A Not-So-Silent Killer
The Philadelphia Inquirer
Monday, June 25, 2007
www.Philly.com
By: Marie MrCullough

Activists won a fight to have the medical establishment recognize that ovarian cancer has early symptoms. But that is only half the battle.

When a gynecologist and three other doctors misdiagnosed April Donahue's symptoms for six months, their confusion was understandable. She was 24 years old, complaining of bloating and abdominal pain. Even a diagnostician as brilliant as cable television's Dr. House might not have suspected she had ovarian cancer, a relatively uncommon disease that typically develops after menopause.

But she did. It was discovered only because her gynecologist removed what he thought was an ovarian cyst. Fortunately, the tumor was still in an early stage. Ten years later, when Donahue again developed persistent bloating and abdominal pain, the confusion was not so understandable. "My gynecologist said, 'You should see a gastroenterologist,'" recalled Donahue, who lives in Kintnersville, Bucks County. "I said, 'No, I'm going to see a gynecological oncologist.'"

Surgery confirmed that the 34-year-old had cancer in her remaining ovary. Now 40 and president of the National Ovarian Cancer Coalition, Donahue and legions of sister survivors have been urging experts to stop calling the disease a "silent killer" and start raising awareness of its symptoms. Their hard-earned wisdom is finally winning out.

Three prominent cancer organizations declared their consensus this month that ovarian cancer does have warning signs. To be sure, these signs - bloating, pelvic or abdominal pain, difficulty eating, feeling full quickly and urinary urgency or frequency - are common to many illnesses, and sometimes bother healthy people. But recent research shows these complaints start more suddenly and are more frequent, severe and persistent in this with ovarian cancer, even in the disease's early stages.

That's why the new recommendations say women who have any of these symptoms almost daily for several weeks should see a doctor. "Early-stage diagnosis is associated with an improved prognosis," notes the consensus statement from the Gynecologic Cancer Foundation, the Society of Gynecological Oncologists and the American Cancer Society.

ADVICE ON OVARIAN CANCER
Although more than a dozen symptoms are related to ovarian cancer, four have been found to occur much more frequently in women with the disease than in those without it.

Those four also tend to arise suddenly, persist and become severe:

• Bloating
• Pelvic or abdominal pain
• Difficulty eating, or feeling full quickly
• Urinary urgency or frequency

Women who experience any of the above almost daily for more than a few weeks are urged to see a gynecologist for a pelvic exam. Follow-up with a CA125 blood test and a pelvic ultrasound may be warranted.

Hormone Therapy
Researchers Reported last week that a new analysis of the landmark federal study of menopausal hormone therapy had found a small heart benefit for women in their 50s who had hysterectomies and took estrogen without progesterone.

Women in that subgroup had less plaque build-up in their arteries than women taking placebos.

But hormone therapy recommendations are still studded with caveats.