Women's Bodies, Women's Wisdom (51 page)

The FDA has just approved a novel new blood test known as OVA1 to be used to screen women who have pelvic tumors and are known to need surgery.
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Right now, this test is not designed to detect ovarian cancer, but it does test for five different proteins that are known to undergo change when ovarian cancer is present. Since women with ovarian cancer do better when their surgeries are performed by gynecologic oncologists, having this test prior to surgery allows the right team of surgeons to be assembled beforehand.

A recent study of women diagnosed with ovarian cancer in thirty-nine primary care centers in England found that these women do, in fact, have early symptoms for which they seek medical attention. But the symptoms are nonspecific and so are not investigated thoroughly. The most common are abdominal distention (bloating), abdominal pain, and urinary frequency. This led to the authors admitting that “ovarian cancer is not silent, rather its sound is going unheard.”
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This study may raise awareness among health care practitioners and patients of the possibility that these symptoms signal cancer. In the meantime, ovarian cancer challenges us to explore the interface between the immune system, the emotions, nutrition, and genetics in new and creative ways. It’s also important to remember that even women with very advanced disease have experienced total healing.

Familial Ovarian Cancer

A woman who has a sister, mother, maternal first cousin, maternal aunt, or other first-degree female relative with ovarian cancer has a higher-than-average risk of getting the disease herself. Familial ovarian cancer was brought to general public awareness by the Gilda Radner story.
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Some women who have a very strong family history of ovarian cancer (and thus have a 20 to 30 percent chance of getting the disease) opt for prophy lactic oophorectomy. Prophylactic removal of the ovaries after childbearing is over is often recommended for these women. Yet even in women who have family histories of ovarian cancer, this does not necessarily prevent the disease. Even after prophy lactic removal, cancers indistinguishable from ovarian cancer can still occur from cells in the lining of the pelvic cavity.
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I’ve noticed that women who have seen a close friend die of ovarian cancer are more inclined to have their ovaries removed because of fear. Though this might be unscientific, I find that most of our major life de cisions are based on our emotional realities and not on statistics.

When a disease runs in families, we need to realize that we’re not dealing solely with a simple matter of genetics. Attitudes also run in families. It would be very interesting to study only those females in families with a history of ovarian cancer who did not get the disease. Most likely these would be the women who have broken the family mold and left their tribe, on both an energetic level and a physical level.

Oophorectomy During Other Pelvic Surgery

When a woman chooses to have a hysterectomy, to remove a fibroid uterus or for any other benign condition, she must also decide whether to remove the ovaries. I ask each individual woman before surgery how high her fear level of ovarian cancer is, and I ask her to check out how she feels about her ovaries. I tell her that it’s not pos sible to discern the condition of the ovaries until the surgeon visualizes them directly during surgery. If there’s a problem at that time, they may need to be removed.

If the patient decides to preserve the ovaries, she must defer to her surgeon’s judgment if the ovaries look abnormal during surgery. It’s best to find a doctor who is “ovary friendly.” The ultimate decision about what to do with the ovaries must be left to the patient following informed consent. There are many factors, conscious and unconscious, that come into play when each of us makes major decisions about our bodies.

As you might imagine, the women who are drawn to my approach usually choose to keep their ovaries during hysterectomy because—like me— they value their female organs. Though my training led me to be lieve that ovaries should be removed as early as age thirty-five, I’m well past that age now, and I value my ovaries as a part of my body that will continue to function and support me as long as I live. I know that they are part of my inner guidance system and they will let me know if adjust ments are required for their health. Recent research lends weight to the idea that removing your ovaries isn’t always the best option. Data from the Mayo Clinic show that women who’ve had their ovaries removed before age forty-five have a fivefold increase in their risk of dying from neurological or mental diseases and nearly twice the risk of dying from cardiovascular disease. They also have an increased risk of developing Parkinsonism, cognitive impairment, and dementia, as well as an increase in depressive and anxiety symptoms later in life.
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Taking hormones helps, but it doesn’t completely negate these risks. (See “Artificial Menopause” in chapter 14, page 543, for more details.)

