diagnosed with breast cancer and we are seeing that ovarian cancer is following along. It does not mean it is related to obesity; it means it is related to breast cancer,” said Makhija.
Do not think that you may be exempt from cancers because your ovaries were removed. “There is a cancer called peritoneal cancer from the surface lining of all the organs and there is a cancer that can develop from the peritenium that acts and is treated just like ovarian cancer,” said Makhija.
Research is underway. “We are looking to see if there could be more directed chemotherapy and we are taking information and what we have learned from other cancers and bringing it to ovarian cancer,” said Makhija. Some organizations are looking for markers based on genes but it is still a ways off. “Somewhere down the road there may be a test or a cure,” said Barron.