It’s usually referred to as the silent cancer since i

It’s usually referred to as the silent cancer since its symptoms often go undiagnosed because they mimic other less serious conditions.
And in the Wilkes-Barre/Scranton region, ovarian cancer is silent for another reason: It isn’t treated locally. Women in the area have to travel, usually to Allentown or Philadelphia and sometimes even New York City, for treatment.
But a new gynecological oncologist in the area is working to initiate care and treatment of ovarian and other gynecological cancers, such as uterine and cervical.
Dr. John Nash, chairman of OB/GYN for the entire Geisinger Health System in Pennsylvania, is working at Geisinger Medical Center in Plains Township to help set up a treatment plan for the region. Initially, Nash will be based in Danville and plans to refer local cases to that Geisinger facility. Dr. Farag Salama, of the Hazleton Health Alliance, said patients diagnosed with ovarian cancer are being referred to Geisinger in Danville.
Nash hopes to bring a gynecological oncologist to the local facility by the end of the year. And that’s good news amid grim statistics noted during September, which is recognized as National Ovarian Cancer Awareness Month.
The difference between gynecological and medical oncologists is that the former have training in both surgery and chemotherapy, whereas medical oncologists are trained in chemotherapy and work in conjunction with surgeons.
Ovarian cancer is a disease in which malignant or cancerous cells are found in the ovaries. An ovary is one of two small, almond-shaped organs located on each side of the uterus that store eggs or germ cells and produce female hormones estrogen and progesterone.
Nash doesn’t have any clear answers as to why there is such a shortage of gynecological oncologists locally. “In Philadelphia, there are an excess of medical oncologists, more than we need, just like in Connecticut,” he said. “In some areas like Wilkes-Barre and Montana, there is a crying need for services.”
Overall, he cites a shortage in medical oncologists nationwide, stating that many physicians chose not to specialize in that field. “That doesn’t mean that women are not being cared for, it just means we need to recruit more physicians into this field,” Nash said.
Tough to detect
Ovarian cancer is the sixth most common form of cancer in women. In Luzerne County, an average of 30 cases of ovarian cancer are diagnosed each year, according to Kristin Hake Klemish, community relations coordinator of the Northeast Regional Cancer Institute in Scranton. She said that about 22 women in Luzerne County die from ovarian cancer each year.
Lung cancer is the No. 1 cancer, followed by breast cancer and colon cancer. According to Nash, there are 200,000 cases of breast cancer diagnosed annually as compared to 80,000 gynecological cancer diagnoses, combining ovarian, cervical and uterine.
“Ovarian cancer is not as common as other cancers,” he said. “When you break it down further, there are about 30,000 to 40,000 cases of that cancer alone each year. While one in every eight women will be diagnosed with breast cancer, only one in every 70 women will get ovarian cancer.”
But what sets ovarian cancer apart from other cancers is that it often goes undetected. Sometimes it is only diagnosed in the third or fourth stages, Nash noted, since it is extremely difficult to diagnose. The cause of the cancer is unknown.
Ovarian cancer is classified in stages I through IV, with stage I being the earliest and stage IV, the most advanced. Staging is determined at the time of surgical evaluation of the disease.
In stage I, ovarian cancer is confined to one or both ovaries.
In stage II, ovarian cancer has spread to other locations in the pelvis, such as the uterus or fallopian tubes.
In stage III, it has spread to the lining of the abdomen or to the lymph nodes within the abdomen. This is the most common stage of disease identified at the time of diagnosis, according to Nash.
In stage IV, ovarian cancer has spread to organs beyond the abdomen.
“It’s very alarming,” said Salama. “There is no test that diagnoses this cancer, like a screening or Pap smear, nor can a patient find something like a tumor on her own.
“All a woman has to go on are vague symptoms that are similar to other diseases. The only thing that can point to ovarian cancer is if these symptoms last longer than two weeks.”
When a woman is diagnosed in a latter stage of the cancer, such as stage III or IV, the prognosis for her recovery is not as great. Salama said there is only a 15 percent survival rate for women who are diagnosed in the fourth stage of ovarian cancer.
Nash stressed that with early detection, ovarian cancer can be a curable disease. He said the best way for a doctor to diagnose the cancer is by a pelvic examination.
“With a pelvic exam, a doctor can feel an abnormality,” Nash said. “If he does, then he can supplement the exam with an ultrasound.”
There is only one true test for ovarian cancer, CA125, a blood test which has been in existence for 15 years. The test is most reliable for post-menopausal women. For pre-menopausal women, it is not specific enough, said Nash, while with other conditions such as endometriosis and pregnancy, it can read false elevations.
Insurance companies will pay for testing as long as there is suspicion of abnormality or increased risk through a personal or family history, according to Salama.
Few preventive options
Although doctors always encourage healthy choices, Nash stressed that there is no medical evidence that losing weight, eating certain foods or taking specific vitamin supplements will reduce a woman’s risk of getting ovarian cancer.
One way to reduce the risk, however, is to take oral contraceptives over a period of time as this will reduce how many times a woman ovulates in her lifetime. He explains that ovulation is a mini injury of an ovary, and when the process goes awry, a cancer is formed. Birth control pills can suppress ovulation, which is why many health experts are now advocating that young women go on the pill to skip some menstrual cycles.
Another way to reduce the risk of incidence is by removal of the ovaries after having children.
According to Nash, only 10 percent of ovarian cancer is handed down genetically. He terms the other 90 percent “sporadic.”
Treatment and recurrence
Ovarian cancer is treated by primary removal of the ovary, Nash said. A gynecologic oncologist will conduct a staging operation to determine how far the cancer has spread, using either a laparoscopic technique or an open incision. After surgery to remove the cancer, a patient must undergo six courses of chemotherapy.
Even with an advanced stage of the disease, 80 percent will initially achieve complete remission, Nash said. But, unfortunately, there is a significant chance of relapse. The data shows that there can be a three-year period of remission followed by a three-year recurrence.
Even after a relapse, the cancer is still treatable and many women are given another session of chemotherapy. “With the second remission, we are extending the lives of these women, but, most important, with a reasonable quality of their lives,” he said. “In-between treatments, they can and do live full lives.”
Ovarian cancer can’t be cured, but it can be controlled, according to Nash.
“We don’t have as many long-term survivors as we’d like,” he said. “But we do have some patients who are still alive after 20 years.”
Symptoms of Ovarian Cancer

These are the symptoms of ovarian cancer. Many mirror those of other disorders. Dr. Faraga Salama, of the Hazleton Health Alliance, advises a woman experiencing any of these symptoms for two or more weeks to see her doctor.
•Abdominal pressure, fullness, swelling or bloating
•Pelvic discomfort or pain during intercourse
•Persistent indigestion, gas or nausea
•Changes in bladder or bowel habits
•Loss of appetite or feeling full quickly
•Persistent lack of energy
•Low back pain
•Unexplained changes in menstruation