Cancer Care

OVARIAN cysts are among the most frequent tumours in a woman’s body. It is believed that probably every woman at one time or the other has had a small cyst on the ovary which may disappear spontaneously.

These are of no particular consequences but when an ovarian cyst becomes large and causes distension of the abdomen and pressure on organs like bladder or rectum, then there should be no hesitation in removing it. Cancer may sometimes develop in the wall of an ovarian cyst, and may then spread to other nearby organs, leading to the obstruction of the bowel. Although ovarian cysts are usually benign, but most doctors feel that it should be removed by surgery without any delay.

Until recently, ovarian cancer was known as a “silent killer.” It was believed to have no symptoms, so most women weren’t diagnosed until the cancer had spread beyond their ovaries, leaving them with relatively low chances for survival. However, the good news is that there is now a hope after almost a decade of research on the disease, courtesy a series of research studies carried out by eminent gynaecologists at the University of Washington. Some scientists, led by Dr. Barbara Goff, have come to a convincing evidence that contrary to the belief in many quarters that ovarian cancer has no early warning symptoms, the disease can actually manifest with some forms of symptoms.

Recently, three leading cancer associations that is, the Gynaecologic Cancer Foundation, the Society of Gynaecology Oncologists and the American Cancer Society, came out with a convincing consensus statement, advising women and doctors to be on the lookout for four key early warning signs. According to their reports, “ovarian cancer is relatively rare as only 1.4 per cent of women will get it in their lifetimes, but its potential deadliness makes early identification of symptoms a matter of life or death. If discovered in the earliest stage, before it has spread beyond the ovaries, almost 90 per cent of women will survive, compared to fewer than 30 per cent of those whose cancers are caught in the later stages.”

Also commenting about ovarian cancer, another expert, Dr.Elizabeth Swisher, a gynaecologist oncologist at the University of Washington says “no one knows how quickly ovarian cancer spreads.” The question is: What then are the early warning signs of ovarian cancer? When asked to comment about ovarian cancer and its symptoms, Dr. Wale Oguntuase explained that women should not joke with any unusual symptoms in their pelvic region. He stressed the importance of regularly visiting hospital for proper check up or pelvic examination whenever there are strange feelings like frequent urination with the urine foaming as if there is a detergent in it, difficulty in eating, frequent back pains, as well as bowel irritation or pains. This is not only to rule out cancer of the ovaries, but all other diseases as well as cervical cancer.

“Since we don’t know what the window of opportunity is for catching this cancer in its earliest stages, it’s critical that women and their doctors take these symptoms seriously,” he stated. Another medical practitioner, Dr. Ishola-Gbenla said cancer is not a disease that should be taken lightly, adding that ovarian cancer is a silent disease that may not show any symptoms at the early stage. He, however, advised women to visit their physicians once they noticed any strange feelings in their pelvic region. While many people think that ovarian cancer is a disease that afflicts mainly high-risk women, that is, women with a family history of breast or ovarian cancer, Goff also stresses that it is important for all women to pay attention to these symptoms, since ninety per cent of the women diagnosed with ovarian cancer each year have no history of cancer in their families.

According to Dr. Goff, 57 per cent of women with Stage 1 ovarian cancer and 87 per cent of women with advanced ovarian cancer experience one or more of the following symptoms: bloating, pelvic or abdominal pain, difficulty in eating or feeling full quickly, Feeling a frequent or urgent need to urinate However, since many of us experience these symptoms from time to time, how would you know when to actually seek medical attention?

The doctor explains that there are two key elements, that is, the symptoms must be new and they must be persistent. “However, if the symptoms are new and persist for more than two to three weeks, they could be a sign of ovarian cancer or other serious conditions, like urinary tract infections or colon cancer. While the majority of women won’t have ovarian cancer, it’s still critical to see a doctor immediately,” Goff stated.

Speaking further, she said any woman who suddenly begins to experience any of the above symptoms lasting for more than a couple of weeks, then there is need to see a doctor, preferably a gynaecologist. A gynaecologist can give you a thorough recto-pelvic examination (entering through both the vagina and the rectum allows your doctor to best feel the ovaries), take a thorough medical history and decide on the next best steps. “Sometimes the best advocate is the patient herself, especially if you feel really uncomfortable about your symptoms, you shouldn’t let your doctor dismiss your symptoms just because your pelvic examination feels normal,” stated Dr Swisher.

Test needed to detect ovarian cancer: CA-125 Blood Test, CA-125 according to the report credited to Dr. Barbara Goff of University of Washington is a cancer marker present in about half of women with Stage 1 ovarian cancer and in the majority of women with advanced ovarian cancer. Since roughly half of women with early ovarian cancer have normal CA-125 levels and some pre-menopausal women (especially those with endometriosis) will have elevated levels, the test however itself is not useful as a sole screening tool. Dr. Swisher was also of the same opinion and he cautioned women to be watchful.

•Specialist/expert must be consulted if a woman is experiencing symptoms, an elevated CA-125 level is caused for concern and warrants further follow-up, she emphasized.

• Trans-vaginal ultrasound —A trans-vaginal ultrasound is an ultrasound in which the probe is inserted directly into the vagina. A trans-vaginal ultrasound is better than an abdominal ultrasound for seeing tumours on the ovaries and in the uterus.

•CT scan — According to Dr. Swisher, if you are having non-localized symptoms, such as bloating or difficulty in eating, a doctor may recommend a CT scan to examine the entire abdomen.
If the manual examination or follow-up test yields concerns about ovarian cancer, the next best step might be to consult with a gynaecologic oncologist, a cancer-doctor who specializes in female reproductive cancers.
These highly specialized doctors are the most qualified to evaluate the results of your tests and decide whether or not biopsies are necessary. “In addition, if you should need biopsies, a gynaecologic-oncologist is the best person to perform them and not any other practitioner.
The assistance of a gynaecologist oncologist can be sought in teaching hospitals all over the country.

• Biopsies: What to expect If your doctor decides there’s enough evidence to warrant a biopsy, be prepared that ovarian biopsies are not like the needle biopsies performed on breast tumours.

•Reason you need to consult gynaeologic-oncologist- Several studies have shown that these specialists are the most likely to properly proceed with the surgery should the biopsy prove cancerous. This includes completely removing tumours and nearby lymph nodes, performing biopsies on the lining of the abdominal cavity, and carefully searching the surfaces of nearby organs for possible cancer cells.

source : www.tribune.com.ng