Ovarian cancer

By Richard P. Holm, M.D.

When this story begins, Mrs. Z. was 70ish and a special patient to me because years earlier, I had discovered her need for heart-valve surgery and later had helped direct her breast cancer care after she had discovered a lump. Now she had pelvic pressure pain and fullness, vaginal bleeding, and some urinary symptoms. She knew something was wrong, and apologized for delaying this visit because she was afraid of what I might find.

It is one of those moments I will never forget. On exam I was surprised to find a grapefruit-sized mass in her pelvis and when I looked up to her worried eyes it must have been written on my face. She knew before anything was said.

The very next day she went to surgery, and I was asked to assist. Indeed the tumor was a malignancy coming from her ovary, and although 85-90 percent of ovarian cancers come from the cells that cover the surface of the ovaries, I think my patient had what is called a germ-cell tumor. This kind of tumor comes from inside the ovary, is usually found in younger women, and starts from egg-producing cells. There is a third kind of ovarian cancer that starts from hormone-producing tissue or stromal cells, but we had to wait for the microscopic exam to tell.

She had several ovarian-cancer risk factors that included a family history of colon cancer, a late menopause, and her previous breast cancer history. Even when we understand risk factors, ovarian cancer is called a silent killer because, like in Mrs. Z’s case, the symptoms usually appear late, often after the tumor has spread. But in her case the cancer hadn’t spread.

Mrs. Z eventually died of heart failure in her late 80s, had many wonderful retirement years with her kind husband, and our friendship grew through those years. It’s the kind of thing that makes my job such a joy.