Ovarian Cancer: Learn Why Knowing Your Family History is Critical
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In October 2013, Debbie Walter began feeling lousy. Her stomach was bloated, and she felt as if she were “five months pregnant.” So the 45-year-old Cincinnati native scheduled a visit with her ob/gyn, who thought it was a gastrointestinal issue and referred her to a specialist. But the weekend before that appointment, Debbie felt worse – bad enough to call her family physician on Saturday. “He recommended going to the emergency room,” she recalls. “I thought he was nuts and said, ‘Do I have to?’ He prescribed an antibiotic but said, ‘if you vomit, go to the ER.’”
That’s where she ended up the next day – the emergency room at Good Samaritan Hospital. There, a computed tomography (CT) scan found a mass, which was confirmed by a blood test the following week to be ovarian cancer. Like most ovarian cancers, it had already spread to other organs, and Debbie’s was classified as stage 3.
“I was stunned,” she says. Her husband, Andy, 46, a vice president of information technology at Procter & Gamble, was scared. “We were high school sweethearts, and I had never seen the man cry. But he cried about this,” says Debbie. “That was shocking to me.” Their two children, Michael, 19, a student at the University of Cincinnati, and Austin, 17, who attends Saint Xavier High School, were equally upset. But Debbie was determined to battle her disease. “I put on my combat boots and got ready to fight,” she says. “I never considered dying.”
She may not have considered it, but the fact is that ovarian cancer is a very dangerous disease. Survival length has increased gradually over the past 20 to 30 years, says Jack Basil MD, a gynecologic oncologist who chairs the Department of Obstetrics and Gynecology at Good Samaritan Hospital and is chair of the TriHealth Women’s Services board, but “in general, the five-year survival for ovarian cancer is about 45 percent.” The odds are poor because, unlike colorectal and breast cancer, ovarian cancer is very difficult to detect in its early stages, when it is more easily treated. “By the time symptoms show up, it has probably spread,” says Dr. Basil. “Debbie’s case was typical in that 75 percent of cases are diagnosed in stage 3 or 4.”
Although her head was “spinning” immediately after her diagnosis, Debbie and her husband began searching for the best doctors in the area. “Dr. Basil’s name kept coming up,” she says. “Everyone said, ‘You need to go to him.’”
She did. And Dr. Basil, who had seen her medical records by the time she consulted with him and was aware of the need to act quickly, had already scheduled time in the operating room for her. “We felt very confident in choosing him,” says Debbie. “Andy and I had made our minds up that we weren’t going to waste time interviewing a lot of doctors. I wanted to get the cancer out of me. We asked him one question that reassured us – why should we choose him? He wasn’t cocky. He said, ‘What I am doing is following protocol, the same as what a doctor at a specialty hospital would do.’ He was not offended that we asked, and he answered the question very well.”
“Debbie was a typical ovarian cancer patient,” Dr. Basil says. “She experienced nonspecific symptoms lasting a couple of months.” Those symptoms usually include abdominal or pelvic pain and bloating. Along with her CT and blood test results and her stage 3 diagnosis, her family medical history included a history of breast cancer, which is strongly correlated with ovarian cancer. “With overwhelming information like that, we feel that no biopsy is necessary,” he says. “Surgery is the initial therapy.”
Just eight days after her first visit to the doctor for abdominal pain, Debbie underwent a total hysterectomy, including removal of her fallopian tubes and ovaries, along with “radical tumor debulking” – removal of cancerous tissue from her surrounding organs. “She seemed to tolerate things very well,” Dr. Basil recalls. “She was in a category called ‘optimally debulked,’ which gives her a survival advantage.”
Debbie spent five days in the hospital. “It was a very hard surgery,” she says. “I basically lay on my couch and slept for a full month afterward.” Her chemotherapy, which she started about a month after the surgery, was difficult too. She received six 21-day cycles of chemo over five months through a port inserted in her abdomen, which delivered the drugs directly to the site of her cancer. “I had to lie flat for five hours,” she says. But the treatments worked, and her blood tests were normal when they were finished. “She had a complete response – there was no evidence of disease,” says Dr. Basil.
But ovarian cancer is an insidious disease, and eight months later, in December 2014, a follow-up CT scan found evidence of cancer near her bowel and bladder and in her upper chest. “This is common,” says Dr. Basil. “The majority of ovarian cancers that are advanced will recur.” Debbie went through another round of chemo, finishing in May 2015. If successful (follow-up visits to determine the results were scheduled for press time), she will likely go on maintenance drug therapy to try to prevent recurrence. If not, she will undergo more chemo.
During her remission, Debbie also had genetic testing. “She was very young to develop ovarian cancer, in her early 40s, so hers was likely hereditary,” Dr. Basil says. Sure enough, she was found to carry the BRCA1 gene, which is linked to both ovarian and breast cancer. Her three sisters were also tested, and two came back positive as well.
“My grandmother and seven of her sisters all died from breast cancer, so that was in my mind,” she says. “I was always concerned about breast cancer and getting my mammograms. But I didn’t know the relationship between ovarian and breast cancer.” In October 2014, before her ovarian cancer recurrence, Debbie had a double mastectomy as a prophylactic measure. She was in the middle of reconstructive surgery when her cancer recurred, so it was put on hold during her chemo treatments. When she is in remission once again, she will return to her reconstruction.
Debbie says Dr. Basil never gave her an ultimate prognosis for her disease. “He told me the statistics, but I don’t think there is a true answer,” she says. “Ovarian cancer is so different in everybody. My attitude is to stay positive. Of course you have moments where you’re upset and scared. But having a positive outlook and being proactive are the best things you can do for yourself.”