This is an archived article that was published on sltrib.com in 2014, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
Joanna never missed an annual pelvic exam for 20 years. Although the practice never yielded results that were abnormal, one year an unexpected diagnosis led Joanna on a medical journey that would save her life in a fight against what could have been a debilitating cancer.
"My gynecologist found a mass on one of my ovaries," recalled Joanna of the exam that she expected to be normal, but resulted in the beginning of what would become an ovarian cancer diagnosis. "She made the arrangements while I was in the office to have an ultrasound done. Her words to me were, 'Here's the gynecological oncologist's number. Give them a call and get an appointment."
What happened next was a blur. Filled with anxiety, Joanna met Mark Dodson, M.D., a gynecological oncologist with University of Utah's Huntsman Cancer Institute (HCI). He performed surgery on Joanna to confirm the diagnosis Stage II ovarian cancer, meaning the disease was present in one or both ovaries or fallopian tubes without spreading to other organs in the pelvis.
Following the confirmation of her diagnosis, Joanna was referred to Theresa Werner, M.D., an HCI medical oncologist who specializes in gynecologic cancers. Dr. Werner worked with Joanna over 18 weeks while she underwent chemotherapy.
"Dr. Werner is the nicest person and she really explains things," said Joanna of her treatment experience. "She also wrote down what she told me which was very helpful because when you're in that situation, you really don't hear what they're saying."
Joanna successfully battled cancer and today can call herself a survivor. However, she is one of the lucky ones to have an early diagnosis of this disease. According to the American Cancer Society, ovarian cancer accounts for about 3 percent of cancers in women, but it causes more deaths than any other cancer of the female reproductive system.
One reason ovarian cancer is so deadly is that unlike other cancers, symptoms of the disease are vague. In Joanna's case, she had no symptoms at all. It's the reason ovarian cancer was once called the silent killer, though is now more commonly referred to as "the cancer that whispers."
Symptoms of ovarian cancer include the following:
Abdominal bloating or increased abdominal girth
Pelvic or abdominal pain
Lack of appetite or feeling full quickly
Unintentional changes in weight (either weight loss or weight gain)
Urinary urgency or frequency
Changes in bowel function or stool consistency
Werner said the trouble with ovarian cancer symptoms is that they resemble common ailments that many women experience at some point.
"Many patients attribute these symptoms to growing older and don't seek medical attention," said Werner. "The take home message here is that if you experience any of these symptoms, and if they are persistent or worsening over time, you should call your doctor."
When it comes to screening for ovarian cancer, there are no truly effective screening tests for women. A blood test called CA-125 is often used to help detect ovarian cancer, but this number can be elevated in non-cancerous conditions or be normal even in patients with cancer. Therefore, it is not considered a reliable screening tool for the disease.
Physical exams, including pelvic exams, are key because they can help determine changes in the ovaries. During these exams, doctors will feel the ovaries to see if there are any changes that are suspicious for cancer, as well as check the pelvis for any abnormalities.
Imaging tests like a CT scans, MRIs, or ultrasounds can help visualize if cancer is present.
According to the National Cancer Institute, the following risk factors for ovarian cancer include:
Age (Half of all ovarian cancers are found in women 63 years old or older).
Obesity (Women who are obese have a 30 percent higher risk of getting ovarian cancer).
Fertility drugs (Studies show use of the fertility drug clomiphene citrate commonly known as Clomid for longer than a year increases the risk for developing ovarian cancer).
Estrogen therapy and hormone therapy (Some recent studies show a link between women using estrogen therapy after menopause have an increased risk of developing ovarian cancer).
Family history of ovarian cancer, or history of hereditary breast cancer genes known as BRCA1 and BRCA2.
Certain practices or lifestyle choices can reduce the risk for ovarian cancer:
Childbirth (Women who have children, particularly before the age of 26, are at a lower risk for developing ovarian cancer. Breastfeeding also lowers the risk).
Birth control (Studies show women who use oral contraceptives for five years or longer have a 50 percent lower risk of developing ovarian cancer).
In recent years, certain treatments, in addition to standard chemotherapy, have shown promise in the fight against ovarian cancer.
One class of targeted drugs known as vascular agents can cut off the supply of blood to tumors, which can affect a tumor's ability to grow. Bevacizumab (commonly known as AvastinĀ®) is an example of such treatment. These drugs are being studied in combination with other treatments and researchers are hopeful they can help decrease recurrence rates of ovarian cancer and improve survival rates.
Another class of drugs, known as PARP inhibitors, can also be effective in treating ovarian cancer. These agents have been studied in women with certain types of ovarian cancer as well as in those patients with mutations in hereditary cancer genes (BRCA1 and BRCA2). Researchers are encouraged that these drugs, when used both alone and in combination with chemotherapy, may slow cancer cells from growing.
"We can usually put this cancer in remission," said Werner. "But then it becomes a waiting game to see if it will come back. The recurrence rates of ovarian cancer, especially in advanced stage disease, can be high. Some of these newer therapies are promising in helping to keep our patients in remission."
In the meantime, Werner stresses the importance of women becoming their own best health care advocates.
"Know your body. If you have symptoms that are new or persistent for you, it is always best to have them evaluated. If you have symptoms that aren't normal for you, and they don't go away, start asking questions and insist on answers," said Werner.
HCI has an active clinical research program for ovarian cancer and has several ongoing clinical trials, Werner noted. She said researchers are looking at targeted therapies for ovarian cancer, including vascular type agents and PARP inhibitors and other new targeted therapies. Researchers are also studying lifestyle modifications and the effect of diet and exercise on ovarian cancer survival rates.
After surviving cancer, Joanna now regularly encourages friends and coworkers to get annual pelvic exams, even as guidelines for a regular pap test have changed.
"It saved my life, I'm sure of it, " said Joanna.
Want more information about clinical trials at Huntsman Cancer Institute? Visit: http://healthcare.utah.edu/huntsmancancerinstitute/clinical-trials/?utm_source=UDS&utm_medium=SLTrib&utm_campaign=Native