<< Previous   of   Next >> (click to enlarge) “I have always tried to deal with things light-heartedly and jokingly because that’s my coping mechanism,” said Kim Graham, wearing her “Cancer Sucks” shirt. Fighting ovarian cancer has brought her to tears from time to time, “but being sad, angry or depressed is such a negative energy. ... It’s such a waste.”

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Fast facts

By the numbers * According to the American Cancer Society, ovarian cancer ranks fifth as the cause of cancer death in women. It is estimated that more than 20,000 women are diagnosed with ovarian cancer annually in the United States and about 15,000 die each year from the disease. * Only about 20 percent of ovarian cancers are found in the early stages of the disease, according to the Mayo Clinic. * When ovarian cancer is detected in its early stages, the five-year survival rate is about 93 percent, according to the Ovarian Cancer National Alliance. When ovarian cancer is detected in an advanced stage, the five-year survival rate is about 30 percent. Symptoms According to Dr. Barbara Goff, director of gynecologic oncology at the University of Washington School of Medicine, symptoms for ovarian cancer include bloating; increased abdominal size; urinary symptoms, including urgency; feeling full quickly; difficulty eating; and abdominal pain or pressure. If any of these symptoms are of relatively new onset and persist for more than three weeks and occur multiple times in a month, a woman should see her medical practitioner, Goff said. Risk factors From age to family history, there are a number of risk factors for developing ovarian cancer, according to the American Cancer Society. Here are some of those factors: * Ovarian cancer often strikes after menopause, with half of all ovarian cancers found in women over the age of 63. * Obesity. * Family history of ovarian cancer, breast cancer or colorectal cancer. * Personal history of breast cancer. Reducing the risk While there isn’t a known way to prevent ovarian cancer, the following have been shown to reduce the risk, according to the National Ovarian Cancer Coalition: * Oral contraception if taken for several years. * Breast feeding and pregnancy. * Tubal ligation. * Hysterectomy. * Prophylactic oophorectomy (surgical removal of one or both ovaries). For more information, go online to www.cancer.org or www.ovarian.org.

CONTACT SCBJ John Wolcott, Editor jwolcott@scbj.com

Detecting ovarian cancer early

Abdominal bloating, pain and pressure among symptoms

By Kimberly Hilden
SCBJ Assistant Editor

Two years ago this month, Kim Graham received a life-changing diagnosis: ovarian cancer. Like the majority of women diagnosed with the disease, the 36-year-old mother of two’s cancer already was well advanced.

“I was late-stage three,” said Graham, service contracts manager and HIPAA coordinator for Philips Healthcare in Bothell.

In the months before the diagnosis, Graham had experienced symptoms of ovarian cancer, “but you don’t think of those,” she said. “I was gaining weight but just assumed my metabolism was slowing with age. I was tired and fatigued, but I have two kids. I had digestive problems, but I have a demanding legal career.”

She went to the doctor’s office complaining of digestive problems. During the physical exam, the doctor pressed on her ovaries but didn’t feel anything. She left the office with a prescription for acid reflux.

“My mom had ovarian cancer 10 years ago in her mid-40s, but nobody else had ovarian or breast cancer (in the family),” Graham said. “I remember her telling me that she, too, was putting on weight and when she pushed down on her ovaries, she felt a lump. My spot was up higher, near the rib cage. You’re not thinking ovarian cancer would be up there.”

Then she experienced fluid retention that made her look as though she was “pregnant with twins,” and the Marysville resident decided to take control of her health.

“I pulled up the (Web site) mayoclinic.com and looked at ‘ovarian cancer,’” said Graham, who discovered that her symptoms were an exact match with the disease. “I called up the doctor and said, ‘I have ovarian cancer.’”

She was diagnosed with the use of a CT scan and a blood test to measure her cancer antigen 125 (CA-125) level. Elevated CA-125 can be an indicator of ovarian cancer but also can be an indicator of endometriosis, pancreatitis, pregnancy, menstruation and pelvic inflammatory disease, according to the Mayo Clinic. For this reason, it is not a sole indicator of ovarian cancer.

“When I was first diagnosed, my CA-125 was five times the normal,” Graham said. “... I remember (my doctor) sitting me down and saying it was cancer. The whole room got really quiet like just before you faint. I was mentally saying to myself, ‘Don’t pass out; don’t hit the floor.’”

She quickly was referred to Dr. Barbara Goff, director of gynecologic oncology at the University of Washington School of Medicine and an affiliate of the Seattle Cancer Care Alliance.

“By the way I described the past couple of years, the cancer began growing when I was 34, is when she’s guessing,” Graham said.

“Studies have shown that about 90 percent (of patients) with early-stage (ovarian cancer) will have symptoms, which is why paying attention to these symptoms is so important,” said Goff, noting that cure rates are 70 to 90 percent when ovarian cancer is detected early, while women with advanced stages of the disease have a “10 to 30 percent cure rate at best.”

Ovarian cancer symptoms can include bloating; increased abdominal size; urinary symptoms, including urgency; feeling full quickly; difficulty eating; and abdominal pain or pressure, Goff said.

While these are common symptoms associated with a number of conditions, research done by Goff has shown how to distinguish them for ovarian cancer. Distinguishing characteristics include:

* If the symptom or symptoms are of relatively new onset.

* If the symptom or symptoms persist for more than three weeks and occur multiple times in a month.

“When you look at those symptoms and you see them occurring — it’s a new symptom, persisting and not explained by something simple — then that becomes concerning, and those are things that women should bring to their physician’s attention,” Goff said.

At that time, a woman should undergo a complete physical exam including a pelvic exam and a recto-vaginal exam, she said. “Depending on the results of the exam, it may be appropriate to wait a couple of weeks to see what happens, or it may be appropriate to have a transvaginal ultrasound performed to take a look at the ovary.”

By the time of Graham’s diagnosis in May 2006, the ovarian cancer was evident in both her ovaries, on both her bowel intestines and close to the lymph node, but not in it. The cancer also had spread into the omentum, a fold of peritoneum that covers and supports the abdomen.

She underwent surgery to remove all traces of visible cancer and then underwent 18 weeks of chemotherapy treatment, finishing up in October 2006.

“I had a full-body CT scan. There were no signs of cancer. Dr. Goff said I was in remission,” Graham said. “But it’s similar to if a child is roller-skating and falls down and is hesitant to get up again. ... It’s hard to get along with life after being diagnosed with late-stage cancer.”

In December 2007, she started to gain weight again. Then came the news that the cancer was back – this time in her liver, spleen, pelvis and abdomen. Graham said she wasn’t surprised. “I kind of suspected it.”

The cancer that returned was low grade and slow growing. But a second round of chemotherapy treatment also revealed that it was resistant to that treatment.

In March, Graham began participating in a research study through the University of Washington and Virginia Mason using a drug approved by the U.S. Food and Drug Administration for use in colon and rectal cancers and another drug that is designed to kill blood cells that would feed the cancer. The study calls for Graham to undergo 12 weeks of treatment.

“The hope is that it works; that it either shrinks or stabilizes the cancer,” she said. “... Yeah, it’s back, but I hope to beat it again.”

As a working mom, Graham said she knows how easy it is for women to discount their own health issues in the hustle and bustle of day-to-day living. But she said listening to your body and your instincts should be a priority.

“Don’t be afraid to take responsibility for your own self,” she said. “... You have to take some control. No one knows your body better than you.”