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Doctor's Diagnosis: Ovarian cancer

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My mom was “old school” and never complained as she experienced the various aches and pains that are a normal part of the aging process.

So it was very alarming when she started having vague abdominal pains, and complained of feeling bloated after eating small meals. Eventually we discovered the source of her problems: she had ovarian cancer. Despite surgery and chemotherapy, she eventually died from this terrible disease.

Unfortunately, many women experience similar tragedies.

The ovaries produce hormones such as estrogen and also generate the “eggs” that may become fertilized to create offspring. They are also a common site for cancer to develop.

Cancers discovered when still confined to the ovary have the best prognosis. However, at this stage the cancer usually will not cause any symptoms. As was the case with my mother, the cancer is usually found after it has metastasized (meaning it has already spread to other parts of the body). Symptoms are very common once the cancer has spread, so it is much easier to detect, but it is also much more difficult to treat.

So why don't we recommend screening women for ovarian cancer the way we use mammograms to screen for breast cancer? The answer is that even in women who are diligent about getting regular checkups, there is no reliable screening test available.

Routine pelvic exams, even with Pap smears, are not effective because Pap smears do not detect ovarian cancer. Screening with transvaginal ultrasound and checking for a blood tumor marker called CA 125 have been studied, but these have not proven useful for routine screening in patients with no symptoms.

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The risk factors for ovarian cancer are not clearly known, and many are beyond the patient’s control, such as being middle aged or older, having previously had certain other types of cancer, having a close family member who has ovarian cancer or having certain inherited genetic mutations. Other risk factors include never having given birth and possibly having used hormone replacement therapy.

Presently we can only encourage women to seek medical evaluation if they experience warning signs of ovarian cancer such as abnormal vaginal bleeding or discharge, pelvic or abdominal pain, quickly feeling full when eating, frequent bloating or changes in bowel habits.

I very much miss my mom, and I sure wish an effective screening test is developed before my daughter gets much older.


Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

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