Friday , January 28 2022

J & J Jones: Ovarian cancer, it whispers


What could I not believe? Discover that it has been 42 years since I wrote recently about ovarian cancer! During my time as a surgeon, what was my main concern about this malignancy? And what happened in the last four decades to bring hope to those diagnosed with the disease?

Ovarian cancer is the third most common malignancy of the female pelvic organs, after uterine cancer and cervical cancer. But it is also the most deadly pelvic malignancy.

The risk of ovarian cancer increases with age. It is also more likely to occur if relatives developed the disease. Also at risk are women without children and those with breast cancer. Too vulnerable, are those with early onset of menstruation, or late menopause. And some women have inherited genetic mutations that put them at increased risk.

Epidemiological studies also show that the incidence of ovarian cancer varies from one ethnic group to another. Japanese women are less likely to develop ovarian cancer. In contrast, the rate is high among Swedish women. In North America there is another interesting gap. The disease is higher than white non-white bricks. And in Africa, white women have twice the rate of ovarian cancer than black women.

So what worried me as a gynecologist? It was not possible to make a technical error during surgery. It was missing the diagnosis.

Cancer malignancy was called silent disease, or whispering disease, for good reason. For example, women with this cancer often complain of constipation, increased urination, mild digestive symptoms, loss of appetite, weight loss, and abdominal swelling. The problem is that many other women who do not suffer from this disease have the same vague symptoms.

Another problem is female anatomy. The ovaries hang on the trumpets like pillows on a line of clothes. This means that intestinal loops are easily sent to the side while the tumor continues to grow, which can cause large ovarian mass before the pain occurs.

What about tests? Pap smears are quite accurate in detecting cervical cancer cells, but they rarely catch those from the ovary. Another test, called CA 125, is more reliable, but again has diagnostic problems. Women with malignant cancer often have high levels of CA125. But others never show an exception. To add to diagnostic difficulties, patients with benign tumors, such as fibroids, pelvic infection, endometriosis, may show increased CA125. So, false reports can lead to other tests that cause additional complications.

Even the annual pelvic examination that should always be done, but not, creates possible trouble. The ovaries are the size of a nut and hard to feel if the patients are obese, or if they have not changed before the test, or if the intestines are loaded with fecal material. In these cases the doctor may decide that the ultrasound may be useful in assessing the ovaries. But it still can not reveal early malignancy.

So what happened in the past 42 years? And why was it so long for me to write again about ovarian cancer? The simple answer is that there was no good news to write about them all these years. We have all seen tremendous progress in many aspects of medicine and surgery during this period. But for ovarian cancer, too many obstacles for researchers.

Standard treatment after diagnosis has been surgical removal of the ovaries and the uterus, followed by either chemotherapy, radiation or a combination of the two treatments. But unfortunately, the recurrence rate continues to remain high.

So, after 42 years what's the good news? During my last visit to Harvard Medical School, I learned how to finally cure cancer in rats with immunological therapy. What does it mean to humans?

A similar study at the University of Toronto reveals that some immunological studies are promising promising new hope for women diagnosed with ovarian cancer. The immune system is a powerful weapon to combat infection. The next step is to take full advantage of its potential to eliminate one of the biggest killers. I believe it will not be another 42 years before it happens.

Note: The column is not medical advice and should not diagnose, treat, prevent or cure diseases. Contact your doctor. The information provided is for informational purposes only and is the author's only opinions. See Remarks; [email protected]

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