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SYMPTOMS Following are some symptoms of early stage ovarian cancer: - Pelvic or abdominal cramping, swelling or pain - Persistent gastrointestinal problems - Nausea, indigestion, constipation, diarrhea - Gas, bloating, a feeling of fullness - Urgency or frequency to urinate - Menstrual disorders - Unexplained weight gain or loss - Pain during intercourse - Leg pain - Ongoing fatigue and backaches While most women have these symptoms from time to time, see a doctor and ask about ovarian cancer if any of these symptoms last more than two to three weeks. SOURCE: Ovarian Cancer Alliance of Nevada Related Story: Ovarian cancer patient forms organization to warn, inform women about deadly disease

Monday, September 10, 2001
Copyright © Las Vegas Review-Journal

LIFE AND DEATH: Furtive Killer

Ovarian cancer deadly because it is difficult to detect at early stage

Crispin Morrison knew something was wrong -- knew it for two years, in fact.

Living in Seattle at the time, she had abdominal bloating, a feeling of fullness, extreme fatigue, a low-grade fever, a litany of changes in her bowel habits.

Not one to wait for a problem to scuttle back into the shadows, she saw her physicians and told them of her concern.

"I had no idea how serious my illness was," she said.

Neither, apparently, did they.

"I was told that I was too young to have anything seriously wrong with me," Morrison said. Don't worry, they said; work on improving that diet, get more exercise, maybe see a therapist and try some anti-depressants.

Then, in May 1999, Morrison noticed a lump in her pelvis.

"It seemed like it was not there one day, and the next morning it was there," she said. "It was a shock."

Back to the doctor. Immediately, she was sent to a gynecologic oncologist. Diagnosis: ovarian cancer. Morrison was 37 years old. Her cancer was in Stage III.

It's now in Stage IV. The cancer that started in her abdomen has metastasized to her neck.

"I will never go into remission," said Morrison, who's now 40 and a resident of Las Vegas, having moved here to live with her parents when she was told she'd need surgery.

"I don't consider myself a statistic. I know that I am an individual and I know that it's possible that the statistics will not apply to me. However, I am also a very educated patient, and I know there is little chance I will ever beat this disease and outlive the five-year survival rate."

The statistics that surround ovarian cancer are daunting.

"It ranks second among all gynecological cancers, with more deaths than any other reproductive cancer," said Tricia Leland, program director for the American Cancer Society.

In the scheme of things, ovarian cancer may not seem to rank as high on the fear-factor scale as some.

"When you look at the list of cancers that take the lives of women in the United States, ovarian cancer is No. 4," said Dr. Mark Turner, director of the division of gynecologic oncology and pelvic reconstructive surgery at University Medical Center.

"The most common cancer that women die from is lung cancer," Turner said. "Breast cancer is No. 2; it used to be No. 1, until women started smoking. Colo-rectal cancer is No. 3."

But ovarian cancer is, as Morrison said, particularly "vicious."

"About 12 women out of every 1,000 will develop an ovarian cancer at some point in their lifetimes," Turner said. "Only two or three of those women will achieve a cure," which means going five years without signs of the disease.

"The problem that we have with it is that it's almost invariably found in the later stages," he said. "It is very rare to encounter a Stage I ovarian cancer."

According to the National Cancer Institute, the stages of ovarian cancer are as follows:

• Stage I: Cancer is found in one or both ovaries.

• Stage II: The cancer has spread to the uterus and/or the fallopian tubes and/or other body parts within the pelvis.

• Stage III: The cancer has spread to the lymph nodes or to other body parts within the abdomen, such as the surface of the liver or intestine.

• Stage IV: The cancer has spread outside the abdomen or to the inside of the liver.

If it's caught in Stage I, Turner said the five-year survival rate is about 80 percent. By Stage III, however, there's about a 30 percent chance they'll be alive five years after treatment.

Turner said because the symptoms of ovarian cancer are so vague, when Stage I ovarian cancer is detected, it's usually because the patient was undergoing a hysterectomy for another reason.

Turner said the most common symptom is distention caused by fluid in the abdomen.

"And we're talking liters -- 5 to 10 liters in their belly," he said. "They're not eating well, have lost their appetite. All of those kinds of things that are really general, nonspecific kinds of complaints. Most of us hope that if we wait long enough, they'll go away on their own."

The fluid buildup, however, should be a tip-off for most people. Five to 10 liters is roughly 2 1/4 to 4 1/2 gallons.

"They really look quite distended," Turner said. "They don't look right. And it's a fairly abrupt change."

A family history of ovarian cancer also will raise a flag of caution, but Turner said genetic testing remains inconclusive.

"Instead, if you have two family members that are really close in the family tree to you, both of those women having had cancer of the ovary, then we encourage those women to have their ovaries out when they're through with childbearing," Turner said.

But even that's no guarantee: "Something along the line of 14 percent of the women who'd had their ovaries removed developed a cancer that would be indistinguishable from ovarian cancer" elsewhere in the abdomen.

"The question is are we dealing with something that we find in late stages because it erupts all over the place, or is it ovarian cancer that we just have a hard time identifying and it grows rapidly? We don't have good information on that."

There is one factor that may reduce the risk of ovarian cancer.

"Women who have been on oral contraceptives between six and 10 years over the course of their lives appear to reduce their chance of developing ovarian cancer about 60 percent," he said.

Of course, the extra estrogen exposure may be linked to an increased risk of breast cancer.

"Nothing comes free," Turner said.

The answer?

"Get your yearly exam," he said. And when there's "a persistent source of gynecological complaints, don't wait until you have 9 liters."

Morrison, as well, stressed the importance of exams, and said to be sure your physician is performing a rectal exam as well.

"Unless they're doing a rectal and a pelvic, they're not going to be able to feel the ovary really good," she said.

And if a woman suspects she has ovarian cancer and has the symptoms and the risk factors, Morrison suggests insisting on a blood tumor marker -- a CA125 -- and a transvaginal ultrasound.

"Those two tests, while not 100 percent accurate, can help diagnose or rule out ovarian cancer," she said. "Unfortunately, most doctors resist doing those two tests," partly because of a fear that a false positive will lead to unnecessary abdominal surgery.

"But the only way things will change with ovarian cancer is if women insist, `This is my body and I will be the one to decide,' " she said.

"When I speak to groups, they have an idea that, well, there are no symptoms so there's no way to diagnose it in early stage and we're pretty powerless to do anything about it.

"There are symptoms; there are specific symptoms, and the only way to reduce the rate of late-stage diagnosis is to pay attention to your body and insist that your doctor take your symptoms seriously."