Ovarian cancer - know the warning signs

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London - Karen Burack is prone to migraines, and so has always made an effort to drink plenty of water each day in order to prevent an attack.

Despite this, she didn’t need to go to the loo very often. “In fact, I used to think I had a very strong bladder - I rarely went more than five times a day,” says Karen, a barber from Borehamwood, Hertfordshire.

Yet four years ago, while moving house, she found herself needing to go more often. “It was a gradual thing,” recalls Karen, 51. “I noticed that I needed to go nearly every hour, though I wasn’t drinking more than usual.”

By the time she needed to go several times an hour, Karen sought help from her GP. “It had got to the point where I was always rushing to the loo, sometimes worried I wouldn’t make it. I also had very quick, sharp shooting pains down my groin, sometimes up to three or four times a day.”

The GP prescribed some pills, which he said were really good for women who had bladder problems. “I was so stressed with the move I just took them and tried to get on with things, but looking back, they didn’t really help,” she says.

Karen now knows the pills failed to help because she was, in fact, suffering from ovarian cancer. While many women might recognise symptoms such as bloating and stomach pain, experts warn that too few of us know that needing to urinate more often can also be a warning sign of the disease.

Around 7,000 women are diagnosed with ovarian cancer every year, and those over 50 are more at risk.

The fact that the symptoms can be confused with other conditions costs many of these women their lives. Indeed, it took another six months before Karen was diagnosed. ‘I started needing to go more and more often,’ she says.

“I’d go before I left home and by the time I’d walked the ten minutes to the train station, I’d have to go again - and sometimes again before I’d done the ten-minute walk to work the other end. I knew where every cafe loo was on the walk to work - it was ridiculous.”

Then Karen moved to a new area and went to see a new GP - who diagnosed a vaginal prolapse, where the muscles and the ligaments that support the vagina and womb stretch and weaken, causing incontinence.

“I was told it was common in women of my age who’ve had children,” says Karen, a mother of two.

In February 2009, she underwent successful surgery to fix the prolapse.”The bladder problems did seem to improve, but only for a short while. Then around four weeks later I started to feel bloated and very ill,’ she recalls.

“It was as if my bowel had become blocked and I was so bloated I looked pregnant. I now know all of this would point to ovarian cancer, but I simply assumed my symptoms were side-effects of the operation to fix the prolapse.”

Karen felt so ill that she phoned the surgeon who’d performed the operation and he advised her to come in as soon as possible.

Once re-admitted, he took one look at her and ordered an immediate CT scan. The news that came next was devastating: Karen had late-stage ovarian cancer and it had spread.

More than six litres of fluid were drained from her abdomen (cancer cells secrete a fluid called ascites, which in Karen’s case had built up in the abdominal cavity).

To shrink the tumours, she started intensive chemotherapy, which was followed by surgery.

“The prolapse appeared to have masked my cancer symptoms, and it cost me vital months,” says Karen. “It’s only now I look back and wonder why I wasn’t examined or given a blood test or CT scan the first time.

“Although I did have a prolapse, the signs of ovarian cancer were also there for everybody to see. I certainly never knew that going to the loo more often was a symptom.”

The charity Ovarian Cancer Action advises that women who experience any of the following symptoms on most days should discuss the possibility of ovarian cancer with their doctor: needing to urinate more frequently; persistent stomach pain; persistent bloating or increased stomach size; or difficulty eating or feeling full quickly.

Other, more occasional symptoms include extreme fatigue, changes in bowel habit or back pain.

“It’s important to remember that these symptoms are most likely not ovarian cancer, but may be present in some women with the disease,” says Professor Hani Gabra, director of the Ovarian Cancer Action Research Centre at Imperial College London. “The majority of women needing to go to the loo more often will likely be suffering from a urinary tract infection - where pain is often also present - or stress incontinence, but it is worth getting investigated if things have changed.”

Ovarian cancer can cause an increased need to urinate because the tumour may be pushing on the bladder, he continues.

“Ovarian cancer causes tumours to grow out in all directions. The mass will start to push on adjacent structures - in Karen’s case, the bladder.

“It could also push backwards into the sacrum and cause back pain, or cause bowel problems such as constipation.

“Also, the ascites fluid which can build up in the abdominal cavity and cause pressure and bloating can disrupt bowel function and the stomach to become squashed, hence a feeling of fullness.

“I have seen women have 12 litres of fluid drained from their belly - over time, they got used to it or blamed it on something innocuous such as weight gain.”

More than 90 percent of women will survive ovarian cancer if it is diagnosed in the earliest stage.

Yet in this country, most women - including Karen - are diagnosed once the cancer has spread beyond the ovaries, when treatment is more difficult and chemotherapy and more complex surgery are likely to be required. “Women often delay seeking advice about their symptoms,” says Professor Gabra.

Gynaecologist Panos Sarhanis, a specialist in gynaecological cancers at North West London Hospitals NHS Trust, adds: “Ovarian cancer used to be called the silent killer. But it may not be that silent if patients and GPs know what to look out for.”

There is a drive to encourage women of menopausal age not to just discount their symptoms as part of this transition, he says.

Ovarian cancer is also often misdiagnosed as irritable bowel syndrome (IBS). But it’s important to stress that IBS is unlikely to occur in women over 50 (those most at risk of ovarian cancer) for the first time - it usually appears earlier in life. The symptoms of it, such as stomach pain and bloating, are also not persistent.

Fortunately, Karen responded extremely well to chemotherapy and in July 2009 underwent surgery to remove the tumours, a procedure called a pelvic clearance.

But devastating news came a year later - the cancer had returned. Since then Karen has undergone numerous cycles of chemotherapy and, three years on, she is still battling the disease.

To make things worse she has discovered she is a carrier of the BRCA1 gene, a mutation thought to account for just under 20 percent of ovarian cancer cases (other risk factors include not having children and experiencing early periods and/or a late menopause).

Karen’s eldest daughter Kelly, 23, has inherited the gene; her younger daughter, 20-year-old Samantha, has yet to be tested.

As someone who works with hair - and usually sports a trademark mane of blonde curls - her journey through chemotherapy and the subsequent hair loss has been particularly painful.

This summer Karen will marry her fiance Simon, who has been by her side since her diagnosis. She says: “I am praying I still have some hair for the big day.

“I just wish everything had been picked up sooner,” she says. “That’s why I want to raise awareness.

“Had I known the warning signs and insisted on a blood test, my whole experience of the disease could have been less traumatic.” - Daily Mail

* For more information: http://www.cansa.org.za

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