Signs from a silent killer

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March 2, 2017 - 12:00 AM

This is a follow-up story to “Embracing her Second Chance,” published Feb. 21. Laura Houk, Humboldt, diagnosed with ovarian cancer, has battled the disease for almost four years. Diagnosed in an advanced stage, the cancer had spread from an ovary to her lung, liver, spleen and colon. Houk dismissed the subtle symptoms in the earlier stages of the disease. In 2007, J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society, said  most ovarian cancer is diagnosed after it has spread from its primary site, and that late diagnosis greatly decreases the chances for survival. Even with that knowledge, only 1 in 5 women are diagnosed in the early stage of the disease that is known as a silent killer.
 Laura Houk knows all too well how subtle the symptoms of ovarian cancer can be. 
Diagnosed in 2013 with stage IIIC of the disease that, according to the Centers for Disease and Prevention, causes more deaths than any other cancer of the female reproductive system, she recalls having a normal result on a Papanicolaou test.  A normal Pap test result brings a sense of relief  to many women, and so ovarian cancer was the furthest thing from Houk’s mind. She is not alone. In a CDC report published early last year, 31 percent of women included in a study believed that the Pap test screens for ovarian cancer. While researchers continue to try to develop better methods of diagnosing the cancer early, there are no reliable methods for screening for the illness, which, according to the CDC, affects about 20,000 women a year in the U.S. According to the American Cancer Society, ovarian cancer is occasionally detected through a Pap test, although all too often at an advanced stage. Even a pelvic examination is not a foolproof way to detect the  abnormal cells that quickly multiply to form a mass on the ovaries. It can be useful in detecting some reproductive system cancers at an early stage, but many times the ovarian tumors grow in areas that make it difficult for examiners to feel. In Houk’s case the cancer originated on the back side of her ovary.
Sound waves are used to look at the uterus, fallopian tubes, and ovaries, yet this is often after the patient is feeling the symptoms of the advanced stages of the deadly disease. In Houk’s case it was extreme back pain that brought her to the emergency room, where an initial sonogram showed nothing out of the ordinary. 
“I thought it was my appendix,” Houk said.
Many times, elevated levels of protein CA-125 are found through blood tests of ovarian cancer patients.  This test, according to the American Cancer Society, can be “useful as a marker to help guide treatment,” but it has not been found to be effective for general screening. It is known among health professionals that other conditions can also cause elevated levels. Further complicating the diagnostic process, not every woman with the cancer will have elevated levels. It was not until after a CT scan was performed that doctors identified the grapefruit-sized mass on  Houk’s ovary that had attached to her colon. There was nothing else in her genetic makeup or family history to put her on guard.
According to the CDC, “30 percent of women with a BRCA1 or BRCA2 mutated gene will develop ovarian cancer by the time they are 70 years old.”  Houk, 45, tested negative for the mutated gene.
The symptoms are simple and easy to dismiss. During the early stages of the cancer, the only signs of its manifestation, Houk said, were bloating and using the bathroom frequently. At the time she dismissed them as complications or side effects from the prescribed medication she was taking for a thyroid issue. The American Cancer Society lists abdominal or pelvic pain and feeling full quickly along with bloating and urinary symptoms such as urgency as the main symptoms women should look out for. Even then, they say, these symptoms typically show up only after the cancer has spread beyond the ovary. Other symptoms can include fatigue, upset stomach, back pain, pain during sexual intercourse, constipation, menstrual changes and abdominal swelling with weight loss. However, the symptoms are often attributed to other ailments. 
Early detection is imperative. In hindsight, the bloating was obvious, said Houk. “Get to know your own body,” she said. “There are just so many things I did not pay attention to.”
The five-year survival rate for all women diagnosed with ovarian cancer is 44.7 percent. When localized to the ovary, the five-year survival rate is 93.1 percent. When the cancer has spread to other organs, the five-year survival rate drops to 29.6 percent, according to the American Cancer Society. 
There is no way to know for sure who will get ovarian cancer, according to the CDC, and most women who get it are not considered high risk. However, the agency lists on their website several factors which may increase a woman’s risk for ovarian cancer, including a close family history of the cancer, obtaining middle age or older, having one of  the genetic mutations  BRCA1 or BRCA2, having a diagnosis of other cancers, having a Jewish background,  having never given birth or suffering from endometriosis. In addition, according to the CDC, some studies suggest that women who take estrogen by itself, without progesterone, for 10 or more years may have an increased risk.
Women diagnosed with Cowden disease, according to the American Cancer Society, are primarily affected with thyroid problems, thyroid cancer, and breast cancer. These women also have an increased risk of ovarian cancer. According to the organization, “ It has been suggested that talcum powder applied directly to the genital area or on sanitary napkins may be carcinogenic (cancer-causing) to the ovaries.”
Although there are no studies linking the use of cornstarch powder with ovarian cancer, talcum powder manufactured before the 1970’s was known to contain asbestos and, according to the organization, may explain the association between powder and ovarian cancer.
 It cannot be sexually transmitted, according to Cinderella Chavez Radu, Central Care Cancer Center.  There is no evidence to support a correlation between the cancer and microbial vectors like HPV.  Research shows that pregnancy and taking birth control pills both lower the risk of ovarian cancer.  Some researchers theorize that there may be some relationship between ovulation and the risk of developing the cancer.
“Also, we know that tubal ligation and hysterectomy lower the risk of ovarian cancer,” Radu said. “One theory to explain this is that some cancer-causing substances may enter the body through the vagina and pass through the uterus and fallopian tubes to reach the ovaries. This would explain how removing the uterus or blocking the fallopian tubes affects ovarian cancer risk.”
Radu believes that more education is needed to spread ovarian cancer awareness.
Radu is board certified by the American Board of Internal Medicine in Hematology and Medical Oncology as well as Internal Medicine. Central Care Cancer Center has facilities throughout Kansas and into Missouri. More information about them can be found at cccancer.com
Sources: The American Cancer Society, The Center for Disease Control and Prevention

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