Recognizing Ovarian Cancer

Dancer and professional choreographer Tiffany Patterson, who counts MC Hammer among her colleagues, knew right away there was something wrong when she felt a sharp pain in her abdomen. Patterson listened to her instincts and went straight to the ER at Lehigh Valley Hospital–Muhlenberg, where they did blood and imaging tests. The results showed the cause of her symptoms was a mass attached to her abdominal wall; bloodwork findings and later testing confirmed it was ovarian cancer.

In a way, Tiffany was lucky. She had a clear sign that told her to act. Typically, ovarian cancer may cause nonspecific symptoms such as abdominal swelling or pain, but often there are no symptoms at all. There is also no reliable screening test. For these reasons, ovarian cancer can go undetected until it reaches an advanced stage. And the 5-year survival rate is only 50.9%

In Tiffany’s case it was caught early. She underwent multiple rounds of chemotherapy. Then, gynecologic oncologist M. Bijoy Thomas, MD, a high-volume robotic surgeon who typically performs 15-20 robotic surgeries each week and has recently reached his 4,000th robotic surgery, performed a robotic total hysterectomy.

Dr. Thomas and the team at Lehigh Valley Topper Cancer Institute encourage women to be aware of the symptoms – in the event they do appear – so that early detection is possible.

Symptoms can include:

• Indigestion, heartburn, nausea or gas
• Belly swelling or a sense of fullness, especially after eating
• Pelvic pain, cramping or backache
• Painful, frequent or burning urination with no infection
• Loss of appetite or unintentional weight loss or gain
• Heavy vaginal bleeding or irregular periods
• Pain during intercourse

While these symptoms could be associated with various other conditions, Christine Kim, MD, a board-certified and fellowship-trained gynecologic oncologist with LVPG Gynecologic Oncology, part of the Cancer Institute, advises being wary. “If you are experiencing these symptoms persistently, or if they are occurring more than six to eight times in a month, it’s a good idea to see your doctor,” she says.

Having ovarian cancer risk factors does not mean that you’ll develop the disease. However, if they are part of your medical profile, it’s a good idea to alert your gynecology clinician so they can be on the lookout. These are some of the most common risk factors:

• Being of Ashkenazi Jewish heritage or of Eastern European Jewish descent
• Having a BRCA1 or BRCA2 gene mutation
• Having a family history of ovarian or breast cancer
• Older age
• Having children later in life or not at all
• Receiving hormone therapy after menopause
• Undergoing fertility treatment
• Having a history of endometriosis
• Being overweight or obese
• Having a smoking history

There are also preventive measures you can take to lower your chance of developing ovarian cancer. “Research has shown that taking an oral contraceptive for an extended period of time, having children, breastfeeding or having your tubes tied can reduce your risk,” Dr. Kim says.

According to the American Cancer Society, approximately 25 percent of all ovarian cancer diagnoses are related to inherited genetic mutations. Therefore, it’s important to talk with family members about the disease.

If you do have a family history of ovarian or breast cancer, a hereditary cancer syndrome (such as Lynch syndrome) or an inherited gene mutation (BRCA1 or BRCA2), you might consider genetic testing through the Cancer Institute’s Gregory and Lorraine Harper Cancer Risk and Genetic Assessment Program.

Talk to your primary care clinician about eligibility and a referral to the program. You can also call 610-402-8787 to request an appointment or get more information.

Surgical options, skilled surgeons and a responsive staff are fundamental for a good operative experience and positive outcomes. These are the top “must-haves” at Lehigh Valley Institute for Surgical Excellence, part of Lehigh Valley Health Network, where cancer specialists use their experience to help determine the best route for a patient.

“With aggressive ovarian cancer, studies show that the optimal type of surgery is the one that ensures removal of all diseased areas,” Dr. Kim says. “Many times, that may mean an open abdominal approach with surgical removal involving bowel, diaphragm and spleen resections.” In some cases, robotic surgery may be appropriate.

"The Surgical Institute is one of the premier robotic centers in the nation,” Dr. Thomas says, noting its fleet of 18 robots including two, recently added state-of-the-art da Vinci 5 robots. “The 3D technology magnifies tissue structures 10 times. The robotic instruments have better articulation than the human wrist, which results in minimal tissue damage and blood loss. Postoperative pain is minimal, and recovery is much faster after robotic surgery compared to traditional surgery.”

“Fortunately,” Dr. Kim says, “we have both avenues with excellent surgical technology and surgical colleagues to help us be as aggressive as we need to be.”