Ovarian Cancer: Early Detection Elusive

by Food and Drug Administration (FDA)

She crowned herself "the Queen of Neurosis," but this time, it was not simply an overactive imagination that made her fear for her health. It was symptoms of the ovarian cancer that eventually claimed her life.

Gilda Radner, one of the original Not Ready for Prime Time Players of television's "Saturday Night Live," claimed in her book It's Always Something that she could get neurotic over any health problem. "I hated to be sick and I had an imagination that could turn a stomachache into the plague."

So, she wrote, when a complete physical examination in January 1986 failed to explain the overwhelming fatigue and general malaise she was feeling, she agreed with the doctor that her symptoms might just be from depression; she had, after all, been going through a rough period in both her personal and professional life. It was not until October — 10 months and several symptoms, diagnoses, and failed therapies later — that cancer of the ovaries was confirmed.

Delay in diagnosing ovarian cancer is not unusual. Early detection is difficult because disease confined to the ovary seldom produces symptoms. When symptoms do surface, they are often vague and easily mistaken for other, often minor, ailments.

Radner's cancer was not discovered until it had spread to her bowel and liver. She suffered from fatigue, low-grade fever, pelvic cramping, abdominal bloating, gas, and aches and pains in her upper thighs and legs. Loss of appetite and a feeling of fullness, indigestion, nausea, weight loss, and, less often, vaginal bleeding and low back pain are other symptoms.

As the tumor grows, it may press on the bowel and bladder, causing constipation and frequent urination. Malignant cells can break away from the tumor and spread directly to other organs in the abdomen, such as the stomach, colon and diaphragm (muscle separating the chest cavity from the abdomen), causing a fluid buildup that results in swelling and discomfort. The cells can also enter the bloodstream or lymph system and spread to other parts of the body.

Radner wrote that her complaints had been variously attributed to Epstein-Barr virus infection, depression, stress, and anxiety. She had undergone blood tests, a barium enema, and ultrasound (pelvic sonogram). According to Radner, the sonogram, done in the summer of 1986, showed "congestion" and the "ovaries weren't exactly in the place they were supposed to be, but that wasn't serious." There was no sign of tumor or bowel obstruction.

Aspirin to Acupuncture

Attempting to combat her ills through both mainstream and holistic medicine, Radner tried remedies that ran the gamut from aspirin, anti-inflammatories and antidepressants to health foods, vitamins, acupuncture, and colonics (unconventional type enemas).

"Suddenly, I began to wonder how to please so many people," she wrote. "Do I take the magnesium citrate? What about the coffee enema? Do I do both? Do I do the abdominal massage or the colonic? Do I tell the doctors about each other?"

Then, late in October, an abnormal liver function test prompted more exams. A CAT scan and analysis of fluid from the abdomen confirmed ovarian cancer.

Diagnosed at age 40, Radner was younger than most women with the disease. The chance of developing ovarian cancer increases with age; most cases are found in women who have gone through natural menopause, with the average age at diagnosis being 61. As was true with Radner, however, women with a family history of the disease generally are diagnosed at a younger age.

Each year in the United States, ovarian cancer is diagnosed in about 26,000 women and claims more than 14,000 lives. It is most common in women living in Europe and North America; Asian women have a relatively low incidence. Although Chinese and Japanese women living in the United States have higher rates of ovarian cancer than their counterparts in Asia, the disease is still less common among this group than among the native white population in the United States. Rates among black women in all parts of the world are low.

Certain factors are associated with an increased risk of getting ovarian cancer. Although the lifetime risk for most women is 1 in 70, it doubles for women who have never been pregnant. Also at increased risk are women who have had breast, intestinal, or rectal cancer. Under investigation as possible risk factors are: high-fat diet, early onset and late cessation of menstruation, being of Eastern European Jewish descent, and use of talcum powder in the genital area.

Women with close relatives who have had ovarian cancer are also at greater risk, reaching perhaps a 50 percent chance if they have at least two first-degree relatives (mother, sister or daughter) with the disease. This compares with a 1.4 percent chance in women without a family history. Women who have a first-degree relative and one or more second-degree relatives (aunt, grandmother) who had ovarian cancer have a somewhat lesser risk than those with two first-degree relatives, but are still considered to be at high risk. Radner wrote that her mother had breast cancer and a cousin had both breast and ovarian cancer. Later, it was learned that other of her relatives had ovarian cancer as well.

About 5 to 7 percent of all ovarian cancer is thought to be inherited. In 1994, scientists identified a gene, which they named BRCA1, that related to the development of inherited breast cancer. Changes or abnormalities in this gene are now also considered responsible for about 80 percent of inherited ovarian cancer. The abnormal gene can be inherited from either parent.

The Gilda Radner Familial Ovarian Cancer Registry, established in 1981 at Roswell Park Cancer Institute in Buffalo, N.Y., and named for Gilda Radner after her death in 1989, included 2,946 cases of ovarian cancer in 1,346 families as of January 1997.

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