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Cancer of the OvaryDr Kingsley’s comments Cancer of the ovary is the fifth most common cancer in women. It occurs in roughly one in every seventy women. It tends to be more common, so the statistics say, in women over 60 years old, but nearly all those I have seen with it are younger. It tends to be more common in women who have never had a baby. Perhaps the most common starting symptom is abdominal distension. Once it has occurred, the appearance of the tummy swelling is really quite characteristic, tending to occupy the lower half of the abdomen. By the time this has occurred, there is likely to be a considerable amount of fluid in that area, and the condition is considered to be fairly advanced. In the early stages, then, there are usually no particular symptoms. Other symptoms are sometimes abdominal pain, weight loss and vaginal bleeding. Otherwise there is strangely very little disturbance of the monthly cycle. Investigations. An ultrasound or CT scan, laparoscopy (when a camera is inserted through a tiny cut in the abdominal wall to have a look inside), examination of a sample of the fluid (called ascites) to look for cancer cells and a blood test for CA125 which is raised in 80% of cases. However, most cases are diagnosed at laparotomy (when a surgeon opens you up and has a proper look inside. Names. If you read about cancer of the ovary in medical textbooks, you will come across various names, which are given according to what a sample looks like under a microscope. Nearly 90% of all cancers of the ovary fall into one of the following descriptions, namely serous cystadenocarcinoma, mucinous cystadenocarcinoma, endometrioid carcinoma, undifferentiated carcinoma or clear cell carcinoma. The rest are either germ cell or granulosa carcinomas. However, these names are merely technical to help the doctor decide on the most appropriate treatment regime. Conventional Treatment. Surgery (an operation) is the mainstay of treatment. The aim is to remove as much of the tumour as possible, including the whole of the uterus, the Fallopian tubes and the ovaries, plus an apron called the omentum (see the diagram). This operation is called a ‘total abdominal hysterectomy plus bilateral salpingo-oophorectomy’, and is referred to as a debulking operation. It is carried out through a vertical incision in the abdominal wall. While radiotherapy is seldom given and of little value, chemotherapy is used, with a reasonable degree of initial success. Spread/Secondaries Cancer of the ovary tends to spread within the abdomen. While satellite tumours, separate from the original one, may develop, it is usually the original tumour that gradually grows locally. The tumour may cause obstruction to other organs, leading to bowel problems, kidney problems or block the return of blood from the limbs, so causing venous obstruction and hence swelling of the legs. An Explanation by Dr Kingsley Before Your Consultation about your Ovarian Cancer “Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having ovarian cancer. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your ovarian cancer, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer. |
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(c) 2006 |
