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Ovarian Cancer: Hope for Early Detection
by Karen Reed Matthee

The “silent killer,” the “disease that whispers,’’ call it what you will, ovarian cancer is the deadliest of all gynecologic cancers. Its symptoms are subtle and easily confused with those of other less-serious ailments and, as a result, it often goes undetected until it has reached an advanced stage and is extremely difficult to cure. This year in the US, about 20,000 women will be diagnosed with ovarian cancer, and 15,000 will die from the disease.
When ovarian cancer is caught early — which happens in only 19 percent of all cases nationwide — the survival rate increases dramatically. About 94 percent of patients with an early diagnosis survive at least five years after treatment. As yet there is no test to catch
ovarian cancer before it spreads beyond the ovaries, not like a Pap test to check for cervical cancer or a mammogram to screen for breast cancer. But progress is being made in that direction.

Researchers at the University of South Florida/H. Lee Moffitt Cancer Center in Tampa, Florida, may have hit on a reliable way to detect ovarian cancer that simply involves asking a patient to pee into a cup. Patricia Kruk, Ph.D., a cell molecular biologist, says she and her team studied the levels of a protein called BCL-2 in urine samples from women with and without ovarian cancer. BCL-2 levels were 10 times greater in the urine of women with ovarian cancer, regardless of how far the disease had progressed.

“I think that’s really exciting,” Kruk says. “The age, type, size didn’t seem to matter. The test seemed to pick up all ovarian cancers.” And the results, she adds, were more than 90 percent accurate. CA-125, a test for a protein that is detectable in 80 percent of advanced-stage patients with ovarian cancer, is currently the only FDA-approved test to monitor for recurrence, but it is not able to reliably diagnose women who have no signs of ovarian cancer.

Kruk says additional funding is needed to expand the BCL-2 pilot study to a larger clinical trial. She presented her findings recently in Seattle at a symposium on ovarian cancer sponsored by the Marsha Rivkin Center for Ovarian Cancer Research and Swedish Medical Center.

In Seattle, a team of researchers coordinated through Fred Hutchinson Cancer Research Center are working to identify the best biomarkers to date for ovarian cancer to determine if a certain combination of markers can provide a reliable screening test. A biomarker, such as CA-125, is a substance sometimes found in the blood, other body fluids, or tissues, and a high level of biomarker may indicate the presence of a certain type of cancer.

“What really matters is can any marker pick up [ovarian] cancers a year or two before the cancer is diagnosed?,” asks Dr. Nicole Urban, head of gynecologic cancer research at the Fred Hutchinson Cancer Research Center and a lead investigator of the Seattle ovarian cancer research team effort. The goal, she adds, is to find the right formula to do just that. Urban participated in earlier research that resulted in an ovarian cancer test based on a marker known as HE4. While HE4 is far less likely than CA-125 to pick up benign ovarian conditions that can lead to unneeded surgeries, the marker on its own may not detect all ovarian cancers.

So while we wait for a sure-fire screening test to become available, what can women do in the meantime to guard against ovarian cancer? One of the most important things we can do is listen to our bodies, says Dr. Barbara Goff, a gynecologic oncologist and professor of obstetrics and gynecology at the University of Washington. Goff is the lead author of a study that examined symptoms reported repeatedly by ovarian cancer patients. The study found that women eventually diagnosed with early-stage ovarian cancer experienced a variety of abdominal symptoms more severely, more often and with more recent onsets than women without the disease.

“The key is not to scare people,” says Goff, noting that these symptoms affect most if not all women at one time or another, and are often associated with menstruation. However, when one or more of the symptoms is new and persists for more than three weeks, it’s time to check in with a physician, she says. If symptoms point to the possibility of ovarian cancer, Goff says, a pelvic/rectal exam is in order, followed by a transvaginal ultrasound should abnormalities be detected. If ovarian cancer is strongly suspected based on these results, the patient should seek the care of a specialist, she advises. “Ovarian cancer survival rates are substantially higher when treated by a gynecologic cancer surgeon.” Goff recommends visiting the Women’s Cancer Network Web site at www.wcn.org for a complete list of symptoms and other information about ovarian cancer.

Dr. M. Robyn Andersen, an epidemiologist with Fred Hutchinson, has been working with Goff toward the development of an ovarian cancer symptoms index to help doctors recognize the disease sooner. “We acquired new data, did more analysis,” she says. “We want to confirm and further refine the results of Dr. Goff’s prior study.” Based on surveys of three groups — women with ovarian cancer, those without ovarian cancer but referred for ultrasound screening, and women considered high risk due to a family history of the disease — six symptoms in particular appear to be the strongest predictors of ovarian cancer when they are new for the patient and occur frequently (13-plus days a month). Those symptoms are pelvic and/or abdominal pain, feeling full, difficulty eating, bloating, and increased abdominal size.

“We found that by using these symptoms we could identify 56 percent of women with early-stage ovarian cancer and 79.5 percent of women in advanced stages,” Andersen says. “These were the symptoms that were reported most often and reported very frequently by women with ovarian cancer.” These symptoms, she notes, should be more recognizable to women in the age group most affected by ovarian cancer — generally 50 to 60 — because, while common in younger women, they usually subside along with a decline in menstruation. “These kinds of abnormal symptoms are not part of normal aging after menopause. Women shouldn’t expect a lot of this kind of stuff in the fifties and sixties.”

“Women really need to pay attention to what’s going on with their bodies,” agrees Sandra Moon, a seven-year ovarian cancer survivor. “If they become suddenly ill, if a doctor gives them an antibiotic for a supposed infection and it doesn’t clear up in a couple of days, they need to be persistent about finding out what’s wrong.”

Moon believes so strongly that knowledge is power when it comes to ovarian cancer that she volunteers with a program called Survivors Teaching Students. She and other ovarian cancer survivors talk with third-year medical students on gynecology rotations about the symptoms they experienced prior to being diagnosed with the disease.

Her symptoms began two months before she was diagnosed in June 1999 with early-stage ovarian cancer and included abdominal discomfort, bowel problems, indigestion, loss of appetite, an expanded waistline despite weight loss, back and abdominal pain, and shortness of breath. New symptoms appeared, some worsened and some went away as the weeks wore on.

The doctors Moon saw, first at a walk-in facility then at a clinic in Everett, treated her for diarrhea and prescribed antibiotics for what they thought were first bladder, then kidney infections. One doctor suspected she had irritable bowel syndrome. “I was getting tired,” Moon recalls. “I couldn’t even button my pants and my waistline was continuing to expand. By Memorial Day I was feeling really bad.”

Finally, when she sought treatment for a swollen ankle, a blood clot was detected in her left leg and she was given anti-inflammatory medication. Her legs continued to feel “achy and leaden,” and during a follow-up visit, not only were clots found in both legs, a large ovarian tumor was also discovered. She had surgery to remove the malignant tumor, followed by chemotherapy. “I didn’t understand,” Moon says. “I had a normal pelvic in January and my ovaries were nice and small. Then I’m diagnosed with a tumor that turns out be the size of a small basketball.”

Moon is monitored for recurrence. She has a blood draw every few months and so far, she says, “My CA-125 counts have been very low.” Moon knows the odds were against her, knows she’s fortunate to be a survivor. But she also feels that taking her own nagging symptoms seriously and her persistence in continuing to seek treatment paid off in an early diagnosis.

Karen Reed-Matthee is the editor and co-founder of Seattle Woman.

©2006 Caliope Publishing Company