No Longer The Silent Killer

Susan Griffin reports on the battle to diagnose ovarian cancer, with advice on symptoms you can look for...

Do you know the warning signs of ovarian cancer? Have you heard about ovarian cancer support groups or seen adverts on ways to raise funds for research into the disease? Probably not. Over the last 20 years, people have become pretty well informed about breast cancer and lung cancer thanks to aggressive campaigns.But ovarian cancer, which affects almost 7,000 British women every year, remains a relative mystery.

Each week around 100 women die from this disease, the fourth most common cancer and the biggest gynaecological killer. As with many other types of cancer, the outcome depends on how far advanced the cancer is when it is diagnosed. Most women are not diagnosed with ovarian cancer until the cancer has already spread beyond the ovaries. This makes it much more difficult to treat successfully, with five year survival rates around 30 per cent.

Professor Patrick Johnston, an expert in ovarian cancer at Queen's University in Belfast, says: "Ovarian cancer is a significant problem for the female population in the UK. One of the major problems with ovarian cancer is that it's insidious - it's a difficult tumour to diagnose, which is one of the reasons why the majority of patients are diagnosed at a later stage."

Once known as the 'silent killer', new research by the American Medical Association has found that 90 per cent of women do experience symptoms, even in the early stages. When detected at this early stage, five-year survival rates can be as high 90 per cent.

"The message from Ovarian Cancer Action is loud and clear. "Until there's a test awareness is best. Listen to your body and seek advice if you're concerned."

Jill Davis, from Ovarian Cancer Action, the only national charity funding research exclusively into the disease, says: "We're hoping to dispel the myth that there are no symptoms for ovarian cancer. UK survival rates are amongst the lowest in the developed world. We want to improve the UK statistics through advising women on what to look out for."

Symptoms can be vague and are similar to more common, mild and benign conditions. Women may experience an increase in abdominal size, a feeling of 'fullness,' unexplained back or abdominal pain or fatigue.

Professor Johnston says: "It is important to seek advice from your GP if you have a sudden on-set, frequently recurring or numerous symptoms and if treatment for other conditions does not work."

Certain risk factors have been identified for the most prevalent form of ovarian cancer, known as epithelial, which affects the surface of the ovary. As with most cancers, the risk of developing the disease increases with age as the majority of cases occur in women over 40. The risk of ovarian cancer may also be increased by family history and about 10 per cent of cases are due toan inherited faulty gene. If two or more close relatives on one side of your family have a history of ovarian or breast cancer, particularly below the age of 50, the risk of developing the disease is also heightened. Many risks factors seem to be related to the working of the ovaries. When one of the ovaries produces an egg, the surface layer covering the ovary bursts to release it. The more eggs produced during a lifetime, the more cells need to divide and so the more opportunity there is for things to go wrong.

For this reason, women who have not had children, not breastfed, started their periods early or their menopause late, are deemed to be at slightly higher risk.

So far, there is no reliable screening tool for ovarian cancer, like the smear test for cervical cancer or the mammogram for breast cancer. Ovarian Cancer Action reports that there is currently a blood test to measure CA125 levels plus an ultrasound scan, which can be used to screen women thought to be high-risk. But a number of less serious conditions can affect CA125 levels and whilst it is good at indicating a recurrence of ovarian cancer, it nay not be as dependable at diagnosing the disease at an early stage.

According to the organisation CancerBACUP, 25 other research trials are being carried out around the world to see whether ovarian cancer can be detected early. But ultimately, until a reliable screening programme is developed, awareness will continue to play a vital role for women.

The message from Ovarian Cancer Action is loud and clear. "Until there's a test awareness is best. Listen to your body and seek advice if you're concerned."

For information, advice or support for those affected by ovarian cancer:

Ovarian Cancer Action
Bush House,
The Waterfront Elstree Road,
Elstree
Hertfordshire
WD6 3BS
www.ovarian.org.uk
0208 238 7605

CancerBACUP www.cancerbacup.org.uk 0808 800 1234 (freephone)

Ovacome www.ovacome.org.uk 0207 380 9589 Mon-Fri 9am-4pm

Case study
Modern & Mature reader Valerie Jerwood, 53, from New Barnet, Hertfordshire shares her experience of overcoming ovarian cancer...

January 2004. A New Year! Little did know what was in store for me. I was 52; I was going through the menopause with irregular periods, experiencing a few aches and pains and some hot flushes; nothing untoward for someone of my age. My life followed its normal routine for the first three months and in March, my husband and I went on our annual ski holiday.

I hit the slopes with my usual verve but during the holiday, I started one of my irregular periods, which persisted on and off. On my return I went to the GP to get it checked out but even though I was also experiencing some pain in my lower left abdomen, nothing resulted. By the end of April, I had a general feeling of indigestion and feeling 'full', pains throughout my stomach area and in my lower abdomen and continued bleeding. After a further examination, I was sent for a scan and blood tests. The radiologist discovered an enlarged left ovary and congratulated me on not ignoring my symptoms. She couldn't tell me what was causing the enlargement but said I would have to see a specialist. The letter notifying me of my appointment was marked CA 125, which I knew from reading articles was a test for ovarian cancer. At my appointment, I was told my ovary was 6cm in diameter and investigative surgery was the only option. The best-case scenario would be removal of the ovary but I felt strangely relieved to be told it was likely to be cancer.

July12th....surgery. In the evening I was told that cancer had been found but because of the effect of the anaesthetic I didn't really take it on board. The next morning I faced up to the reality of my diagnosis and to the extent of my surgery; a hysterectomy, removal of lymph glands, removal of a membrane in the abdomen and an appendectomy! My cancer was diagnosed as early stage 3, which I was told is as good as it gets for this disease. The surgery had gone well but I still had to undergo six doses of chemotherapy to mop up any remaining microscopic calls. It was a strange feeling watching what was effectively poison seeping into my body. I experienced various aches and pains, tingling in my toes, and I lost my hair, but fortunately I got through the whole course without too much suffering. On August 16th I had a scan, the results of which came back clear. On November 23rd, I had my last dose of chemo. I was told I had responded well to the treatment and I take great comfort in that.

I can't quite believe that I have had cancer. When I was diagnosed I decided to meet it head on. I feel I remained positive and strong from the outset apart from a few wobbly days. I had always been fit and firmly believe that my fitness helped me recover from the surgery and cope with the chemo; it also may have helped me realise that all was not right with my body back in April. I'm not sure I could have recognised symptoms any earlier, but then I wasn't really looking out for such symptoms.

Almost a year to the day I was back on the ski slopes, albeit at a slightly reduced speed, but I was elated to be in the mountains again. Eighteen months down the road, I feel as if I am almost back to normal.

SYMPTOMS:
Consult your doctor if you have sudden on-set, frequently occurring or numerous symptoms such as:

• Constantly swollen abdomen
• Increased urinary urgency
• Unexplained back or abdominal pain
• Abnormal vaginal bleeding
• Feeling full/bloated
• Changes in bowel patterns
• Ongoing excessive fatigue
• Onset of unexplainable indigestion or nausea