PINEHURST — Good luck trying to keep up with 75-year-old Margaret Baker of Pinehurst. She is a local tennis champion. Avid swimmer. She has hiked in most Western states and parts of Canada with Jack, her husband of 56 years and best friend. Ovarian cancer was never on her agenda.
Ovarian and other cancers are seldom on any woman’s agenda. Therefore, Margaret and FirstHealth of the Carolinas are sharing information about cancer affecting female reproductive organs, including the ovaries, cervix, uterus, fallopian tubes, vagina and vulva, in observance of Gynecologic Cancer Awareness Month in September.
“In August 2019, I started feeling very tired and out of breath,” Margaret said. “Almost overnight I went from swimming a mile at a time to not even four laps. Something was wrong.”
She originally attributed her tiredness to thyroid issues, but tests came back with normal levels. An electrocardiogram showed the heart of a woman decades younger than 75. A lung x-ray revealed pneumonia, but treatment did not alleviate her fatigue.
“My husband reminded me of my age and said that perhaps I was just doing too much,” Margaret said. “That did not go over well.”
A CT scan revealed fluid in her lungs and an enlarged omentum, a usually delicate tissue that hangs like a curtain from the colon. At that point, she was referred to FirstHealth gynecologic oncologist Michael Sundborg, M.D., “because those two markers gave us a good idea of what it was,” he said. A biopsy of the fluid and omentum told doctors where the cancer was coming from and informed her diagnosis: stage 4 ovarian cancer.
Understanding the symptoms of gynecological cancers is the key
“Ovarian cancer spreads throughout the abdomen, like leaves falling off a tree,” said Dr. Sundborg. “It doesn’t get into the bloodstream but spreads within the abdominal cavity. It also often generates fluid around the lungs, as in Margaret’s case, but we don’t yet know why. With fluid compressing her lungs, they couldn’t expand to get enough oxygen in and that’s why she was tired.”
Ovarian cancer is sometimes called the “silent killer” because some presenting symptoms are often mistaken for everyday issues, particularly ones that affect the gastrointestinal system or simply changes in a woman’s body as she ages. Symptoms can include fatigue, pelvic and abdominal pain and bloating, difficulty eating or feeling full quickly, abnormal vaginal bleeding, and urinary issues, including changes in frequency or urgency to urinate.
“Out of every 100 patients we see with ovarian cancer, 85 will have advanced cases because the signs and symptoms are so vague,” said Dr. Sundborg. “Plus, unfortunately, we don’t yet have an effective screening test for ovarian cancer.”
A pap smear, often thought to screen for a range of gynecologic cancers, covers only cervical cancer.
The Centers for Disease Control offers a chart showing symptoms and the types of gynecologic cancer they may indicate as well as a symptom tracker. These tools are not substitutions for a professional diagnosis and women are encouraged to see their doctors with any concerns.
“The good news is that when diagnosed and treated in the earliest stages, the five-year survival rate of gynecologic cancer is more than 90 percent,” said Dr. Sundborg. “The key to early detection of gynecologic cancer is knowing your body, noticing what’s not right and talking with your doctor.”
Dr. Sundborg also said that while every woman is at risk of developing gynecologic cancer, increased risk factors include obesity, menopause at a late age, smoking, never having been pregnant, advanced age and a family history of cancer.
The most significant risk factor for cervical cancer in particular is the human papillomavirus (HPV). The Centers for Disease Control (CDC) reports that more than 9 of every 10 cases of cervical cancer are caused by HPV, but they can be largely prevented by the HPV vaccine. The CDC recommends HPV vaccination for girls ages 11 to 12 to protect against cancers of the cervix, vagina and vulva. (It’s important to note that HPV affects not only women. Nearly four out of every 10 cases of cancer caused by HPV occur among men and the CDC also recommends the vaccine for boys ages 11 to 12.)
Margaret is among the 1 in 78 women nationwide who develop ovarian cancer in her lifetime. The American Cancer Society estimates that in 2020 about 21,750 women nationwide will receive a new ovarian cancer diagnosis and 13,940 women will die from the disease. In North Carolina, the estimates are 680 new cases and 430 deaths. And that’s just ovarian cancer. An additional 91,770 women in the United States will be diagnosed with other cancers of the reproductive system this year and 19,680 will die, according to the ACS.