Back cancer ovarian pain

If someone whose knowledge and credentials I respected told me I had one chance in two of winning a jackpot in Las Vegas, I'd head straight for that city's casino tables--because I'm a gambler at heart and an optimist by nature. But I'm neither an optimist nor a gambler when it comes to life or death. So when I realized last spring that I could have close to one chance in two of getting ovarian cancer, I decided that my best bet was on the operating table.

So it was there I headed last January to have my ovaries removed and, along with them, my fear of getting the dread disease that fate dealt my mother and older sister. That fear had been on the back burner of my brain since I first learned in 1986 that my mother's fatal cancer 30 years ago had been ovarian. Until then, I thought it had been "stomach cancer," which is how my father described it in his phone call to break the news of her condition. (Quaint as it may seem to today's generation--which has sex education in school and movies showing practically every functional part of the exterior human body in living, moving color--in the 1950s, males of my father's generation respectfully spoke of any part of a woman's anatomy between the waist and the groin as the "stomach."

In 1986, the urgent family-news phone call was from my oldest sister, Zoe, in Georgia, who informed me that our sister, Garth, had been diagnosed with ovarian cancer--"the kind Mama had." She was amazed that I was unaware of that. In all the years since our mother's death, during Zoe's and my rare visits together and infrequent phone calls, the location of Mama's cancer had never been mentioned. We each assumed the other knew. So with that knowledge added to my awareness that ovarian cancer can be hereditary, my fear jumped to the front burner of my brain, where it remained and many times boiled over during the ensuing 18 months of witnessing Garth's painful decline and death.

At my regular gynecologic checkup thereafter (knowing that my health insurer strongly practices preventive healthcare), I asked if they ever removed women's ovaries to prevent ovarian cancer. I was hesitant to ask, feeling I'd be on record then as a cancer-phobia neurotic.

I was pleasantly surprised to hear, "Oh yes--and in most cases, it can be done now by laparoscopic surgery, which is simpler and requires less convalescent time than the old method. I'll have you talk to one of our genetic counselors to help you decide."

The genetic-counseling session was psychologically supportive, as well as scientifically informative. My counselor, Barbara Ziel, M.S., was currently experiencing the grief and regret of a close friend's terminal stages of ovarian cancer and regarded my anxiety as quite normal, considering my family's cancer history. It was also reassuring to hear that even though nearly one in 70 U.S. women gets ovarian cancer, the kind medically classified "hereditary" is rare. Some researchers report that hereditary ovarian cancer accounts for less than one percent of all ovarian cases; others report a rate of 3 to 5 percent.

Hereditary ovarian cancer refers to a group of cancer syndromes, the signs and symptoms of which occur together and characterize a particular abnormality. They include: (1) sitespecific ovarian cancer, (2) breastovarian cancer syndrome, and (3) ovarian-endometrial-colon cancer syndrome. In other words, the same types of faulty genes keep showing up and become dominant enough to be passed on to the next generation. The hereditary ovarian-cancer groups tend to develop earlier in life with each succeeding generation. The lifetime probability that these genes will result in ovarian cancer can be as high as 50 percent.

For women without a family history of an identifiable syndrome, the risk of ovarian cancer is tied to the number of first- or second-degree relatives who have it. First-degree relatives include mothers, sisters, and daughters; second-degree include aunts and grandmothers. The lifetime risk for a 35-year-old woman with one first-degree relative with ovarian cancer is approximately 5 percent. Having two or three relatives with it puts her risk at approximately 7 percent. I was right in the bracket for it, and the risk increases with age. The genetic counselor pointed out that I was probably more at risk for breast cancer. One woman in nine can now expect to get it, and it's the number-two cancer killer of women (number one is lung). Still, that's never been high on my list of anxieties, because early detection is possible with regular self-exams and mammograms, and survival statistics are good for those caught early.

Ovarian cancer is more ominous. Gilda Radner's 1989 bestseller, It's Always Something, described her desperate battle with this insidious disease. The book has made women--many doctors, too--more alert to the symptoms. Pelvic exams rarely reveal the cancer because the almond-sized glands are tucked deep inside the abdominal cavity and are hard to find and feel. By the time its symptoms--abdominal bloating, indigestion, weight loss, fatigue--merit attention, the cancer has usually spread beyond surgical cure.

Garth, the stoic in our family, did not seek medical help until her symptoms had coalesced to pain. Surgery revealed her cancer had seeded throughout her abdomen.

Improved screening techniques are promising. An exciting genetic breakthrough was announced last year regarding breast cancer. This breakthrough could have ramifications for ovarian cancer as well. Medical researchers who have labored for years to pinpoint genes among the body's 100,000 that cause hereditary breast cancer now have located at least two. The difficulty of the search was compared to that of having to comb every state, county, city, and town in the country to find one burned-out light bulb, then finally discovering at least what town it's in. A house-by-house, room-by-room search then must follow. After identification of the gene, a simple DNA test will determine whether a woman carries it.

New, more effective drug therapies are emerging to combat recurrence of ovarian cancer after surgery, but the grim prognosis prevails. Ovarian cancer kills six of ten unfortunate women who get it--most of them within 18 months to two years.

I left my genetic counselor's office with some "homework": a medical history questionnaire to complete on my immediate family and ancestors as far back as I could trace--three or four generations past, if possible. It wasn't possible. The only limbs of my family tree that I could shake down were bare beyond my grandparents. No record existed, and no one was around to ask. My paternal grandmother died of cancer, type unknown. ("Of the arm," I recall my father saying once. She apparently had refused surgery sometime before that, but exactly what kind of surgery Daddy didn't know. A first cousin and a second cousin on my father's side died of breast cancer--one in her 30s, the other in her 40s. I didn't think that would be significant, but it was. The gene linked to ovarian cancer can be inherited from either the father or the mother. Furthermore, my surviving sister, Zoe, had a mastectomy for breast cancer four years ago. Fortunately, hers was discovered early by mammogram, and she has done well, but that had to be factored in as well. Without a complete family pedigree, it's difficult for a geneticist to accurately assess my lifetime risk of developing ovarian cancer. It was concluded that with my family's known medical history, coupled with known statistics, my risk for getting ovarian cancer was somewhere between 7 and 45 percent, a risk factor that well supported prophylactic oophorectomy (removal of the ovaries). The psychological benefit from this preventive treatment also was considered. Dr. Timothy Jones, my primary physician-internist, concurred.

Next was an appointment with my gynecologic surgeon, Dr. John Husokowski, for his opinion and his explanation of what a laparoscopy is and what it accomplishes. It's a relatively quick surgical procedure requiring only small incisions. It lets a doctor look directly at the pelvic organs through a long, slender, fiberoptic, telescope-like instrument called a laparoscope. The organs are viewed on a screen next to the operating table. Other instruments can be used to remove abnormal tissue growths or samples for testing, block the fallopian tubes for birth control, and remove certain organs--in my case, the ovaries.