Ovarian Cancer “The Silent Killer” of Women

This cancer has been called the silent killer of women because it is generally not discovered until late in its course. Early detection increases survival as in all cancers. But it is especially true with this one. Only one woman in five is lucky enough to discover it before it spreads outside the ovaries. Of these women, over 90% will live five years or more. In women it is responsible for three per cent of all cancers but is the second most common among the gynecologic cancers. It causes the most deaths of the gynecologic cancers. In 2005, almost 20,000 new cases were diagnosed. Statistically, it occurs most commonly at age 55 and most often in post-menopausal women.

The symptoms are general in nature and common to various other diseases. There are no specific indicators of the disease. Bloating, abdominal fullness or swelling, weight gain or loss, painful intercourse or other simple digestive and bladder problems are observed. Changes in appetite, gas, fatigue, or menstrual changes can herald the disease. Consistent, continuing and progressive symptoms are of major significance.

Women with the BRCA 1 gene mutation (breast cancer gene) have a high rate of ovarian cancer. Ashkenazi Jews do also. Risk increase in post-menopausal women up to age 70. It appears that use of birth control pills and child bearing offer some protection, while infertility increases the risk. Obesity also enhances the risk.

A high level of suspicion is the best screening test. No simple blood test is diagnostic or helpful f as a general screen. A blood protein test (Ca 125) may be useful but is non-specific.

A thorough history and physical examination of the abdomen and pelvis by your doctor may find an abnormality. Tests such as an ultrasound, CT or MRI may be more definitive. If positive, then the cancer is staged by exploratory laparotomy. A surgeon will look into the abdomen and take tissue biopsies of any suspicious tissues. There are four stages: 1.The cancer remains isolated to the ovaries; 2. Spreads to pelvis; 3. abdominal involvement (most common); and, 4.Spread outside of the abdomen.

Surgical exploration and removal of all the female organs and debulking of the tumor is done by an oncological gynecologic surgeon. All tissue where the cancer is found is taken out if possible. After this, chemotherapy is used. New regimens are being studied. The intravenous use of Taxol and Paraplatin are currently used. Side effects can be extreme and some cannot tolerate the therapy. Direct injection into the abdomen via a catheter is also being used to increase success.

Early detection is paramount to survival in this disease. A high level of suspicion is the patient’s best defense followed by a good visit to your doctor for evaluation.