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“НАШЕ ЖИТТЯ”, ВЕРЕСЕНЬ 200 8 17 The Silent Killer by Ihor Magun, M.D., F.A.C.P. As the leading cause of death from a gynecological malignancy and the fifth leading cause of cancer death in women, ovarian cancer has been named "the silent killer." This "silent killer" label is fitting because the symptoms do not develop until the disease is advanced — when the chances of cure or remission are poor. Every year, ovarian cancer takes the lives of 15,000 women in the United States. One out of 40 to 60 women is at risk for developing this fatal disease. Ovarian cancer is uncommon before the age of forty. Older women fall into the higher risk category, whereas one-quarter of deaths occur in women between 35 and 54 years of age. Half the deaths occur in women between 55 and 74 years of age. These are frightening statistics. The exact cause of this disease is unknown, but certain factors seem to lower the risk for some one. For example, a protective effect is seen in women who bear children an early age, women who have their last pregnancy at an older age, and women who have multiple pregnancies. Breast feeding and tubal ligation also appear to decrease the risk as does the use of oral contraceptives. Familial history is a major risk factor. Women with one affected first-degree relative have a five percent risk factor. If two or more such familial connections are present, the risk exceeds fifty percent. A strong family history of gastroin- testinal cancers, colon cancer, or a history of uterine cancer all create a higher risk for ovarian cancer. Women who test positive for genetic mutations of genes known as BRACA1 or BRACA2 are also at risk. So what are the symptoms? Although most patients with ovarian cancer are first diagnosed when the disease is already spread beyond the pelvis, symptoms may occur earlier. Pelvic or abdominal pain, difficulty eating or feeling full quickly, bloating, or frequent or sudden urges to urinate, all constitute red flags. But these are nonspecific symptoms that are sometimes over- looked or ignored or attributed to other causes. Moreover, ovarian cancer is notoriously asympto- matic. Evaluation of individuals with suspected ovarian cancer includes measurement of a tumor marker CA-125. This has been studied as a screening tool, but early stages of cancer have low levels of this marker and nonmalignant disorders can elevate the level with both false-negative and false-positive results. Unfortunately, this is cur- rently the only available marker. An exploratory surgical procedure called a laparotomy is generally required to establish the extent and complexity of the disease. Imaging studies such as the CAT scan and transvaginal ultrasound are also performed. Because of the nature of the disease and the high mortality rate associated with it, women should pay close attention to subtle changes in health, watching for the red flag symptoms described above, see their gynecologists regularly, and check out their family health history. These simple steps can make "silent killer" easier to detect, diagnose, and fight before it has progressed to the point where it is fatal. We ask that all articles submitted for publication include a telephone number to allow us to acknowledge submissions and verify information. We also appreciate comments from our readers and hope that you write and share your opinions about the materials that we publish. Please forward your articles or letters to English-language editor Tamara Stadnychenko c/o UNWLA headquarters.
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