In Canada today, you would be hard-pressed to find someone who has not been affected by cancer. Whether it’s a family member, a friend or oneself, every Canadian has experienced the cruelties of the disease that can come in so many forms.

Some types of cancer are more familiar to us than others. Breast cancer, which is the most common cancer in Canadian women, is high in the public consciousness through awareness campaigns and large-scale fundraising activities. Breast cancer is also one of the easiest forms of cancer to detect, making survival chances relatively high.

Unlike breast cancer, ovarian cancer is not as widely known or understood. The latest Canadian figures available show that in 1999, an estimated 2,500 new cases of ovarian cancer were discovered in Canadian women. That makes ovarian cancer responsible for only about 4% of new cancer cases in Canada. However, 1,500 deaths were also attributed to it, or 5% of all cancer deaths in Canadian women.

The reason the mortality rate is so high is that ovarian cancer is very difficult to detect—especially in its early stages, when it can be treated most effectively. In fact, only about 10% of ovarian cancers are detected in the early stages.

WHY IS IT SO HARD TO DIAGNOSE?

There are three main reasons that ovarian cancer often goes unnoticed. The first is the female physiology. The ovaries, where ovarian cancer is housed, are deep within the abdomen, and when symptoms relating to the cancer are apparent, they are often misinterpreted as other ailments. Secondly, symptoms of ovarian cancer are generally very subtle until the cancer has reached its later stages. This lack of noticeable physical warning is why ovarian cancer is referred to as “the whispering disease.” All too frequently, both women and their doctors ignore symptoms when they are faint. And thirdly, there is no single, definitive test available to detect ovarian cancer in its early stages. Women need to pay attention to their bodies and their family history, and work with medical professionals who can then use a series of tests to establish a diagnosis.

WHO IS AT RISK?

• Older women: six out of ten women diagnosed with ovarian cancer in 1999 were between the ages of 50–79.
• Women who have never had children.
• Women who have never taken oral contraceptives.
• Women who are of Ashkenazi Jewish, Icelandic or French Canadian descent.
• Women whose close relatives (two or more of mother, sister, daughter) have had ovarian cancer.
• Women who carry the gene mutations BRCA-1 or BRCA-2, which brings with it a much greater risk of both breast and ovarian cancers (This can be determined through genetic testing).
• Women whose menstrual periods began at an unusually young age and ended at a later-than-usual age, and who therefore have had more menstrual cycles than average.

WHAT CAN YOU DO TO REDUCE THE RISK?

There are several things that women can do to reduce the likelihood of developing ovarian cancer. Childbearing, breastfeeding and taking birth-control pills all have a positive impact on women’s risk factors, possibly because of the interruption of ovulation. For women at high risk, such as those who carry the mutated BRCA-1 or BRCA-2 genes, tubal ligation, hysterectomy or removal of the ovaries are options that can help to reduce the occurrence of ovarian cancer.

WHAT ARE SOME OF THE SIGNS?

It is incredibly important for women to pay attention to their own bodies. The symptoms of ovarian cancer are usually vague, and include: bloating, indigestion, abdominal/pelvic pain, changes in urinary/bowel habits, nausea, fatigue, abnormal vaginal bleeding and constipation. The key to differentiating these symptoms of ovarian cancer from other less serious disorders is persistence. If you find you have had vague symptoms like the ones listed above for more than three weeks, consult a doctor. Even if you feel your symptoms are not serious, remember that ovarian cancer does not produce severe symptoms until it is in its late stages, when the disease has a secure foothold in the body. It is better to be safe than sorry.

HOW WILL YOU AND YOUR DOCTOR KNOW?

Contrary to earlier widespread reports, there is no single test that can detect the disease. The CA-125 blood test is only 50% effective in detecting early-stage cancers, and is therefore not definitive. A combination of a pelvic/rectal examination, vaginal or abdominal ultrasound, and a CA-125 blood test can often detect the cancer. There is another diagnostic tool emerging called the “Ovarian Pap Test,” which uses laparoscopy to collect cells from the ovaries and abdomen, much as a pap test collects cells from the cervix to test for cervical cancer. This test has not yet been widely accepted, but will hopefully come into practical use in the near future.

Unfortunately, ovarian cancer is still not widely understood, and screening methods in the medical community must be improved through continued research. The best thing that women can do to protect themselves is to pay attention to their bodies, visit their gynaecologist annually and listen for any unusual whispering from within.

For more information, visit www.ovariancanada.org, www.hc-sc.gc.ca or www.ovariancancercanada.ca.