by S. Todd Stolp MD
©August 2008
Leroy Sievers, an award-winning journalist, died on August 15, 2008, of colon cancer after writing a daily blog since mid-2006 entitled “My Cancer”. He described the blog as “…a daily reminder that none of us walks this road alone.” Mr. Sievers’ work provided unmeasureable benefits to cancer patients and potential cancer patients alike, which pretty much covers all of us. By breaking down the barriers that create a sense of stark isolation for the cancer patient, this journalist was able to neutralize perhaps the most fearsome characteristic of the cancer diagnosis: cancer comes from within. The entire community shares the burden of cancer by virtue of the fact that each one of us is made up of cells that might at any time begin to grow willy-nilly without regard to the usual cellular responsibilities. Detection of these rebellious cells at the earliest possible point is one of the prime goals of cancer prevention and treatment. We can focus on ovarian cancer to explore how partnerships with our health care providers can be best used to detect otherwise invisible cancers, and diminish the sense of isolation which so often darkens the skies of cancer patients.
Any cell of the body can potentially become cancerous, although some are more likely to do so than others. When a cell becomes cancerous, it devotes all of it’s energy to reproducing itself. This occurs because of a mutation in the cellular DNA which changes the instructions the cell receives. Thus, a cell which is normally instructed to behave like an ovary cell is advised to reproduce as fast as possible and forget about producing the usual chemicals and enzymes that are characteristic of ovaries. It is the constant effort towards reproduction that is the distinguishing feature of a cancer cell.
Ovarian cancer presents problems because the ovary is a small organ suspended in the abdomen. As many mothers can attest, a growth in the abdomen can become quite large before it causes enough problems in it’s neighborhood to become apparent to the owner. As a result, ovarian tumors (growths) often grow without detection for years before causing symptoms.
Certain cancer cells will release abnormal chemicals which can be detected by a simple blood test. This occurs because the defect that leads a cancer cell to grow abnormally also often alters the assembly line for chemical production. Similarly, a pastry that is mass produced, like a Hostess Twinkie, cannot be expected to be equivalent to a muffin meticulously prepared by the loving hands of a grandmother. The abnormal chemicals produced by cancer cells are called “markers,” because they can often be used to identify the presence of cancer or monitor the progress of cancer during treatment.
For ovarian cancer, one of these “abnormal” chemicals is called CA-125. The problem with cancer markers is that they are actually often not truly “abnormal” chemicals, but instead are produced by normal cells in small amounts. Thus, there are other conditions besides ovarian cancer that can explain elevations of CA-125 in some patients. The question, then, is when do we measure a CA-125 in women, and if it is elevated, what should be done with the information?
The risk of ovarian cancer increases with age, especially after 50 years old. Women who have never had children, women who are infertile or who have had their first child after age 30 at are increased risk for ovarian cancer. The risk of ovarian cancer is increased for many women with a history of breast cancer, or a family history of breast, colorectal or ovarian cancer. There have been several genes, such as the BRCA-1 and BRCA-2 genes, identified that predispose to ovarian cancer in some families. Women with any of these risk factors should speak with their health care providers to determine if they are candidates for ovarian cancer screening.
The U.S. entity charged with the responsibility to develop and update recommendations for health screening of otherwise healthy people is the United States Preventive Services Task Force (USPSTF). This group has found insufficient evidence to either support or oppose routine pelvic examination except for screening for cervical cancer, gonorrhea and chlamydia. Screening for these latter conditions is still recommended every three years between the age of 21 and 40 years depending upon the patient’s sexual activities and the recommendations of their health care provider. After age 40, a pelvic examination should be obtained depending upon your health care provider’s advice.
Symptoms of ovarian cancer often include nothing more than vague bloating, abdominal enlargement, nausea, or pelvic pressure. However, these symptoms are commonly caused by minor conditions unrelated to cancer. To recognize when such symptoms warrant further evaluation, describe your symptoms carefully to your health care provider, and if your symptoms continue despite treatment, be sure to convey this fact.
For high risk individuals or patients with specific symptoms, your health care provider may advise you to obtain a CA-125 blood test. At this time, this blood test is not used to screen the general population because it can lead to unnecessary tests and complications. Rely upon your health care provider to help you determine if this test is appropriate for you, but provide the information necessary to make a well-considered decision.
We have more tools available to us to improve our health than any society before us. The trick is to use these tools efficiently and effectively, and to participate in the decision by partnering with health care experts. Doing so will not guarantee that we will avoid illness, but it will maximize our benefits and remind us that we are part of a larger family.