Women diagnosed in the earliest stages of ovarian cancer—before the cancer has spread outside the ovary—have a 93 percent chance of surviving beyond five years. Not bad, right?
But here’s the problem: Less than 20 percent of all cases of ovarian cancer are detected early, because the disease has only subtle symptoms at first and tests can miss it in its nascent stages. As a result, ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system, including cervical cancer.
For the year 2009, the American Cancer Society estimates that 21,500 new cases of ovarian cancer were diagnosed, and 14,600 women died from it.
“We need to develop better risk assessment,” says Dr. Diljeet Singh, a gynecologic oncologist at Northwestern Memorial Hospital’s Lurie Cancer Center, and co-director of the Northwestern Ovarian Cancer Early Detection and Prevention Program.
The symptoms of ovarian cancer mimic those of other conditions, including irritable bowel syndrome (IBS) and depressive disorders. It’s common for a woman with ovarian cancer to be misdiagnosed and treated for several other conditions before her doctor decides to test for cancer.
So, what do you look for?
“Approximately 60 to 70 percent of women diagnosed with ovarian cancer present with advanced disease, primarily because there are no early warning signs,” says Dr. James Dolan, a gynecologic oncologist at Lutheran General Hospital in Park Ridge, adding that this is one of the biggest challenges in treating ovarian cancer.
However, there are things to watch for. One main indicator in recognizing possible ovarian cancer is that, unlike the symptoms of IB, symptoms associated with ovarian cancer are constant and gradually worsen.
The most common symptoms are:
- Abdominal pressure, fullness or swelling
- Urinary urgency and changes in bowel habits
- Pelvic discomfort or pain
Additional warming signs include:
- Persistent indigestion, gas or nausea
- Sudden loss of appetite
- Dyspareunia (pain during intercourse)
- A persistent lack of energy
- Low back pain
- Changes in menstruation
Barbara Wick, a Northfield resident and ovarian cancer survivor, says the most important thing women can do is “watch for the symptoms and act promptly if you have them.”
Because the symptoms are very subtle and often nonspecific, both Dolan and Singh stress the importance of noticing any irregularities or changes in your body.
“When there is something that feels different about your body, trust your instincts and see your doctor,” Singh adds.
The tests you should know about
The most common diagnostic tests include a physical and pelvic exam, blood tests, ultrasound and ovarian biopsy. These tests can help detect ovarian cancer, but it still may not show up if it’s in the early stages.
The “Ovarian Pap Test” is a new diagnostic test that is minimally invasive and can detect pre-cancerous or early cancerous changes on the ovaries.
Newer developments in diagnosis include blood tests, ultrasounds and PET scans (using radiologic markers for detection), but all are still currently in the research phase. As Dolan points out, there is no current “good, effective screening test that has a high degree of accuracy.”
And the treatment is…
The number one treatment for ovarian cancer is surgery; it’s the best way to target the cancer and remove all or most of it from the body. Biologics, anti-hormonal therapy and types of chemotherapy are secondary treatments. For women who are not healthy enough to have surgery, these are the first line of treatment.
Dolan reports that approximately 80 percent of women with ovarian cancer will achieve complete remission following surgery and the first line of chemo. Unfortunately, roughly half these women will relapse down the road. Wick, who was treated at the Kellogg Cancer Care Center at Evanston Hospital, prefers to look on the bright side.
“You do get through treatment, and your energy and strength and vitality return,” she says. “More and more of us are living more than the dire two years or even five years often predicted by doctors.”
A call to action
Singh’s goal is to empower women to be aware of how they are feeling and to recognize symptoms when they occur and not to brush them off as “normal” or “menopausal.” She says that every woman’s awareness of her own health is the most important step in ovarian cancer prevention.
Wick agrees: “You have to be your own advocate.”
10 tips for staying positive
The diagnosis is in, and you’re going to be fighting ovarian cancer. It’s not the end of the world, though it may feel like it, and a positive mental attitude goes a long way toward helping the healing. Ovarian cancer survivor Barbara Wick offers these tips that will help keep the positive energy flowing:
Keep a journal. It provides a sense of control, allows you to rid yourself of emotions and becomes a useful reference.
Each day find something to do that you enjoy, that brings you pleasure—and do it.
Give your friends the gift of accepting their offers of help.
Explore what are stress reducers for you and do at least one a day. Meditation, guided imagery, exercise, praying, journaling, walking, listening to music and so forth.
It is OK to get angry, frustrated and frightened—for awhile. Do that, for a defined amount of time, and then look at something that gives you pleasure and remember the joy of today.
Determination is essential. Grit your teeth and get on with it.
Make a list of projects you’ve intended to do, and then do them, one at a time.
Laugh, even if you have to force yourself to do it. Breakfast or lunch with girl friends is great.
Walk, stay physically active, especially when in treatment and awaiting test results.
Avoid negative, toxic, hand-wringing people.
The Risk Factors for Ovarian Cancer
The most pervasive genetic link to ovarian cancer is in women with the inherited mutation in breast cancer gene 1 (BCRA1), at 35-70 percnet high risk, and breast cancer gene 2 (BCRA2), at 10-30 percent higher risk.
Diet and exercise
Eating healthfully promotes health. Vitamin D deficiencies may increase risk for ovarian cancer, as well. There is a link between overweight individuals and more aggressive ovarian cancers. Maintaining a normal or ideal body weight decreases this risk.
Women under 65 do better with treatment and live longer than women over 65.
A link is suspected between the male hormone androgen (found in the medication Danazol and use to treat endometriosis) and increased risk for developing ovarian cancer.
Women who take the pill (with progesterone) for 5 or more years decrease their chances of getting ovarian cancer 30-50 percent. For each year of use, risk of ovarian cancer decreases 8-10 percent. Conversely, certain studies have suggested that women who take estrogen by itself (without progesterone) for 10 or more years may increase their risk of ovarian cancer.
Women who have never been pregnant are at increased risk for ovarian cancer.
Family or personal history of cancer
Women with an immediate family member with ovarian cancer have an increased risk of developing the cancer themselves and may also be at increased risk if an immediate family member has breast, uterine, colon or rectal cancer.
Make It Better articles:
When the Odds are Against You
Cancer Wellness Center
215 Revere Drive
Northbrook, IL 60062-1556
Chicago Ovarian Cancer Alliance
2258 North Lincoln Park, West #B2
Chicago, Illinois 60614
The Women’s Cancer Network
Gynecologic Cancer Foundation
230 W. Monroe, Suite 2528
Chicago, Illinois 60606
American Cancer Society
250 WIlliam Street
Atlanta, GA 30303
An international newsletter on ovarian cancer
200 First St. S.W.
Rochester, Minnesota 55905
National Cancer Institute
Booklet on ovarian cancer: http://www.cancer.gov/cancertopics/wyntk/ovary
National Ovarian Cancer Coalition
2501 Oak Lawn Avenue, Suite 435
Dallas, Texas, 75219
P.O. Box 12504
Arlington, Virginia 22219
Ovarian Cancer Journeys: Survivors Share Their Stories To Help Others
Ovarian Cancer: Your Guide to Taking Control (Patient-Centered Guides)
Kristine Conner and Lauren Langford