Scary Gifts

Christmas came early for me this year.

I had a bad scare last week. My dearest friend got some bad results back from her health screen. Ultrasound and X-ray detected a mass on her right ovary and her CA-125 tumour marker (for ovarian cancer) was 68 - twice the acceptable level and 7 times normal. She made an appointment with a gynie.

I consulted Google, of course. It wasn't comforting. Ovarian cancer is one of the deadliest cancers going. It's called the silent killer because it usually has no symptoms until it's too late. The risk factors for Ovarian cancer include age (usually >50), no children and some genetic risk. Apparently prolonged use of oral contraceptives has some prophylactic benefit but genital use of talcum and consumption of caffeine and milk have some positive correlation with occurrence.

It was a 5 day wait to see the gynie. In the interim, I did my homework and came up with some dietary prescriptions to help improve my friend's health (as well as my own). I also had a chance to find out if there was some stress that had contributed to this health problem. There was. We has some good talks.

After 5 very nervewracking days for me, I joined her at the gynie. The gynie said that given her age (43) and elevated CA-125 levels, there was certainly a risk however given the characteristics of the mass, it was almost certainly a dermoid and not malignant.

Dermoids tend to be:

• well defined
• calcifications (bone, teeth and hair)

Cancerous Tumour tend to be:

• not well defined
• fatty and liquid

Her mass was a small (1cm) hard calcification. It was probably benign.

The options she had were:

1. wait three months to do another scan and blood test
2. do a CT scan to see if there is lymphnode swelling (another sign of cancer)
3. do a PET scan (very accurate but $2000+)
4. do a laproscopic biopsy (invasive and may actually spread malignant cells if present)
5. do a conventional surgery to remove the lump and/or ovary (overkill)

She will do a CT scan so that she has a bit more info. If that comes back clear, she will wait 3 months otherwise I will plomp for a PET scan for my own peace of mind. Ovarian cancer can grow extremely rapidly so if there is a hint of it I'd rather pay to ensure we catch it early.

Generally however, I'm feeling pretty good that this is going to be OK. The added bonus is that we found a really awesome gynie (Motoko Yeo at Paragon) who is both knowledgable and willing to take the time to explain the risks and answer all your questions.

So this ended up being one of those scary gifts that reminds you what's important. In one fell swoop it has made me more compassionate and it also gave me an opportunity to chat with my friend about her cares and to offer some releif. This is better than any Christmas present I could ever hope for.

Good links:

• Dermoid Cyst Images
• Ovarian Cancer Images
• A Good Summary from CNN
• Another Summary
• Staging of Ovarian Cancer
• A similar dermoid case And another - both with elevated CA-125 levels
• Milk Linked to Ovarian Cancer

Ovarian Cancer, is the second most common gynaecological malignancy; endometrial cancer is the commonest. However, because of its high mortality, ovarian cancer is the commonest cause of death from gynaecological malignancy. The lifetime risk of ovarian cancer in women is 1.5%. Approximately 60% of women who develop ovarian cancer will die because of it. The relatively high mortality of ovarian cancer is largely due to the fact that most cases present late, when the disease has already reached an advanced stage. The peak age of incidence of ovarian cancer is 70 years, but 50% of cases occur in women under 65 years.

Despite numerous epidemiological investigations, a clear-cut cause of ovarian cancer has not been defined. Positive family history, late menopause, nulliparity or late childbearing are risk factors.

- GE Healthcare

Labels: personal