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Rare disease of reproductive system difficult to diagnose
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Buy This PhotoEach year some 22,000 women are diagnosed with ovarian cancer and, of those, 15,500 die. The cause is unknown.Getty Images
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December 16, 2012 2:00 AM
"; aryZooms[imgCounter] = "javascript: NewWindow(870,625,window.document.location+zTemplate+'&img="+imgCounter+"')";Ovarian cancer is often called a silent killer because by the time symptoms show up, the disease is usually very advanced, and hard to treat.
The cancer walk to raise awareness of the disease is called the Whisper Walk for Ovarian Cancer. The signature color is teal.
Symptoms
Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows, symptoms may include:
Pressure or pain in the abdomen, pelvis, back, or legs
A swollen or bloated abdomen
Nausea, indigestion, gas, constipation, or diarrhea
Feeling very tired all the time
Less common symptoms include:
Shortness of breath
Feeling the need to urinate often
Unusual vaginal bleeding (heavy periods, or bleeding after menopause)
Most often these symptoms are not due to cancer, but only a doctor can tell for sure. Any woman with these symptoms should tell her doctor.
Source: National Cancer Institute
The disease represents a true Catch 22 for doctors and patients for several reasons, the first being that it is a rare cancer of the reproductive system so it is not often the first consideration when making a diagnosis. And doctors say that while there are symptoms, the signs are often misinterpreted as being related to gastro-intestinal ailments. Only when treatment for that fails do doctors begin to suspect ovarian cancer. Finally, there is no definitive test for ovarian cancer.
Ovarian cancer causes more deaths than any other type of female reproductive cancer. The cause is unknown.
Dr. John Schorge is the chief gynecological oncologist at Massachusetts General Hospital. Through a collaborative agreement he also consults at Wentworth-Douglass Hospital in Dover.
There are four classic symptoms," said Schorge. "Unfortunately, the symptoms do mirror those of many gastrointestinal upsets. Only one in a hundred women with the same symptoms might have the disease."
Schorge said the numbers for ovarian cancer are grim. He said about 22,000 women are diagnosed in a year and, of those, 15,500 die.
"It's highly lethal because two-thirds of women diagnosed are already in stage three or four," said Schorge. "There is more awareness now and that's good. The issue is for women in more rural areas. Here in New Hampshire there are only four or five gynecological oncologists to cover the entire state."
Dr. Robert McLellan, an oncologist at Portsmouth Regional Hospital, estimates that 75 percent of women diagnosed with ovarian cancer are already at the stage three of four.
"We need to talk more about family," said McLellan. "If there is a history of breast cancer, colon cancer or uterine cancer, this has to be considered sooner. There is no good screening test but a trans-vaginal ultrasound can show the presence of fluid (ascites) or a mass that shouldn't be there."
Symptoms of ovarian cancer are excessive bloating, pelvic pain, a feeling of early fullness that is not usual, and increased urinary fullness. If you have these four signs, lasting longer than they should or not responding to treatment, Schorge said patients should ask for a pelvic and ultrasound exam. Family history is a very important indicator, as is looking for gene abnormalities with the BRCA1 and BRCA2 tests. Most ovarian cancer appears in women ages 55 and older.
McLellan said women with known BRCA risks are advised to complete their child bearing years and then consider surgery to remove the ovaries.
Maybe the biggest piece of misinformation out there is that a Pap smear will detect ovarian cancer.
"It will not, said Dr. Danny Sims, an oncologist from New Hampshire Oncology and Hematology who sometimes works out of Exeter Hospital.
"A Pap smear will detect cervical cancer only," said Sims. "People assume the test is accurate for all reproductive cancers but it does not detect uterine or ovarian cancers."
Surgery is used to treat all stages of ovarian cancer. Surgery involves removal of the uterus (total hysterectomy), removal of both ovaries and fallopian tubes, partial or complete removal of the omentum, the fatty layer that covers and pads organs in the abdomen, examination, biopsy, or removal of the lymph nodes and other tissues in the pelvis and abdomen.
Chemotherapy is used after surgery to treat any remaining disease. Chemotherapy can also be used if the cancer comes back. Chemotherapy may be given into the veins, or sometimes directly into the abdominal cavity (intraperitoneal).
Schorge is an advocate of intraperitoneal chemotherapy. He said he believes applying the chemo directly to the abdominal area is more effective than traditional IV therapy. Locally, the treatment is only available at Wentworth-Douglass Hospital. Schorge said he pushed to make the treatment available there.
"The survival advantage is 16 months longer in studies," said Schorge. "The abdomen is where the cancer would spread, so splashing it around there has more optimal results."
Still, the chances for recurrence of cancer is great, said all three doctors. Sims said it is likely that the cancer will return at some point in most women diagnosed with ovarian cancer.
About three out of four women with ovarian cancer survive one year after diagnosis. If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the five-year survival rate is high
Complications can include spread of the cancer to other organs, loss of organ function, fluid in the abdomen (ascites), and blockage of the intestines.
Women should call for an appointment with their health care provider if they are over 40 years old and have not recently had a pelvic examination. Routine pelvic examinations are recommended for all women over 20 years old. And if you have those four symptoms persistently, or have had them for a while, ask your doctor about ovarian cancer.
