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Think teal? Early dectection key in fight against ovarian cancer


Carmen K. Sisson



Think pink. Thanks to a widespread awareness campaign, people have become more comfortable talking about breast cancer, from its symptoms to the importance of early detection through self-exams and annual mammograms.  


Ovarian cancer, though symbolized by a teal ribbon, has not yet reached the same level of media prominence and household familiarity -- partially because it is less common and partially because people aren't always comfortable discussing such an intimate part of the female anatomy.  


And yet, the American Cancer Society estimates 22,280 women will be diagnosed with ovarian cancer this year, and it will claim the lives of 15,500. While it is the ninth most common cancer among women, it is their fifth leading cause of cancer-related death, primarily because it is often not discovered until it has reached an advanced stage. 


Almost 70 percent of patients diagnosed with ovarian cancer will experience a recurrence. 






Symptoms are often vague, mimicking other diseases, and researchers have not been able to find a safe, effective screening mechanism that is sensitive and specific enough to detect this "silent killer." 


Women should be aware of changes, even slight, in their bodies and be vigilant in discussing those changes with their physicians, said Dr. Wail Alnus, a medical oncologist at Baptist Memorial Hospital-Golden Triangle.  


The problem is women may discount their symptoms, which can include bloating, abdominal aches, heartburn, feeling full quickly while eating, pelvic pain, back pain, abnormal vaginal bleeding, pain during sexual intercourse or frequent urination, constipation or diarrhea.  


"If a woman has even vague symptoms, she should get checked," Alnus said. "Most women will receive the diagnosis out of the blue, without any warning." 






The annual Pap smear is only effective in diagnosing cervical cancer, not ovarian. By the time a doctor detects ovarian cancer by pelvic exam or palpation, it has usually spread beyond the pelvis to the lymph nodes or abdominal lining, Alnus said. 


The Ovarian Cancer National Alliance reports 62 percent of ovarian cancer cases are found at this stage, which carries only a 28.2 percent five-year survival rate. If caught early, while the cancer is limited to the ovaries, 93.8 percent of women will survive. But only 15 percent of cases are caught at stage one and only 17 percent at stage two.  


"Women should be aware that ovarian cancer is a significant incident, and while we have a good treatment for it, we unfortunately always detect it at stage three or sometimes stage two," Alnus said Friday. "At stage three, we see some cures, but a lot of times it recurs, and it can be treated for several years but not cured. If we catch it early, it can be curable." 


But even though the Pap smear doesn't detect ovarian cancer and pelvic palpations are rarely definitive, they're still a critical part of a woman's overall health care and shouldn't be skipped, said Amanda Mordecai, oncology nurse navigator at BMH-GT. Women should begin having a yearly Pap smear and pelvic exam when they turn 18 or as soon as they become sexually active.  


And it's still important, even after menopause, she said. The majority of women who are diagnosed with ovarian cancer, 23.1 percent, are diagnosed between the ages of 55 and 64; 19.7 percent are diagnosed between 65 and 74; 19.1 percent between 45 and 54; and 18.2 percent between 75 and 84. Eight percent of women 85 and older will be diagnosed.  


Those in their 20s and 30s -- and younger -- also can have ovarian cancer, though the incidences are more rare. Between the ages of 35 and 44, 7.3 percent of women will be diagnosed, while 3.5 percent of women between 25 and 34 will be diagnosed. Approximately 1.2 percent of women 20 years old and younger are diagnosed with ovarian cancer.  


Alnus said CAT scans will show ovarian masses and suspicious spots in the pelvis, but frequent CAT scans are discouraged due to risks associated with radiation exposure. Pelvic and transvaginal ultrasounds can also detect it, but they may show abnormalities, causing women to undergo unnecessary, invasive procedures.  


"It's not easy to find a screening," he said. "It must be very accurate, very safe, sensitive and specific without catching benign problems." 




Risk factors  


A woman may be at high risk for developing ovarian cancer and yet never get it, but the Centers for Disease Control and Prevention suggests women remain extra-vigilant if they have one or more risk factors associated with the disease. 


Women who have had breast, uterine, endometrial or colorectal cancer, as well as those who have close family members on either side diagnosed with ovarian cancer, are at increased risk. About 10 to 15 percent of women who are diagnosed have a hereditary tendency, and five to 10 percent have an inherited genetic mutation of breast cancer gene 1 or 2 (BRCA1 or BRCA2). 


Women who begin menstruating before the age of 12, have not given birth, have never taken oral contraceptives, had their first child after age 30, experienced menopause after age 50 or did not take hormones afterward, are also at risk. 


Researchers believe obesity may also play a factor. 




What can be done? 


Women in the Golden Triangle who are diagnosed with ovarian cancer are typically referred to Jackson or Memphis to see a gynecological oncologist, who may perform surgery. Chemotherapy treatments are offered at BMH-GT. 


Hysterectomy is not usually recommended as a preventative for healthy women who have no family history or medical problems which warrant it, Alnus said, though researchers at the Gynecologic Cancer Foundation believe tubal litigation, hysterectomy or removal of the ovaries may reduce the risk of developing ovarian cancer. 


Still, the best defense may be a good offense. 


"Report symptoms, even if they're vague," Alnus said. "We've made a lot of progress with surgery and chemotherapy, and we continue to make improvements. We're still waiting for better ways of catching it early and curing it. There are good treatments, but most of the time we catch it at later stages." 


And though they may not be fun, and they may not detect ovarian cancer at its early stages, annual Pap smears, pelvic exams and mammograms are an important part of a woman's health.  


"Women need to see their gynecologist," Mordecai said. "They should plan it as kind of a gift to themselves, maybe the month of their birthday. We spend lots of money on our appearance and we need to spend money on staying healthy, too." 


Statistics provided by the Centers for Disease Control and Prevention, American Cancer Society, Ovarian Cancer National Alliance and the National Cancer Institute.


Carmen K. Sisson is the former news editor at The Dispatch.



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