Ovarian cancer

September 17, 1999|By KATE COLEMAN


Are you listening?


* Vague but persistent gastrointestinal complaints such as gas, nausea and indigestion

* Frequency and/or urgency of urination

* Abnormal postmenopausal bleeding

* Unexplained change in bowel habits

* Pelvic and/or abdominal swelling and/or pain

* Bloating and/or a feeling of fullness

* Ongoing fatigue

* Pain during intercourse


* Weight gain or loss

* Leg pain

National Ovarian Cancer Coalition Inc. and American Cancer Society

Just the facts

* Risk increases with age and peaks in the eighth decade of life.

* Women who never had children are at higher risk.

* Pregnancy and oral contraceptives appear to reduce risk.

* Women who have had breast cancer or ovarian cancer or family history of either are at increased risk.

* Genetic mutations have been observed in some of those families. The mutations can be detected in genetic testing. Removal of the ovaries after childbearing can be a preventive option for those women.

- American Cancer Society

Ovarian cancer often has been called a "silent killer," because people believed that by the time a woman has symptoms, the disease has spread through her abdomen and beyond, according to information on the Web site of Gilda Radner Familial Ovarian Cancer Registry.

[cont. from lifestyle]

But it's not silent - it whispers, according to National Ovarian Cancer Coalition.

Many women fail to recognize the symptoms, says Dr. Barbara Goff, a gynecologic oncologist in Seattle.

The signs are subtle - abdominal pressure, bloating, pants too tight, increased or decreased frequency of bowel movements and increased frequency of urination, says Dr. Frederic H. Kass, director of John R. Marsh Cancer Center, in Hagerstown.

Rarely is there horrible pelvic pressure, he adds.

After being diagnosed with later-stage ovarian cancer, women recognize that they had symptoms, Kass says.

Shirley Grossnickle, 58, received her diagnosis five years ago. For at least a year before, she had bloating, backaches, fatigue, weight gain and difficulty breathing.

Her diagnosis came when fluid from her lungs tested positive for cancer. Then two large tumors - one grapefruit-sized and one nearly grapefruit-sized - were found on her ovaries. There also were several smaller tumors.

"If I had known then what I know now ...." she says.

Goff surveyed women with ovarian cancer to learn what symptoms they had prior to diagnosis, if any. Classically, doctors were taught that ovarian cancer presented no symptoms until it reached advanced stages.

Goff's survey was distributed to the mailing list of Conversations, a newsletter published by The International Ovarian Cancer Coalition, and Goff considers the number of responses - 1,725 - "phenomenal."

Although she emphasizes that results are preliminary, only 5 percent of the respondents reported that they were completely without symptoms.

Listen to the whisper

Ovarian cancer requires a high index of suspicion, Kass says.

"You have to be active in your own health care," says George Ann Blough, 53, of Hedgesville, W.Va. "Women know their bodies."

Two months after Blough had her annual gynecologic exam in June 1990, she felt bloated and had some bleeding, so she went back to her doctor.

A vaginal sonogram revealed a softball-sized tumor on her ovary.

Ovarian cancer is difficult to diagnose early, Kass says.

Women can feel for a lump in their breasts; they can't feel for a tumor on their ovaries, Goff says.

And while mammograms screen for breast cancer and PAP tests screen for cervical cancer, Kass says there is no good screening test for ovarian cancer.

Transvaginal ultrasound and the CA125 tumor marker, which is a blood test, may assist in diagnosis but are not recommended for routine screening, according to American Cancer Society.

Blough's initial CA125 test did not indicate the presence of cancer. A subsequent test did.

Because women's bodies are made to expand for childbirth, the abdomen can accommodate a large tumor, Kass and Goff say.

Pelvic and rectal exams should be done so your doctor can feel for tumors.

Also talk to your doctor about a vaginal sonogram, Kass recommends.

"Women need to be educated and insistent," Goff says.

Treatment always includes surgery, Kass says. One of the bright spots is that surgery is more aggressive, and newer chemotherapy drugs are getting better response rates, he says.

Early detection is important. There can be excellent results - 75 to 90 percent survival - if the cancer is confined to the ovaries, Kass says.

But about three-fourths of cases have spread beyond the ovaries, Kass says.

When should you see a gynecologist?

Make an appointment if symptoms are present for longer than a week, Kass recommends.

Even if your symptoms don't point to ovarian cancer, it's important to rule it out, Goff says.

"Women deserve that," she says.

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