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1 of 10 Premium Clicks used this month
Rare disease of reproductive system difficult to diagnose
Today's most viewed articles
Buy This Photo
Each year some 22,000 women are diagnosed with ovarian cancer and, of those, 15,500 die. The cause is unknown.Getty Images
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UPGRADEyour account for full access to SeacoastOnline.com
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December 16, 2012 2:00 AM
"; aryZooms[imgCounter] = "javascript: NewWindow(870,625,window.document.location+zTemplate+'&img="+imgCounter+"')";Ovarian cancer is often called a silent killer because by the time symptoms show up, the disease is usually very advanced, and hard to treat.
The cancer walk to raise awareness of the disease is called the Whisper Walk for Ovarian Cancer. The signature color is teal.
Symptoms
Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows, symptoms may include:
Pressure or pain in the abdomen, pelvis, back, or legs
A swollen or bloated abdomen
Nausea, indigestion, gas, constipation, or diarrhea
Feeling very tired all the time
Less common symptoms include:
Shortness of breath
Feeling the need to urinate often
Unusual vaginal bleeding (heavy periods, or bleeding after menopause)
Most often these symptoms are not due to cancer, but only a doctor can tell for sure. Any woman with these symptoms should tell her doctor.
Source: National Cancer Institute
The disease represents a true Catch 22 for doctors and patients for several reasons, the first being that it is a rare cancer of the reproductive system so it is not often the first consideration when making a diagnosis. And doctors say that while there are symptoms, the signs are often misinterpreted as being related to gastro-intestinal ailments. Only when treatment for that fails do doctors begin to suspect ovarian cancer. Finally, there is no definitive test for ovarian cancer.
Ovarian cancer causes more deaths than any other type of female reproductive cancer. The cause is unknown.
Dr. John Schorge is the chief gynecological oncologist at Massachusetts General Hospital. Through a collaborative agreement he also consults at Wentworth-Douglass Hospital in Dover.
There are four classic symptoms," said Schorge. "Unfortunately, the symptoms do mirror those of many gastrointestinal upsets. Only one in a hundred women with the same symptoms might have the disease."
Schorge said the numbers for ovarian cancer are grim. He said about 22,000 women are diagnosed in a year and, of those, 15,500 die.
"It's highly lethal because two-thirds of women diagnosed are already in stage three or four," said Schorge. "There is more awareness now and that's good. The issue is for women in more rural areas. Here in New Hampshire there are only four or five gynecological oncologists to cover the entire state."
Dr. Robert McLellan, an oncologist at Portsmouth Regional Hospital, estimates that 75 percent of women diagnosed with ovarian cancer are already at the stage three of four.
"We need to talk more about family," said McLellan. "If there is a history of breast cancer, colon cancer or uterine cancer, this has to be considered sooner. There is no good screening test but a trans-vaginal ultrasound can show the presence of fluid (ascites) or a mass that shouldn't be there."
Symptoms of ovarian cancer are excessive bloating, pelvic pain, a feeling of early fullness that is not usual, and increased urinary fullness. If you have these four signs, lasting longer than they should or not responding to treatment, Schorge said patients should ask for a pelvic and ultrasound exam. Family history is a very important indicator, as is looking for gene abnormalities with the BRCA1 and BRCA2 tests. Most ovarian cancer appears in women ages 55 and older.
McLellan said women with known BRCA risks are advised to complete their child bearing years and then consider surgery to remove the ovaries.
Maybe the biggest piece of misinformation out there is that a Pap smear will detect ovarian cancer.
"It will not, said Dr. Danny Sims, an oncologist from New Hampshire Oncology and Hematology who sometimes works out of Exeter Hospital.
"A Pap smear will detect cervical cancer only," said Sims. "People assume the test is accurate for all reproductive cancers but it does not detect uterine or ovarian cancers."
Surgery is used to treat all stages of ovarian cancer. Surgery involves removal of the uterus (total hysterectomy), removal of both ovaries and fallopian tubes, partial or complete removal of the omentum, the fatty layer that covers and pads organs in the abdomen, examination, biopsy, or removal of the lymph nodes and other tissues in the pelvis and abdomen.
Chemotherapy is used after surgery to treat any remaining disease. Chemotherapy can also be used if the cancer comes back. Chemotherapy may be given into the veins, or sometimes directly into the abdominal cavity (intraperitoneal).
Schorge is an advocate of intraperitoneal chemotherapy. He said he believes applying the chemo directly to the abdominal area is more effective than traditional IV therapy. Locally, the treatment is only available at Wentworth-Douglass Hospital. Schorge said he pushed to make the treatment available there.
"The survival advantage is 16 months longer in studies," said Schorge. "The abdomen is where the cancer would spread, so splashing it around there has more optimal results."
Still, the chances for recurrence of cancer is great, said all three doctors. Sims said it is likely that the cancer will return at some point in most women diagnosed with ovarian cancer.
About three out of four women with ovarian cancer survive one year after diagnosis. If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the five-year survival rate is high
Complications can include spread of the cancer to other organs, loss of organ function, fluid in the abdomen (ascites), and blockage of the intestines.
Women should call for an appointment with their health care provider if they are over 40 years old and have not recently had a pelvic examination. Routine pelvic examinations are recommended for all women over 20 years old. And if you have those four symptoms persistently, or have had them for a while, ask your doctor about ovarian cancer.
We reserve the right to remove any content at any time from this Community, including without limitation if it violates the Community Rules. We ask that you report content that you in good faith believe violates the above rules by clicking the Flag link next to the offending comment or fill out this form. New comments are only accepted for two weeks from the date of publication.
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Source: http://www.seacoastonline.com/articles/20121216-LIFE-212160311
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