Most gynecologists train in large university centers that, because of their specialty nature, treat more women with ovarian cancer in a week than the average practicing gynecologist sees in a decade. Thus, gyne cologists tend to see more ovarian cancer in their training years than they ever see again. This creates a bias against the ovaries. An ovarian cancer death is difficult to watch; it can be associated with pain, recurrent bowel obstruction, huge amounts of fluid collecting in the abdomen, and a variety of other extremely uncomfortable symptoms. A doctor who has seen someone die of ovarian cancer is apt to be prejudiced in his or her relationship to ovaries from that point on, even though the vast majority of women will not get ovarian cancer.

One of the hospitals in which I worked in the past is the major referral center for our state. The gyn pathologist at that time said, “I’m scared to death of ovarian cancer. I’m having my wife have her ovaries removed when she’s forty, and I even think she should have her breasts removed prophylactically.” He was not completely serious about this recommendation, but this physician spent his days doing autopsies on women from all over the Northeast who had died of breast and ovarian cancer. He saw the devastation of these diseases as a daily part of his work. He cut into huge tumors and received surgical specimens in which a woman’s uterus, tubes, ovaries, and even vagina, bladder, and rectum had been replaced by tumor. He saw the devastation of breast tumors that had eroded into the chest wall. It is little wonder that he felt the way he did, and it is no wonder that routine ovarian removal at the time of hysterectomy is still advocated by many.

Conventional Treatment

When diagnosed at advanced stages, ovarian cancer is considered a difficult disease to treat. Conventional treatment is surgical, sometimes followed by chemotherapy and radiation, depending upon how far it has spread. The diagnosis itself is usually made definitively at the time of surgery for some kind of pelvic growth. Despite advances in treatment and attempts at early diagnosis, long-term survival has been statistically unfavorable. According to American Cancer Society statistics, only 45 percent of ovarian cancer patients survive five or more years after diagnosis (with those under age sixtyfive having the highest rates of survival). The five-year survival rate jumps to 93 percent if ovarian cancer is caught before it spreads outside the ovary, but this is the case less than 20 percent of the time.

Without looking in the abdomen and taking a biopsy, there is no way to tell whether an ovarian growth is benign or malignant. If an ovarian growth is malignant, treatment usually consists of removing the ovaries, tubes, uterus, omentum (the apron of fat covering the bowel), and any tumor that has spread into the pelvis. This is fol lowed by chemotherapy. Pumping two cancer drugs—paclitaxel and cisplatin—directly into the pelvic cavity in patients with advanced ovarian cancer who meet certain criteria has been shown to improve survival by an average of sixteen months. This new treatment, though not a cure, is clearly a major breakthrough. The National Cancer Institute issued a clin ical announcement early in 2006 to encourage doctors to use the abdom inal treatment or refer their patients to medical centers that do it.
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For further information, visit the NCI website and go to
www.cancer.gov/newscenter/pressreleases/IPchemotherapyrelease
or call 800-4-CANCER. In the very early stages of ovarian cancer, surgery can be curative. Let me hasten to add that there have been well-documented cases of so-called sponta neous remission even in advanced cases of ovarian cancer.
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That means there’s always hope.

Women’s Stories

One of my patients who died of ovarian cancer healed her life and her emotional issues more in her last month of life than in all her prior years. She had gone through extensive surgery and had also followed a dietary approach to her problem. She had done all the “right” things. But still her tumors grew. A physical cure was not part of her healing, though her healing came in the course of her search for a physical cure.

A doctor friend of mine who was working with her for her pain took her through a process of meditation during deep relaxation in which he asked her body to tell him what was feeding her tumors. She replied, “Fear and sadness.” He then asked her to remember and reexperience a time when she did not have this fear and sadness. She went back to a time when she was a twelve-week fetus in her mother’s uterus. Her mother had tried to abort her with a red and white pill. In her final days she was able to bring this information to consciousness and share it with her mother, who herself was in need of healing around this incident from many years before. My patient died in her mother’s arms, free from pain, and finally free from a lifelong burden.

CARING FOR YOUR UTERUS AND OVARIES, OR PELVIC SPACE

Know that the inherent creativity symbolized by your ovaries is always present for you, regardless of whether they are still physically present in your body.

Find a creative endeavor that makes time stand still for you. Im merse yourself in something so absorbing that you forget to eat. If you don’t know what that is, ask your higher power to guide you to it. What you are seeking is also seeking you!

Make time each day to do something of creative value that has meaning for you. Let it come through you. This could be as simple as organizing your underwear drawer beautifully!

Write down a list of your past creations. Notice how many of them have a life of their own now.