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
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
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
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
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
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.