A defensive move: Removing the ovaries before cancer develops

Rinki Agarwal, MD, performs a laparoscopic oophorectomy (ovary removal) and salpingectomy (Fallopian tube removal) on the author. (PHOTO BY SUSAN KAHN)

Rinki Agarwal, MD, performs a laparoscopic oophorectomy (ovary removal) and salpingectomy (Fallopian tube removal) on the author. (PHOTO BY SUSAN KAHN)

BY SUSAN KEETER

The day my mother spiked a fever, we had no idea it was a symptom of ovarian cancer and that we would lose her just seven weeks later. Looking back, the only other possible symptom had been several months of unexplained bouts of nausea.

During the sad time of adjusting to the death of my mother, I began to worry about my own health. Five years before, my mammogram caught early stage breast cancer, and treatment left me virtually 100 percent cured. Was there a similar test for ovarian cancer that I didn’t know about?

When I asked my oncologist, he said, “I think you’re a good candidate for ovary removal, and if you choose to have the surgery, make sure they remove your Fallopian tubes as well. That cancer can show up in the tubes, as well.”

He referred me to Rinki Agarwal, MD, the Upstate gynecological oncologist who had been part of my mother’s cancer care team. She explained that the current tests for ovarian cancer are no better than a coin toss. “There are ultrasounds and blood tests for ovarian cancer, but they have only 60 percent accuracy,” she told me. “This cancer tends to develop on the surface of the ovaries, and we can’t see it.”

Each year in New York state, about 1,500 women — including 40 in Onondaga County — are diagnosed with ovarian cancer. About two-thirds die from the disease, according to statistics from the New York State Department of Health. Those at highest risk for the disease can reduce their chances of developing it by having their ovaries and Fallopian tubes surgically removed.

My family history made me a candidate for the surgery. Breast cancer affected both my maternal and paternal aunts, one of whom was diagnosed young and died of the disease. My maternal great-grandmother had ovarian cancer, like my mother. And, I had an early-stage breast cancer known as DCIS, ductal carcinoma in situ.

Our next step was to weigh the benefits of surgery against the possible health costs.

Agarwal explained that removing the ovaries means losing the estrogen and progesterone they produce, which increases the risk of osteoporosis, heart disease and dementia for women under age 60.

That was sobering.

However, since the ovaries gradually decrease hormone production and secretion, within about five years of menopause, these risks are no longer increased by ovary removal.

At the age of 56, my risk of ovarian cancer is in front of me, counseled Agarwal, with any benefit from ovary-produced hormones likely behind.

She scheduled a couple of tests, and almost 10 months after my mother’s death, Agarwal operated laparoscopically, through three tiny incisions in my abdomen. Some patients have lengthy recovery and significant pain, but I was fortunate. I had the surgery in the morning at Upstate; that evening, I watched my daughter’s dance rehearsal.

Who gets ovarian cancer?

Women in their 50s are at the greatest risk for ovarian cancer, but the overall risk falls on women between the ages of 30 and 60. The ovaries are the two almond-shaped organs on each side of the uterus.

Ovarian cancer symptoms

— Bloating

— Pelvic or abdominal pain

— Trouble eating or feeling full quickly

— Feeling the need to urinate urgently or often

Layout 1 Fatigue, pain during sex, upset stomach or heartburn, constipation, back pain and menstrual changes can also be symptoms

They may be vague, but if these symptoms exist daily for two to three weeks, a woman should seek gynecological care. Women of all ages are at risk, especially those with a family history of breast, colon or ovarian cancer. Early detection dramatically increases survival rates.

This article appears in the summer 2015 issue of Cancer Care magazine.

About susankeeter

Occasional contributor Upstate’s Susan Keeter has written about and painted Upstate’s Dr. Sarah Loguen, one of the first African American women physicians. Keeter created the horse sculpture in front of the Upstate Golisano Children’s Hospital and illustrated a children’s book on autism, “Waiting for Benjamin.” She’s written for Physician Practice, Upstate Alumni Journal, Cancer Care and Upstate Health magazines. Reach her by email at keeters@upstate.edu or by phone at 315-464-4834.
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