EULALEE THOMPSON
OVARIAN CANCER symptoms are often vague, usually nothing as dramatic as pain or excessive bleeding that would send a woman running for medical attention.
It is perhaps because of the vagueness of the symptoms that gynaecologist/oncologist Dr. Matthew Taylor said that the majority of patients show up for treatment when the cancer is far along. These patients, usually age 50 or older, would sit and watch their tummies grow larger and larger as the tumours in their ovaries expand to abnormal proportions. They would ignore the 'gas' pains and abdominal discomforts associated with this cancer until it was too late.
"The earliest symptoms are 'gas' pains and abnormal bleeding. Unfortunately, most doctors do not think about ovarian cancer (because it is so relatively uncommon) and will miss it until it is quite advanced. Most women (especially the elderly) also ignore these symptoms (especially in relation to the gas pains)," said Dr. Taylor.
He identified abdominal pain or discomfort, abdominal distension or large lump, indigestion, change in urination, weight loss and abnormal bleeding as the main symptoms of ovarian
cancer.
Peak incidence for the disease fall in the 60 to 64-year-old age group, they tend to have the type of tumour from epithelial origin but about three per cent of cases occur in women younger than 35 year old and their tumours tend be of the germ cell origin.
"Germ cell tumours tend to occur in females less then 20 years. Generally they respond very well to treatment, whatever the age, with good survival outcomes and in some cases with preservation of fertility," Dr. Taylor said.
In 2000, 66 cases of ovarian cancer were identified here; 2001, there were 109 cases identified and in 2002, 81 cases. Though it is a relatively uncommon cancer ( that is, when compared to other cancers such as cervical and breast cancers), it is the fourth commonest cause of death from cancers in developing countries.
"(This is related to the fact that) the ovaries are inaccessible (deep in the pelvis); the symptoms are vague and present late and it is unknown whether the stepwise progression of (dyplastic) precursors are available for early detection," Dr. Taylor said.
If vague symptoms and inaccessible ovaries were not enough to dread this type of cancer, then consider also that it appears that medical science has not yet sort through a general screening tool for ovarian cancer (in the same way like for example, there's the Pap smear for cervical cancer).
"All studies to date on screening the "normal" woman unfortunately show poor sensitivity. A combination of tumour markers and ultrasound have been used (but) the majority of women who are picked up as positive actually do not have ovarian cancer. They will then will need a laparotomy (surgery) to confirm that they do not have ovarian cancer. So a lot of women have unnecessary major surgery. Regular screening for the normal population is not practised. For women with familial disease there are several screening programmes actively pursued in the USA and UK. They can be pursued out here as well," Dr. Taylor said.
Regular examination of the abdomen by a medical practitioner, though not good for screening, will pick up ovarian cancer at an earlier stage when the disease is more responsive to treatment.
Expensive treatment
Treatment of ovarian cancer usually involve surgery and chemotherap. Dr. Taylor explain however, that the recommended first line drug therapy is very expensive -- $40,000 per course, and the patient usually needs about six courses over an 18-week period. This hefty sum for drug treatment of course, does not include the cost of other therapies and tests related to the disease management.
"The majority of patients who do not survive I have found are those who do not complete treatment whatever age. Many patients cannot manage the physical and emotional stress of radical surgery and chemotherapy. This is where the need for support services in Jamaica (such as the MacMillan nurses in the UK) would be very useful to encourage follow-up of treatment," he said.
You can send your comments to eulalee.thompson@gleanerjm.com.
