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Ovarian Cancer Is Often Elusive
by Camey

Studies indicate that the more a woman ovulates, the greater the risk she will develop ovarian cancer. That is because when a woman ovulates, it ranks the lining of the ovaries, causing a breakage when an egg is released. This breakage stimulates inflammation, which in turn increases the risk of ovarian cancer. In contrast, the less a woman ovulates during her life span, the less likely she is to contract ovarian cancer. According to Dr. Nada Samah, a gynecologist at Harvard Pilgrim Health Care, one way to control ovulation and therefore decrease the chances of contracting ovarian cancer is to take birth control pills. Birth control pills have been proven to decrease the risk of ovarian cancer in those who take them. Although race is not a risk factor for ovarian cancer, age is. "The chances of contracting ovarian cancer gradually increases as a woman gets older, peaking in their 50s, when menopause typically occurs," Samah said. Other risk factors include never having had a child, experiencing a delayed pregnancy, having few children, having a family history of ovarian cancer, and having a history of using fertility drugs. The jury is still out on whether diet plays a role in the incidence of ovarian cancer. There is no evidence that changes in diet either increase or decrease the risk of getting ovarian cancer.

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Predicting ovarian cancer is still an inexact science, according to Dr. Samah. "We don't know what causes ovarian cancer. We know some women have a family history of ovarian cancer and women in those families are more prone to get it. But in general we have no clue. It happens to women with no family history." Complicating the matter is that ovarian cancer is very difficult to detect in the early stages. "Ovarian cancer is one of the hardest diagnoses to make," Dr. Samah said. "A lot of the symptoms relate to other diseases. By the time the diagnosis is made the cancer is too far advanced. Women do not generally have any symptoms until the center has progressed to the final stages." Even yearly checkups are no guarantee of avoiding ovarian cancer. "Even when a woman has yearly pelvic exams and the gynecologist gives her a clean bill of health, she can still develop a tumor before her next visit. An ovarian tumor can grow fast. By the time her next visit comes around, the tumor could be incurable." Samah nevertheless recommends annual checkups for most women, and twice yearly checkups for women with a family history of ovarian cancer. If ovarian cancer is suspected, Dr. Samah takes action immediately. "We go into the history of the patient, then follow with a pelvic exam. Our next step would be to obtain a pelvic ultrasound." The ultrasound enables the gynecologist to tell how large the tumor is, and whether it is benign or malignant. The ultrasound can also detect excess fluid around the ovary. The more fluid, the greater the chance the cancer has spread. The other ovary will also be checked, as usually more than 25 percent of ovarian cancers are bilateral.

Dr. Samah indicated that symptoms to look out for include pain in the lower abdomen, bloating, shortness of breath, weight loss, vaginal bleeding, indigestion, fluid in the stomach, clothes that feel tight, changes in bowel habits, and frequent urination. The most common complaint is pain related to the size or shape of the cancerous mass. Shortness of breath could indicate that the cancer has advanced and fluid has spread to the lungs. In the case of frequent urination, a test is made to see if the woman has a urinary tract infection. If the test comes back negative, then ovarian cancer is suspected. "We want to clean out as much of the cancer as possible. We look for spreading in the liver, gall bladder, kidneys and lymph nodes. If there is no evidence that the cancer has spread, chemotherapy may not be needed. If the cancer has spread, chemotherapy will be prescribed after surgery." Women who completed their childbearing years have their ovaries and uterus removed. "If there is evidence the cancer has spread, we de-bulk as much of the tumor as possible. If the cancer is too far advanced, we close the abdomen so the patient can have some quality of life. After surgery we go straight to chemotherapy in hopes the cancer will shrink, and give the patient some relief." Radiation is not used for 99 percent of ovarian cancer, as the cells are not radio sensitive. The only type of ovarian cancer that will adapt to radiation is where the ovarian cancer cells are very close to germ cells. All other ovarian cancers would be treated with chemotherapy. "Carboplatium and cytoxan are two standard chemo therapeutic regimens women receive. If cancer recurs, women who already had the maximum dosage of the two drugs have to discontinue them because of side effects. If a woman doesn't respond to those agents then the doctor goes to clinical trials, using newly developed chemical agents that have been tested on animals, other cancers, and passed these trials. If other drugs fail, the only other outlet for a woman with ovarian cancer is to try these drugs, to see if they will diminish the cancer."

After surgery, the patient returns home. Home health care is provided so she can stay in her home for as long as possible. This improves the patient's mental well-being. "It is most important to keep the patient comfortable. They are given pills by mouth as long as they are able to tolerate them. Then an IV is placed in their arm, they are hooked up to medication they can release whenever they have pain." A blood test called CA-125, not accurate in diagnosing ovarian cancer, works very well in the follow-up. A woman diagnosed with ovarian cancer will have this test performed during her post-surgery treatments. If the CA-125 blood test results are up, it is a sign the cancer has recurred.

In older women, there is a greater likelihood of malignancy, so a CAT scan is taken to check the surrounding organs. "We look for kidney involvement, liver involvement and stomach involvement. The lower GI studies check to see if the cancer has spread into the colon and other areas. IVP is taken to see if there is dilation in the kidneys or ducts."

Dr. Samah said that another side-effect of the cancer is little growths found outside the ovary, indicating the cancer mass has ruptured and leaked into surrounding tissues. The most common reason women die from ovarian cancer is that the tumor constricts bowel movement. Women with ovarian cancer are frequently nauseated and are unable to keep calories in their stomach. They lose weight, become very weak and are susceptible to infection. Dr. Samah said that she treats every situation with sensitivity. "I don't leave a message on the answering machine or with a family member. Instead I ask to have the patient call me. When she does I have her come in, then I go over the results with her. A woman doctor, like myself, who has gone through avenues other women have traveled, learns how to cope with emotions. I say to the patient that it is likely to be ovarian cancer. I never mention that it is 100 percent. I tell them I could be mistaken. Because I have known the patient for several weeks, I've had time to get acquainted with her, I can try to deal with her emotions. Women go through different stages when they learn they have ovarian cancer. The first stage is denial. They ask questions like, 'Are you sure? Can we do more tests? Are the pathologist's reports right?' After denial comes anger: 'Why did it have to happen to me?' Some women never leave the denial stage; others pass through it quickly and go on to the acceptance stage. They open up, talk about ovarian cancer, ask about surgery and treatments.... Women who have a small chance of survival ask, 'How am I going to feel after surgery? How long are chemo treatments? How much pain do I have to endure? How do I tell my family? What are my chances of survival?' When young women have ovarian cancer, it is even harder, especially when they have to make provisions for their younger children. They ask questions like, 'How do I explain to my children they will only have their mother for a short period of time? What do I tell them when they ask me why?' It's never an easy task."

Bio: Camey is listed in several Who’s Who publications, in USA and England. Some of her children’s stories have been published in The Advocate, a local newspaper. She is a nonfiction/fiction/song writer as well as a photographer, having won a local newspapers/Industry Magazine Editor’s Choice Award. You can visit her website here.

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