Unmasking A
Silent Killer
Written by JENNY DEAM
Karen Meyer lay alone in her hospital room with only the slash of light from the hallway splitting the pre-dawn darkness. Her post-surgery morphine was starting to wear off. She decided it was time to have a talk with God. “I’m not ready to go yet,” she prayed silently but vehemently.
That moment in the early hours of Jan. 16, 1999, was
almost a decade ago. Now 48, Meyer has overcome the odds by beating ovarian cancer, the deadliest of all pelvic cancers. Called the silent killer for good reason, ovarian cancer may be rare, but it is also among the types least likely to be caught early.
By the time the cancer is discovered, typically it has already advanced. Of the 21,000 women expected to be diagnosed with ovarian cancer in 2008, an estimated 15,000 will die within five years, doctors say. That compares with a roughly 80-percent to 90-percent overall survival rate for the more common breast cancer and uterine cancer.
In addition, about 75 percent of women with later-stage ovarian cancer will have a recurrence in their lifetime.
“The majority of women when they are finally diagnosed (with ovarian cancer) are already behind the eight ball,” says Dr. Daniel Donato Jr., one of the nation’s leading gynecological cancer experts, based at the Rocky Mountain Cancer Centers at Rose Medical Center.
Unlike breast cancer, where a lump can be detected early, or uterine cancer, where unexplained bleeding or pain is a tip off, ovarian cancer grows vigorously in stealth without telltale, specific symptoms in the beginning.
A busy professional with a new marriage and a daughter in high school, Meyer thought her vague lower back pain was a holdover from an old sports injury and her fatigue was from stress and a perpetually crowded Daytimer. “Who at the end of the day isn’t tired?” she asks.
At her annual checkup in December of 1998 she didn’t even mention her complaints. During the exam her gynecologist discovered a cyst about 4 centimeters in size. It was dismissed as nothing to worry about. After all, there was no cancer history in her family. A week later the tumor had grown to 10 centimeters. Two weeks later the diagnosis was cancer, and the prognosis was grim. Meyer was later told if her exam had been in June rather than December, she probably would already be dead.
Because her tumor was caught early and she could quickly undergo chemotherapy, she was lucky. Donato says at least 25 percent of cases are diagnosed by accident when a doctor is looking for something else.
Currently, he says, there are no reliable screening tests for ovarian cancer. Although an intervaginal ultrasound can detect tumors, it is rarely part of a routine examination. The blood test CA-125 can identify markers for later-stage ovarian cancer, but Donato says it is mostly unreliable for early detection.
Adding to the medical mystery is that no one seems to be able to pinpoint risk factors. Sometimes a family history of cancer is a clue, but the majority of women diagnosed with ovarian cancer have none. And while typically it strikes women in their menopausal years, Donato has had patients as young as 23.
Scientists now speculate there may be some link to monthly ovulation and the body’s recovery after an egg is released. There appears to be some protection from ovarian cancer if a woman’s cycle was interrupted or altered at some point in her life, either from pregnancy, subsequent breastfeeding or even the use of birth control pills. Women who are infertile or who have never been pregnant are considered more at risk. So, too, are women who began menstruation early or entered menopause late.
“You never forget that moment when they tell you you have cancer,” recalls Tracy Maxwell, a single 38-year-old Denver woman who was diagnosed with ovarian cancer two years ago. Her voice catches as she begins to remember.
Doctors had found a burst cyst on her right ovary in January 2006. Six weeks later a second cyst was found. In May she somewhat cavalierly checked into the hospital to have it removed. While she did not consciously anticipate what was coming, something must have triggered a last minute call to her mother in Kentucky to ask if she would fly to Denver to be with her.
“You begin to view your whole life differently from that moment on,” she says of getting the phone call asking her to come in for her biopsy results. Everyone knows an office visit means the news is not good. She had always assumed she would someday marry and have children. Now doctors were talking to her about a hysterectomy at age 36.
Maxwell says single women especially struggle. “While everyone goes through cancer alone, single women are really, really alone,” she says. She underwent an aggressive six sessions of chemotherapy over a four-month period. She chose not to have a hysterectomy because her treatment was so successful. Even though she may still be fertile, she now says she probably will never try to have children.
Dating is difficult. She wonders about the right time to tell someone she has had ovarian cancer. Maxwell created a monthly online column called A Single Cellto reach out to other single women who are struggling with cancer and its aftermath.
Both the medical community and patients alike say there is simply too little public knowledge about ovarian cancer because other types of cancer and disease get more publicity. And publicity brings not only awareness but research dollars.
Comedic actor Gilda Radner died of ovarian cancer in 1989 at the age of 42, which helped raise awareness at the time. Two decades have since passed, and many younger women may not even know who she was. Angelina Jolie’s mother, Marcheline Bertrand, died of ovarian cancer last year.
Cancer survivors such as 55-year-old Paulette Yeatts of Denver say women must be assertive with their own health and demand their concerns be taken seriously and explored fully. The unexplained bloating that came with her near-fatal ovarian cancer was first diagnosed as a colon problem even though her mother died of ovarian cancer at age 34.
Still, a diagnosis does not always mean the worst. Survivors say it is what you do afterward that makes the difference.
Maxwell reorganized her priorities during recovery. She went on trips she always wanted to take but used to put off. She quit her job and started her own nonprofit. Yeatts took an early buy-out and is taking some time out for herself before starting another job. Meyer relied on her sense of humor to get her through. The first Christmas, as she was undergoing chemotherapy, she sent out holiday cards with pictures of her bald head decorated as a Christmas ornament.
“The first thing you have to do is decide you are going to live,” Meyer says. “The rest flows from there.”
