April 28, 2015
Early this past summer, national headlines trumpeted the news: the once-stealthy ovarian cancer, long believed to be a “silent killer,” may actually announce its presence. It does so quietly, however, and that’s why patients and their physicians are advised to listen carefully. Because ovarian cancer is so frequently discovered in later stages, it is far more difficult to achieve successful treatment and thus has a high mortality rate. That’s why the new symptom guidelines bear such glad tidings.
Ovarian cancer can spread quickly, which makes early detection critical. It affects the ovaries, reproductive organs that produce the eggs and which lie deep within the pelvis. Although the cause is unknown, there are some identifiable risk factors for ovarian cancer, including smoking, age (as most patients are diagnosed after menopause), being overweight and family history.
The early symptoms identified and endorsed by more than a dozen women’s health organizations and research groups are admittedly subtle. They are:
– Bloating, pelvic or abdominal pain
– Difficult eating or feeling full quickly
– Frequent or urgent need to urinate
– Increased abdominal size
I emphasize to my patients at Riverside Medical Clinic that these symptoms are common to many illnesses and also occur in healthy patients. What’s important is the relatively new, severe or persistent occurrence of these symptoms for more than two or three weeks. That’s when it’s time to make an appointment for an exam.
It is critical to discover ovarian cancer in its early stages; the majority of cases are presently discovered quite late. Until now, many women (and their physicians) dismissed these early symptoms or assumed they were related to something else such as urinary infection, menopause or aging. Cancer experts have determined that 75 percent of women diagnosed with advanced ovarian cancer exhibited the symptoms I have outlined here. Interestingly, more than half the women diagnosed with stage 1 ovarian cancer, the earliest stage, also have experienced the early warning signs.
If you’re concerned and you’ve had symptoms for more than a couple of weeks, don’t worry about appearing overly cautious with your gynecologist. Admittedly, these symptoms are subtle and can signal a host of other causes. I know that my colleagues and I at Riverside Medical Clinic would rather err on the side of caution. We want to rule out disease and put patients’ minds at ease (at a minimum) or diagnose another condition, such as a bladder infection, if that is the cause.
First your physician will conduct an abdominal exam, a pelvic exam and a rectal/vaginal examination. I would then recommend a trans-vaginal ultrasound, a simple imaging test. This may be accompanied by a blood test to measure the CA125 level, (a cancer tumor marker). It can be a helpful adjunct diagnostic tool in our arsenal.
The ultrasound will determine if there is anything on or about the ovaries that might be of concern, such as a mass. Should something show up on the ultrasound suspicious for ovarian cancer, surgery is advised.
Should ovarian cancer be suspected, surgery determines the stage of the cancer (the extent of area affected).
During surgery, a staging procedure involves removing the ovaries, uterus, omentum and removal of the pelvic and para aortic lymph nodes. Furthermore, as much of the cancer as possible is removed and biopsies of suspicious lesions are done. Proper staging is the key for prognosis and treatment.
In my practice, depending on the clinical situation some patients will be referred to the gynecologic/oncologist for surgical and medical treatment.
Chemotherapy is usually given post-surgically and the treatment plan is individualized depending on the patient’s type and stage of cancer.
As with all forms of cancer, a healthy lifestyle may be the best preventative measure a person can take. Eat right, maintain a healthy weight, get plenty of exercise, don’t smoke and limit alcohol. For patients without a family history or major risk factors, an annual pelvic exam is recommended, particularly for women over the age of 50.
For my patients with a family history of ovarian cancer, I recommend a pelvic exam every six months, accompanied by a test to measure the CA 125 level and a pelvic ultrasound.
In the Inland Empire, I have witnessed a number of cultural barriers and misconceptions, particularly in the Hispanic community. There tends to be a lot of misinformation circulated in the community by friends and relatives who have had bad experiences with physicians who are not perceived as being culturally sensitive.
I am proud to be Spanish-speaking and to offer patients who are less comfortable communicating in English the opportunity to relate to someone who understands their language and their culture. In the arena of very personal health care of obstetrics and gynecology, culturally sensitive care can be a distinct advantage in allaying fears and promoting understanding.
Open and honest communication is the foundation of great patient/physician relationships in all cultures. If you have concerns, or have exhibited these warning signs for more than a few weeks, please make an appointment with your doctor. It could make all the difference in your care.
Dr. Saenz is a doctor of obstetrics and gynecology at Riverside Medical Clinic who recently moved to Riverside from Canton, Ohio, where he maintained a private practice for nine years. A graduate of Stanford Medical School, Dr. Saenz performed his residency at UC Irvine Medical Center and is delighted to be back in California. Patients can schedule appointments with him through his office at 951-697-5505. Riverside Medical Clinic is the largest private provider of ambulatory care in the Inland Empire. If you’d like to find a general physician or a specialist, call the clinic’s physician referral line at (951) 782-3602 or go to HYPERLINK “https://www.riversidemedicalclinic.com/” https://www.riversidemedicalclinic.com ; for an online physician directory by location and specialty.