Silent killer

Liza Finlay talks to one young survivor of ovarian cancer.

Silent killer
Liza Finlay talks to one young survivor of ovarian cancer.

Alexandra Rodgers loves her body. She likes her petite, five-foot-two frame and her long, blond hair. But what Alexandra really treasures is a five-inch seam—a thin, raised line running from her belly button to her pubic bone that demarcates a division between past and present.

The scar is a trophy, proof that Alexandra beat ovarian cancer. She was 20 when she learned she was sharing her beloved body with a cyst four times the size of her ovary. For most women, this stealthy form of cancer is deadly: many are in the
final stages before they figure out something is wrong and seek help. Alexandra herself had no tip-off that a small city of cancer cells was growing in her abdomen, nor did she have a family history.

While only about one in 70 women is expected to get ovarian cancer in her lifetime, historically, more than 60 percent of those women have presented themselves to physicians in late stages, when survival rates bottom out at only about 20 percent. That makes ovarian cancer the most fatal gynecologic cancer. The frightening morbidity rate owes everything to the eerie subtlety of early symptoms—such as abdominal heaviness, bloating or pain; feeling full quickly; frequent urination, gas and nausea—which disguise themselves as the flu, a cold or even PMS

For Alexandra, June 1, 2006, dawned like any other spring day. The temperature was climbing and clouds were settling to make the Toronto skyline resemble a charcoal sketch. Alexandra had a busy day ahead: there was work, then the 20-year-old and her boyfriend would celebrate their first anniversary. She would accomplish none of it.

Seconds after waking, she fell to the floor with a crippling pain. Curled in the fetal position, she wailed like a baby as the pain cut through her abdomen like a knife stroke. With the help of a friend, Alexandra made it into emergency at her local hospital. A few hours later, still waiting in triage, the pain had subsided and Alexandra considered leaving.

“I almost got up and walked out,” she says, “but I decided, on second thought, since I had waited so long, I might as well stay.” That second thought saved Alexandra’s life. A pelvic examination and ultrasound revealed a cyst the size of a mango nestled in her abdomen.

“I was scheduled for surgery at the end of August. On July 13, the hospital called and told me they were operating on me the next day. I couldn’t decide whether I should feel relieved that they were moving so fast or afraid that they felt they needed to.”

The doctors went in blind. The ultrasound, and subsequent MRI, told them how large the cyst was, but what they couldn’t predict was how much of the ovary and fallopian tube they’d need to remove. “I went into surgery knowing I might wake up with terminal cancer or that I might never have kids.”

Neither proved to be true. A skillful surgeon carved out all the cancer while leaving Alexandra with one working ovary. Alexandra is one of the lucky ones. A tumour the size of a mango is normally found in late-stage cases of ovarian cancer, when the chance of survival is only about 20 percent. While her growth was huge, Alexandra’s cancer was caught early. She listened to the little voice that asked, “What if this is more serious than a stomachache?”

Listening to little voices isn’t very scientific, but knowing the vagaries of your own body counts for a lot. There are no screening tests for ovarian cancer. And, as Barbara Vanderhyden, the Corinne Boyer chair in ovarian cancer research at the University of Ottawa, puts it, it’s not that there aren’t symptoms, it’s that this particular set of symptoms is easily overlooked by doctors with waiting rooms full of patients who have viruses and hormonal issues.

They are symptoms easily dismissed by women, too, who assume it’s just a little bug. Wrong. “Quite often, [women] put up with annoying symptoms for a long period of time. They’ll pass it off as that time of month or that time of life,” says Dr. Dianne Miller, division head of gynecologic oncology at the University of British Columbia in Vancouver.

Vanderhyden advises women to take symptoms seriously—very seriously. “Flu and cold symptoms are there for a few days, and then gone. But if symptoms persist for two or three weeks, you know it’s not a transient change in hormones or a cold—it’s something you need to follow up on.”

While yearly Pap smears can detect precancerous cells on the cervix, no such early-detection device exists for ovarian cancer, and the deadly disease flies under the radar for many women and their physicians. A blood test, the CA125, does allow doctors to measure a protein secreted into the blood by ovarian cancer cells, but while useful for monitoring the speed of tumour growth or cancer recurrence, it is unreliable as a screening tool (noncancerous lesions can also secrete the protein, and half of all early-stage cases of ovarian cancer do not show increased levels of CA125).

There’s good reason to be assertive about even the subtlest of symptoms. Caught early, ovarian cancer is curable in 90 percent of cases. But that assertion hasn’t been easy—until now. This past June, America’s Gynecologic Cancer Foundation announced it had reached a national consensus on the presence of common symptoms and, now, a set of early-warning signs is formally recognized here. Organizations such as Ovarian Cancer Canada urge doctors to “listen to the whispers” and recognize the flu-like signs for what they really are: precursors to a deadly disease.

Knowing the early signs is a must for all women, says Dr. Miller, as are regular pelvic exams (generally a touch-based examination of your abdomen performed most regularly by a general practitioner during your annual physical). “Nine times out of 10, you can feel what’s going on,” she says. Yet many young women are still not getting regular pelvic exams. “It’s amazing how many women have had CT scans, MRIs and ultrasounds, but they’ve never had a pelvic exam. It’s a simple test, and any doctor can do it in [his or her] office.”

There are also steps you can take to minimize your risk. While 90 percent of cases are seemingly random—like Alexandra’s, they can’t be explained by genetic inheritability—it appears that hormonal regulation reduces risk. For every year oral contraception is used, there is a 10 percent drop in risk. Put another way: using the birth control pill for five years means risk declines by 50 percent. “That’s huge,” says Vanderhyden. “There’s not much we [experts] can do to reduce risk that dramatically.”

Paradoxically, risk is reduced by childbearing, too: for every one birth, risk drops by 10 percent. Dr. Miller is quick to add the following warning, however: “Low risk does not mean no risk. Yes, you should try to lower your risk, but that doesn’t mean you don’t have to worry about it.”

Alexandra isn’t worried, but she isn’t complacent either. In addition to getting regular exams and blood work, the graduate of Ryerson University’s communication and design program is raising funds for ovarian cancer research at She’s talking about her experience to anyone who will listen. She’s refusing to be silent about the silent killer.

“My boyfriend bought me an army-print bikini so I’d look tough with my scar,” she says, laughing. She wears the bikini a lot. It reminds her and others of the importance of a fighting spirit.

Know the Early Signs
Maybe it’s just the flu or a cold or that time of month. Or maybe not. If any of these symptoms persist for more than two weeks, see a doctor and demand a pelvic exam.

?Abdominal heaviness, bloating or pain .
?Feeling full quickly
?Frequent or urgent urination
?Gas, nausea or indigestion
?Change in bowel habits
?Unusual vaginal bleeding
?Backache or pelvic discomfort