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The Honolulu Advertiser
Posted on: Thursday, November 8, 2001

Health
Early signs of ovarian cancer can be subtle

By Katherine Nichols
Advertiser Staff Writer

Betty Reeter, a cashier at Liberty House, received discouraging results from a CT scan, but remains confident of beating the disease.

Gregory Yamamoto • The Honolulu Advertiser

Ovarian cancer screening

Dr. Frank Voralik, 944-9144

Intravaginal scanning using an ultrasound technique $75 (normally $300)

Screening is recommended for postmenopausal women

Lynn Vogt trekked 54 miles through the Sierras in eight days last year — with new gear. The reason the veteran hiker had given away her equipment? "Because I thought I'd never do it again," she said.

After suffering through ovarian cancer and the debilitating chemotherapy, she didn't believe that anything requiring strength and energy was possible.

Three years after finishing her last chemotherapy treatment, however, the Moloka'i resident's outlook is different. Even though she would undergo a biopsy because of a "funky mammogram," she refuses to let it get her down.

She smiled to the group of seven women in the ovarian cancer support group at the Kapi'olani Women's Center and said, "Worry robs today of its energy."

It used to be called the silent killer. Ovarian cancer occurs in organs deep in the pelvis. It produces nebulous, easily dismissed symptoms. There is no standard, early detection method. But people say, "It's not silent. It whispers. So listen."

Listen to symptoms like abdominal pressure and bloating, abnormal bleeding, nausea and indigestion, unusual fatigue, unexpected weight gain or loss. Paying attention to physical changes can save your life, say women who have been diagnosed with ovarian cancer.

"I think it's real important for women to know their own bodies," said Jere Masumoto, who was diagnosed in 1990 at age 50 during her annual gynecological exam. If you're constipated for some reason, she said, that could be a sign. "Any deviation (from normal bodily functions) should be checked out — even in young people."

Masumoto did not feel sick. She thought only that she had gained a little weight.

If the disease is caught in its early stages, she said, "it's not a death sentence any more."

She should know. In 1993 she was diagnosed with breast cancer. She has survived both.

"Women are blessed with wonderful instincts," Sally Donellon said. Before she was diagnosed, Donellon was told she had kidney stones, or was suffering from gastrointestinal problems, stress and symptoms associated with menopause. "We need to trust ourselves as much as we trust the medical profession."

Early detection is essential to successful treatment of ovarian cancer. Only 25 percent of cases are discovered quickly. One in 55 women is diagnosed with ovarian cancer each year.

It is the fourth-leading cause of cancer deaths in American women behind lung, breast and colon cancer. The reason? Too many women ignore the symptoms. Or they are not forceful enough with some physicians who, in rare circumstances, may attribute those symptoms to less serious ailments.

"I was full of anger," Gayle Okada admitted to the support group. She had experienced bleeding, discharge and bloating symptoms, which the gynecologist thought were related to hormonal issues.

When Okada finally was diagnosed, her cancer had advanced to Stage 3, which meant it had spread to her abdominal area. "My problem was I gave all my trust and faith to my doctor."

During chemotherapy, which Okada finished in June, she said, "I felt like I was in a dungeon." She touched her head gently. "I still have to wear my wig."

Compliments about Okada's wig flew around the circle. She smiled, then straightened in her chair. "So now I let young girls know the experience I went through so they will be more assertive."

When the support group asked how Betty Reeter was feeling, she revealed that her CT scan showed a spot on her liver, and her blood counts were rising. The women offered support. She confessed her fear of more chemotherapy treatments — an experience with which she is all too familiar — and asked if anyone knew about with the specific drug she will receive weekly.

Karen Stern, another survivor in the group, sympathized with the turn of events, then said firmly to Reeter, "You're going to get rid of it this time."

Reeter nodded confidently. "Yes, we are."

Dr. Keith Terada, a gynecologic oncologist in Honolulu, said that women who fall into high-risk categories, such as having a family history of ovarian cancer or a history of cancer themselves, should get an ultrasound once a year to check the ovaries.

"We recommend that women pay attention to changes in their bodies," he said. "If they're having symptoms, discomfort or bloating — even relatively mild symptoms — to have them checked."

While annual gynecological check-ups are paramount, women should know that a Pap smear does not detect ovarian cancer.

If a woman suspects she might have ovarian cancer, she should ask for a pelvic/rectal exam, a transvaginal sonogram and a

CA-125 blood test. These are not screening tests, however, and are not recommended for all women because ultrasound and CA-125 are not 100 percent diagnostic. Other noncancer conditions can cause abnormal test results, Terada said.

If an ultrasound appeared worrisome or suspicious, he said, the doctor would perform surgery to remove the tumor and determine if it was cancerous.

Ovarian cancer is diagnosed in one of four stages, Terada said. In Stage 1, the cancer is contained in the ovaries, and has an 80 to 90 percent cure rate. With Stage 2, the cancer has spread to other areas of the pelvis, and has a 50 to 60 percent cure rate. When ovarian cancer is diagnosed in Stage 3, it has spread to the abdominal area. In Stage 4, other organs like the lung or liver are affected. The cure rate for stages three and four drops sharply.

Just because a woman no longer has ovaries doesn't mean she is safe from ovarian cancer. The cancer can arise from the peritoneum, the lining inside the pelvis. Though it technically doesn't originate in the ovaries, the cancer is identical to ovarian cancer, Terada said. This, however, is extremely rare.