In the News
Making Efforts to Prevent Ovarian Cancer
by Julie Ohnemus, M.D., The Times-Standard, 9/12/06.
Ovarian cancer makes up 4 percent of all women's cancers, and yet is the fourth leading cause of cancer-related deaths among women in the United States. Last year, 22,000 new cases of ovarian cancer were diagnosed and more than 16,000 women died from this disease.
More than 70 percent of women diagnosed with ovarian cancer have advanced disease at the time of diagnosis, which results into a poor five-year survival rate of 20 to 30 percent. On the other hand, 90 percent of women diagnosed with early disease survive more than five years. Thus, early detection of ovarian cancer is essential for improved survival.
It's important to realize all women are at risk, and this risk increases with age and if you have not ever been pregnant. Risk factors include: genetic predisposition and a personal or family history of breast, ovarian or colon cancer, especially if it occurred at a younger age (less than 50).
Risk can be reduced with pregnancy, breast-feeding, and removal of one's ovaries. Usage of oral contraceptives greater than five years reduces the risk by 25 percent and for 10 years reduces the risk by 50 percent.
The delayed detection is partly due to a lack of clearly recognizable early symptoms. However, they do exist and though vague, do get worse over time. Symptoms include:
- Pelvic or abdominal pain or discomfort.
- Pelvic and/or abdominal swelling, bloating and/or feeling of fullness.
- Vague but persistent gastrointestinal upsets such as gas, nausea and indigestion.
- Frequency and/or urgency of urination in the absence of an infection.
- Unexplained changes in bowel habit.
- Pain with intercourse.
- Backaches.
- Unexplained weight gain or weight loss.
- Ongoing unusual fatigue.
Should such symptoms persist beyond two to three weeks, then you should see your medical provider.
The other major reason that ovarian cancer is detected so late is because there is no proven screening test. It's important to realize: The Pap test does not detect ovarian cancer. It determines cancer of the cervix. A preliminary report released in November 2005 from an ongoing study, the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, reiterated that currently available screening methods such as transvaginal ultrasound and testing for a protein biomarker called CA-125, alone or in combination, can detect ovarian cancer, but can also produce many false-positive test results, causing needless surgery. The study showed that of 570 women who had an abnormal test result in one or both screening tests 541 women underwent surgery but did not have cancer. It is obvious we need a better screening tool. There are ongoing studies to search out such a tool.
Treatment is dependent on disease stage. Initially one needs surgery to biopsy the mass, determine if the cancer has spread, and remove as much of the tumor as possible. Studies have clearly shown that if this surgery is performed by a gynecologic oncologist or someone with their skills and training, then the survival rate goes up. At this time we do not have a gynecologic oncologist on the North Coast, and therefore women must go outside the area for their diagnosis and surgery. Chemotherapy is given to women if the cancer has spread outside of the ovary.
In January, the National Cancer Institute announced a new recommendation for treatment of ovarian cancer that has spread into the abdomen (Stage 3). It involves the flooding of chemotherapy directly into the abdomen through a port or catheter. This is called "intra-peritoneal chemotherapy." Those who received this treatment survived on the average 16 more months than women who received their chemo through an IV in their arm. There were more short-term side effects, though they were manageable. This treatment is not yet available locally. Women need to seek it out in a larger medical center.
The bottom line: Listen to your body. If ovarian cancer is suspected, seek out surgical and treatment options with a gynecologic oncologist to determine the best mode of treatment. It may or may not be possible to get treatment locally.
For more information about ovarian cancer and other gynecologic cancers you may call the Humboldt Community Breast Health Project at 825-8345. The breast health project is a community resource of education, hope and support for women experiencing a breast health concern, breast cancer or gynecologic cancer. It's open to the public Monday through Friday from 9 a.m. to 2 p.m. Evening appointments can be made by special arrangement.
A gynecologic cancer support group meets the second and fourth Tuesdays of every month from 3 to 4:30 p.m. at the project's office at 987 Eighth St. in Arcata.
Dr. Julie Ohnemus is founder and medical consultant for the Humboldt Community Breast Health Project and medical director of North Country Clinic