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Photo: Shiraz with devoted husband Alistair and Islay
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While breast cancer threatens to be an unstoppable steam engine barrelling down the tracks, often spewing some smoke that can be seen or blowing a whistle that can be heard miles ahead, ovarian cancer is like a glider carrying a time bomb, beyond the clouds, unseen and silent. We are constantly on the lookout for trains, but who looks up in the sky for gliders?
The irony is, while the train can be hard to get rid of even if it were standing still, the fragile glider can be easily disabled before it leaves the ground. But once in the air, it can be tough to find, and deadly.
Early detection is key
Ovarian cancer is relatively easy to cure if found early and confined to the ovary. About 90 per cent of such confined cases can be cured with surgery alone. But there is no mammogram, no breast exam for ovarian cancer. The ovaries are deep inside a woman's abdomen. They cannot be felt. Relative to the size of the breast, they are tiny. So for most women with ovarian cancer, it grows beyond the ovary, quietly and insidiously. It can invade nerves, make large blood vessels become narrow and slowly compress the bowel, all with no symptoms for a long time. Only at late stages do women begin to notice that something is odd.
Digestion seems off, some bloating, a change in bowel habits perhaps, tiredness, maybe some weight loss (usually not a bad thing these days, is it?). Nothing seems terribly alarming to the unsuspecting woman. However, by this time, ovarian cancer has spread throughout the abdomen. Intense chemotherapy and surgery can tame some ovarian cancers, but usually only temporarily, and the attack on a woman's quality of life is devastating. Ovarian cancer almost invariably returns, sometimes in months, often within a year or two. Rarely is it gone for good. Furthermore, even gynecologic cancer doctors will admit that the research focus has naturally been on breast cancer because of the relatively greater number of women stricken by it.
A silent killer
Huge improvements in public awareness has translated into some great progress in treatment of advanced breast cancer. But sadly, the opposite is true of ovarian cancer. The last 20 years have seen little decrease in deaths from advanced ovarian cancer. Even with present treatments, fewer than five to 20 per cent of women will survive beyond five years. Relatively little basic research is being conducted in ovarian cancer because it has not been the "squeaky wheel"; its silence deep inside the body has kept it relatively unnoticed, usually until it is too late.
A vision of hope on the horizon
We need to understand the science behind what prompts ovaries to develop cancer. We need to look for the early telltale biological signs of ovarian cancer. If we could reliably find the ovary containing a cancer, the affected ovary could be removed, something far less difficult to bear than the disfigurement of mastectomy or breast surgery. And the ovarian cancer cure would be real and reliable. A runaway train might be stopped if you know it's coming, but how do you stop the deadly glider if you can't see or hear it?
Dr. Bagli is an Associate Professor of Surgery/Urology and Associate Research Scientist at the Hospital For Sick Children in Toronto. His specialty is surgery and treatment of urinary and genital tract disorders in children. His research interests are in wound healing and cancer biology. He trained in Physiology, Music, and Medicine at McGill University in Montreal, and Urology at Harvard Medical School in Boston and the University of Washington in Seattle. Most importantly, he is Shiraz's brother who lost his sister (pictured above) to ovarian cancer and misses her so very much.
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