Thirtysomething Raises Ovarian Cancer Concerns; Here Are Some Answers
Among the viewers has been ovarian cancer specialist Dr. John Lurain, 43, director of gynecologic oncology at Chicago's Northwestern Memorial Hospital and professor at the Northwestern University Medical School. A 1972 graduate of the University of North Carolina Medical School, Lurain has treated hundreds of women suffering from the disease and has written and lectured extensively on the subject. Finding a cure for this cancer, unfortunately, is not one of medicine's success stories. Over the past decade, the number of reported cases has shown a gradual increase, and deaths have tripled in the past 50 years. Just last year, public attention was focused on the disease when it claimed the life of Gilda Radner at age 42. Yet there have been advances. In 10 years the survival rate for advanced ovarian cancer has risen from only 5 percent to 20 percent. Lurain won't try to anticipate the outcome for thirty-something's Nancy Weston, but he believes that someone in her condition, with a cancer that has spread only slightly, has about a 75 percent chance of survival.
Born in Princeton, III, Lurain now lives in Oak Park with his wife, Nell, a Ph.D. candidate in molecular virology, and two daughters, Alice, 13, and Kate, 6. He talked with correspondent Giovanna Breu about this devastating disease.
Why do you think viewers are so gripped by Nancy's illness?
When you are in your 30s, you are in the prime of life. You don't think of yourself as getting cancer and dying. People get upset because they know this could happen to them. However, less than 10 percent of the women diagnosed with ovarian cancer are under 40.
Who is most likely to get the disease?
The women most at risk are those who have had few or no pregnancies and have never taken oral contraceptives. In other words, their ovulation has rarely been interrupted. In general, it is a disease of older women. The average age of onset is about 54; the risk peaks in the 70s.
Is a family history of the disease a factor? For women who have more than one maternal blood relation—mother, sister, aunt or grandmother—with ovarian cancer, the chances of getting the disease may increase up to 50 percent. Such women also tend to develop the disease earlier and should be watched closely.
Are there any preventive steps?
Regular checkups by your gynecologist are vital. We suggest that patients with a family history of ovarian cancer consider having their uterus, tubes and ovaries removed after childbearing is complete. Unfortunately that does not always prevent the disease. The abdominal cavity is lined with the same tissue that forms the outside of the ovaries. Whatever stimulates the cancer on the ovary occasionally does the same elsewhere in the abdomen.
Is ovarian cancer easy to detect?
No. Seventy percent of the time, women don't have any symptoms until the cancer has already spread. It tends to spread early because the cancer cells develop on the outside of the ovaries. As those cells drop off the ovary, they attach themselves to other surfaces in the abdominal cavity and grow there.
Can the cancer be treated if it has spread?
Yes, but the chances of cure are reduced. Stage I ovarian cancer, where the tumor appears to be confined to the ovaries, has a 70 percent to 90 percent five-year survival rate, depending on whether there are cancer cells floating in the abdominal cavity. Stage II, where the cancer has spread to other pelvic regions, has a 40 percent to 60 percent cure rate. Stage III, where the tumor has spread throughout the abdominal cavity but not beyond, has a 15 percent to 20 percent survival rate. In Stage IV, where there are distant metastases, the five-year survival rate is near zero.
What symptoms should women look for?
Many women being treated for ovarian cancer report having had vague gastrointestinal symptoms, which they ignored or dismissed as unimportant. These could be such things as abdominal bloating, pain and persistent indigestion. Middle-aged and older women who develop such symptoms should be checked promptly.
How is the disease diagnosed?
A routine gynecologic exam may disclose an abdominal or pelvic mass. An ultrasound scan through the abdominal wall or the vagina may provide more information, but it won't tell whether a tumor is malignant. It doesn't eliminate the need for diagnostic surgery.
How is ovarian cancer treated?
The most important step is surgery. The initial operation almost always involves removal of both ovaries and the uterus as well as taking multiple biopsies from other areas. If the cancer has spread, it is vital to aggressively remove as much of the metastatic tumors as possible. We have ultrasonic aspirators that blast the tumors and suck up the cancer cells. If we can remove all of the diseased tissue, you have a 40 percent cure rate.
What does postoperative treatment entail?
Most patients receive chemotherapy, usually one day of treatment every three to four weeks. We now have techniques and drugs that virtually eliminate the nausea and vomiting associated with chemo. Through a catheter implanted into the abdomen, we can also put the chemotherapy in direct contact with the remaining cancer cells. We can't prevent hair loss, but that is temporary.
How do you know if treatment is successful?
After chemotherapy, we often do a second-look operation to see if there is any cancer left. There is also a blood test, called CA 125, that measures an ovarian tumor antigen that is present in 80 percent of patients who have ovarian cancer. If the antigen goes down to normal limits, it's a good sign.
Why have the incidence and death rate of ovarian cancer kept increasing?
We aren't certain. Perhaps it is the aging of the population or better diagnosis or other factors we aren't yet aware of.
Is thirtysomething giving an accurate picture of what it's like to have ovarian cancer?
I think Nancy's reaction of "Why me?" followed by anger is true of most women. She feels that she has had her femininity taken away from her, and she thinks she may not see her child grow up. People treat her differently and don't allow her to talk freely about her disease.
What approach do you take with patients?
We are always truthful, we are kind and we are hopeful. I think that's very important, for patients to feel there is some hope. We tell them that almost all the patients we treat have an excellent response to chemotherapy and a chance for cure. But even if they don't survive five years, they are living longer and leading more productive lives than they used to. The whole idea of having cancer makes all of us very nervous—on the TV show, one friend was even afraid to touch Nancy. That's a shame. Women with ovarian cancer, or any type of cancer, need people to talk to.