A few years ago I was asked if I knew what the most deadly gynecologic cancer was and I answered “Well, breast cancer of course.” Oh, how I was wrong. The American Cancer Society estimates that the average five year survival rate of breast cancer at any stage to actually be 89 percent. While no cancer is good that’s a pretty good rate. The correct answer to the question is ovarian cancer, and its five year survival rate (estimated by the American cancer society) is only 46 percent. We need to find out why this cancer is so deadly.
Cancer is a dangerous and mysterious thing to people that don’t know much about it. Well, everyone is made up of cells, cells are what make up tissue and tissue is what makes up our organs. Normally when a cell gets old and tired it dies just like we do and a new cell takes its place. Our body produces these new cells by growing and dividing healthy cells. Sometimes our body overproduces cells and this is when tumors (mass of tissue) are formed. These tumors aren’t always cancer; when they are not they are called benign tumors. When they are cancer they are call malignant; these are the ones that can be life-threatening. Both types of tumors can be removed but the cancerous ones are more likely to grow back and only they also can spread to different parts of your body. When this happens the cancer cells are breaking away from the original tumor and entering the blood stream to use it like a highway to travel around your body. When the cancer cells spread like this it’s called metastasis and the cancer can start to go new tumors. If these cells reach any of your organs and start to go new tumors and this is when damage can be done.
They call it ovarian cancer because the tumor first starts at the ovaries and is made up of over productive ovarian cells. The ovaries are part of the women’s reproductive system and are attached to the uterus by the fallopian tubes. When a malignant tumor starts to grow these areas can also be affected because of their close proximity to the ovaries. When this tumor starts to shed cancer cells the cells typically go to the abdomen first because it’s closest to where the reproductive system is located. Then as I said before the cancerous cells can start to affect your lymph nodes and enter your blood stream to travel to different organs.
Ovarian cancer is so deadly because it’s very hard to detect. Every year more than 14,600 women die from ovarian cancer in the United States. This may not seem like a lot when you think of all the billion people that live here but when about 20,000 women are diagnosed with ovarian cancer each year that number seems like a lot. So this means that on average 7 out of 10 women will die from this disease and this is all because it is so hard to detect. In order to detect it you have to know what the symptoms are. The most common symptoms are pain in the abdomen, pelvis, back or legs because of where the cancer is located in your body. You can also have a swollen or bloated abdomen because it can fill up with fluids. You will also feel very tired all the time and would have some nausea, indigestion, gas, constipation, or even diarrhea. Some less common symptoms would be shortness of breath, the urge to urinate often, and unusual vaginal bleeding. Now these are pretty general symptoms and many other disease or illnesses can cause them and that’s why it’s so hard to detect because ovarian cancer is not typical the very first thing we think of when we have one or more of these symptoms.
Most women would think if there was a problem that it would show up on their Pap test which is a once yearly screening that women get from their doctor. However, a Pap test is only screening for cervical cancer and it cannot be used to diagnose ovarian cancer. When women do go in to your doctor for the Pap test he or she should be doing a pelvic exam as well, during this they will feel your ovaries and organs in close proximity for any lumps or changes in shape and/or size. More often than not the doctors will not be able to feel a tumor until they are a substantial size. This is why we look to other testing as well as the pelvic exam to diagnose this cancer. If women who have abdominal bloating or pain and would go to the doctor, they may check your abdomen for fluid buildup. If they some find some a sample can be taken to test for ovarian cancer cells as part of the diagnoses. There is also blood testing where your doctor would check your CA-125 level to see if it is high. The CA-125 is a substance that is found on the surface of the ovarian cancer cells but also on some normal tissue, this is why a high level might indicate cancer. Unfortunately this test cannot be used as the only test for diagnosing ovarian cancer.
It is mainly used for monitoring a woman that has already been diagnosed and is going through treatment or as an early detection for the return of cancer after treatment has been completed. The next way to get diagnosed is by having an ultrasound done. There are two different types of ultrasounds that can be done; the first is the less invasive of the two. This is where they take the ultrasound device and press it up against your abdomen and the sound waves that it produces bounce off the organs to produce a picture for us to see. By using this they would be able to get a picture of the ovaries to see if there was a tumor or any abnormalities. The second type of ultrasound they can do is a transvaginal ultrasound and it does the same things as the regular one however this device is inserted into the vagina for a much better view of the ovaries. The last test to help diagnose this cancer is a biopsy. They will only do a biopsy if blood test and one of the ultrasounds have indicated that there may be a tumor. A biopsy is when they take a sample of tissue or fluid to look for cancer cells. Once they biopsy has been done a pathologist will look as the sample under a microscope for any cancer cells. If there are some found then they will be described as either grade 1, 2, or 3 and this is based off of how abnormal the cells look.
