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Special to Kalamalama by Ryan D. Thornton

In attempting to understand ovarian cancer, it is helpful to think of the ovary as an orange. An orange consists of the peel, the fruit, and seeds. An ovary should be thought of in similar terms. An ovary consists of the skin surrounding the organ, the tissue inside the ovary, and the tiny follicles that develop into eggs after they are stimulated with hormones. Ovarian cancer can develop on the outer surface, or skin of the ovary, inside the ovary, or in the follicles. Ovarian cancer is most easily classified based on where it begins to grow in or on the ovary.

If the cancer begins on surface of the ovary it is called epithelial cancer. According to the American Cancer Society, epithelial cancer starts in the outer lining of the ovary. This cancer, or carcinoma, develops in the cells that cover the ovary. At present, late stage epithelial cancer is a death sentence.
There is no effective treatment for epithelial ovarian cancer. Comedian Gilda Radner and civil rights activist Coretta Scott King both died from epithelial ovarian cancer. For women attending HPU this cancer is a remote possibility. Girls as young as fifteen have been diagnosed with epithelial cancer, but the disease is more prevalent in post-menopausal women. Epithelial cancer patients are predominantly diagnosed in the later stages of the disease, and these patients typically die within 24 months.

If the cancer begins inside the ovary, it is classified as a stromal tumor. This type of tumor develops in the connective tissue that comprises the ovary and actually produces female hormones. There are several types of stromal tumors, including: granulosa cell tumor, granulosa-theca tumors, and juvenile granulosa cell tumor. The American Cancer Society classifies all these tumors as “low-grade” cancers.

Juvenile granulosa cell tumor (JGCT) can afflict women below the age of 30 and as young as 14. JGCT is not a death sentence if it is detected early. If it goes undetected and spreads, then cancer cells can attach to other organs within the abdominal cavity, (e.g. liver and intestines). Granulosa cell tumor accounts for roughly five percent of all ovarian cancers detected. Juvenile granulosa cell tumors accounts for a fraction of the diagnosed ovarian cancer cases, and doctors in Hawai‘i consider it rare. JGCT is so rare that doctors have no case studies to reference and piece together treatment plans by drawing on the treatment of other ovarian cancers.

If the cancer begins in the eggs or ova, it is classified as germ cell tumor. Often tumors that develop in the germ cells are benign. However, germ cells account for 5 percent of all ovarian tumors.
The most common type of cancerous germ cell tumor is immature teratoma. This classification usually impacts women of reproductive age, from 14-45. HPU’s female students are at greatest risk of developing immature teratoma.

Cancer’s growth within the body is classified in one of four stages. Whenever a cancerous tumor is discovered before any cells have migrated to another organ or into the abdominal cavity, it is categorized as a stage I tumor. Stage I ovarian cancer patients typically have a 90 percent five-year survival rate. The odds of survival dwindle with each progressive stage. Stage III ovarian cancer patients have about a 15 percent five-year survival rate.

Women who are fortunate enough to be diagnosed with a stage I tumor can look forward to the surgical removal of the affected ovary, fallopian tube, and tumor. This surgery can be accomplished through a small incision in the belly button. Women with stage I tumors have a good chance of survival.

Patients whose ovarian cancer is caught late have a different treatment regimen to look forward to. Once cancer metastasizes (doctor-speak for “spreads”), the chances of effectively removing all the cancer with surgery alone is greatly diminished. Instead a woman with stage II or stage III cancer will most likely undergo a hysterectomy and up to six treatments of chemotherapy. After chemo a women’s hair will grow back but so might the microscopic cancer cells. These pose a unique challenge, because now they are floating freely within the body and can latch onto any organ surface and grow into a malignant, cancerous tumor.

Ovarian cancer is especially hard on patients who survive beyond five years because odds are that the cancer will come back. Ovarian tumors can reappear after 37 years. Women who survive the cancer and subsequent treatments are at a greater risk of developing breast cancer, osteoporosis, and heart attacks. A young woman who has had her ovaries removed will go through menopause and its hot flashes, regardless of her youth.

Medical technology has made great strides in extending people’s lives, but it has yet to provide women with an effective test for the different types of ovarian cancer. Woman cannot count on a blood test, a pap smear, or physical examination to provide a fail-safe, early warning. Breast cancer can be detected by regular mammograms; there is no mammogram for the ovary. There is no definitive list of symptoms for ovarian cancer, but a list compiled through Internet research and my conversations with gynecological oncologists and my wife’s ob/gyn would include sudden weight gain, increased abdominal girth, irregular bleeding, and unexplained abdominal pain.

What a freshman girl might believe to be the “freshman 15” could be something more ominous. Tragically, my wife thought that she had just gained a little weight after she had quit smoking in 2004. Instead, an ultrasound in December of 2005 showed that she had a cancerous tumor that was more than nine inches wide and four inches tall growing from her left ovary.

Family history is no indication of a woman’s risk for developing ovarian cancer. It is not like breast cancer. Women shouldn’t be lured into a false sense of security because their mothers, aunts, and grandmothers didn’t develop ovarian cancer. My wife’s mother and father are both cancer free, as is the rest of her extended family.

In fact, a physical examination by an ob/gyn doesn’t guarantee that a small tumor will be detected. At present there is very little that a woman can do to protect herself against ovarian cancer, and unfortunately ovarian cancer research isn’t as well funded as breast cancer. Ovarian cancer kills tens of thousands of women every year, but no one is wearing colored ribbons on t-shirts to call attention to it. Instead women know very little about ovarian cancer until after they have been diagnosed themselves.

Technology, family history, and normal visits to the gynecologist can’t effectively identify ovarian cancer. Treatment options are limited compared to other ailments. A person who suffers a heart attack can have a balloon inserted into their femoral artery and then inflated in their heart (angioplasty), undergo a by-pass surgery, or get a heart transplant. A woman diagnosed with ovarian cancer can either undergo a hysterectomy and chemotherapy or die, and in some cases the surgery and chemotherapy just add a few months to a woman’s life.

A woman’s best chances of survival lies in being intimately familiar with her body and listening to the little voice that tells her that something isn’t quite right. An informed woman is still her own best chance of survival.



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