Locked in mortal combat

Like any grandparent helping a daughter with a new baby, Barbara Shellow was busy changing diapers, giving baths and reading stories.

The routine had her huffing and puffing, tired and losing weight. But the grandmother didn't give much thought to those symptoms 11 years ago. “I blamed it on the weather and running around after three kids,'' she says.

Like many who are diagnosed with ovarian cancer, Shellow's symptoms — fatigue, bloating, stomach upset, changes in bowel habits, loss of appetite — were as vague as they are common. And she, like so many women, waited far too long to consult a doctor.

The very banality of this cancer's early symptoms is what makes it so deadly — that and the fact that there is no early-screening to either reassure women that they're healthy or find cells at curable stages.

As a result, the majority of women diagnosed with ovarian cancer are already in the late stages, when it has already escaped the ovaries.

Hope for more years

“Ovarian cancer is our albatross in ob-gyn oncology,'' says Dr Beth Karlan, director of the Women's Cancer Research Institute at Cedars-Sinai Medical Centre in Los Angeles.

But some patients will see more years than they dream possible when they hear the diagnosis.

Ovarian cancer's stealthy onset makes it far more worrisome than its prevalence would indicate.

Infrequent disease

There are 22,000 cases each year in the US and a woman's lifetime risk of ovarian cancer is about 1 in 70.

That compares with a one-in-eight lifetime risk of breast cancer. “It's an infrequent disease,'' says Dr Carmel J. Cohen, professor of gynaecology at the Mount Sinai School of Medicine in New York and co-chairman of the Ovarian Cancer Research Fund.

But compared with breast cancer, the risk of dying of ovarian cancer hasn't improved much in the past 30 years.

The goal for ovarian cancer is a simple test that would find the disease early enough for it to be cured.

Cervical cancer has known precursors: abnormal cells that show up years before cancer develops.

And the annual Pap can find them. If ovarian cancer has similar precursors, they are hidden in the ovaries and medicine hasn't learnt how to get at them.

So women and doctors remain unaware of the disease as it develops.

“In the first stage, ovarian cancer can be cured 95 per cent of the time,'' says Dr Robert Morgan, oncologist and researcher at the City of Hope National Medical Centre.

Sole test

But fewer than 20 per cent of women find it that early. So far, the only test for ovarian cancer is the CA125 test, a blood test that measures a protein found in greater concentration in ovarian cancer cells than in other cells. But as a screening tool, the test is not specific enough.

About 20 per cent of women with ovarian cancer don't have an elevated CA125 count at the time of diagnosis. And of those who do, only 3 per cent have ovarian cancer.

Helpful to some

Combined with an ultrasound examination of the ovaries, the test can be useful for women at high risk: those with a family history of the disease; those who carry the BRCA1 or BRCA2 gene; or who have had breast cancer.

But even then, the test provides only short-term reassurance.

And so use of the test is limited to monitoring women who know they have ovarian cancer to see how well chemotherapy is controlling the disease.

Roughly 20-30 per cent of late-stage patients survive longer than five years.

More than a decade after her diagnosis, Shellow is one of the lucky ones.