Once the doctors have determined that there are cancer cells present they have to determine what stage the disease is in before they can start any treatment. In order to find out what stage the cancer is in the doctor must know grade the tumor is which we discussed earlier and they also may need to run a series of more test such as a CT scan or a chest x-ray. The CT scan is where they would give you some contrast material and the machine would then take several pictures to get a clearer picture of your pelvis and abdomen to see any tumors or abdominal fluid. The chest x-ray is used to see if the cancer has spread to your lungs and if there is any fluid buildup there as well.
There are four stages of ovarian cancer; the first stage is called stage 1. Stage 1 is where cancer cells can be found on one or both ovaries or in abdominal fluid. Only 15 percent of the total women diagnosed have stage 1 and they have a 5 year survival rate of 93.8 percent (statistics). Stage 2 is where the cancer has spread to other reproductive organs such as the fallopian tubes and the uterus. It can also be found in abdominal fluid as well as other tissue in the pelvis area. The 5 year survival rate for stage 2 is 72.8 percent and only 17 percent of women diagnosed have this stage. Stage 3 is where the cancer has spread to the lymph nodes and can be also found on the outside of the liver. This is the most common stage that women are diagnosed (62 percent) with only a 28.2 percent survival rate or 5 years (statistics). The last stage is stage 4 and this is when the cancer can be found in the lungs or in any other organs. So, at this point it has traveled out of both the pelvic and abdominal areas. This has the lowest survival rate of 27.3 percent and the lowest percent of women diagnosed at 7 percent (statistics).
Once the doctor has determined what stage you are in you can start treatment accordingly. Most women will have surgery to remove cancer cells and also both ovaries and fallopian tubes, your uterus, any nearby lymph nodes, as well as the omentum which is a thin fat pad that covers the intestines. If you only have stage 1 sometimes the doctors will leave the uterus intact and only take one ovary and fallopian tube but this depends on your age and whether or not you would like to become pregnant and have children. If the cancer is one of the other stages (2, 3 or 4) then they might have to go in further and remove as much cancer as they possibly can.
They can also do chemotherapy as a form of treatment. This is when “anticancer” drugs are given to kill the cancerous cell. The drugs can be given by either inserting them into the vein (IV), intraperitoneal (IP) which is given directly into the abdomen through a very thin tube, or by mouth via pill form (ovarian cancer 13). The side effects to the chemotherapy can be hair loss, vomiting, and diarrhea. This is because the drugs also harm normal cells, so it can damage your hair cells (hair loss) and the cells that line your digestive tract (vomiting and diarrhea) but it can also damage your blood cells and make your body bruise easier and you would be more susceptible to get infections because your blood cells are what help fight infections off.
As of right now we cannot explain why one women may develop this cancer and another will not but there are some women that are at higher risk. If you have any women in your family that has had ovarian cancer, specifically your mother, daughter, or sister you or a family member are at a higher risk. But, also if you or any other family members have had uterus, colon, rectum, or breast cancer you or a family member will be at a higher risk. Most women that are diagnosed with this disease are over the age of 55 and have never been pregnant. If you or a family member is at an increase risk you want to talk to your family member to make sure they are aware of these risks. Then I would encourage those at risk people to consult your doctor and see if anything can be done to make sure if you would so some signs of cancer, it could be detected early.
They may recommend genetic testing to see if you have a certain mutation of the BRCA 1 or BRCA 2 gene which has been linked to ovarian cancer and breast cancer. If you go and have this testing done you will have to provide a detailed family history and also give a blood sample. They will test they blood for mutations in your DNA, specifically looking at your BRCA 1 and 2 genes. When you get the results back they will let you know if they found a mutation and if they did you know that you for sure are at an increase risk. If they don’t find a mutation they will still put you into an at risk category based on your family history. This testing has been very important in determining the links between certain mutations and ovarian cancer. The more data we can collect the better off we are on finding a connection.
The most important thing to remember is that this is the most deadly gynecologic cancer with very nonspecific symptoms, 15,000 women die from this cancer every year. If you or anyone you know are having any of these symptoms you should talk to them and encourage them to contact their doctor in hopes of early detection. The earlier the detection the better chances you or a family member has of not becoming one of the 15,000.