Good morning to all of you. I hope you are all feeling well and looking forward to the day. Over the past couple weeks, we've been discovering how our ovaries work and what it means when we are told we have cysts. We've learned that cysts do not necessarily mean cancer or that you are more likely to get cancer.
We have learned that, before menopause, we make cysts called follicular cysts (or follicles) every single month. Our eggs mature in these. Then, once we ovulate or release the egg, all the rest of the follicles shrink up and go away. In a normal menstrual cycle, the balance between the hormones estrogen and progesterone regulate the buildup of the uterine lining (the endometrium), so that it doesn't get overly thick or come out at the wrong time. Without this precise synchronization, it can cause prolonged, irregular or excess bleeding or miscarriages.
So many of us worry about getting cancer or have friends and family members who have died because of it. It is just so scary! Some cancers are genetically linked, but the majority are not and have no hereditary or genetic link.
It is important to note that most ovarian cysts, whether cancerous or benign, cause very slight or no symptoms. So what changes should we look for in our body? Is it pain, extreme weight loss or weight gain, or weakness and fatigue? Or perhaps sharp stabbing and shooting pains down our legs or in our lower back and vagina? Well, when women reflect after being diagnosed with cancer, they often agree on some of these symptoms:
- Persistent abdominal bloating, indigestion or nausea
- Changes in appetite or feeling full sooner
- Feelings of pressure in the pelvis or lower back that can make you feel like you have to pee or poop more often
- Sometimes there are changes in bowel movements like diarrhea or constipation
- Feeling like your pants are too tight, but you are not gaining weight
- Feeling tired or low energy for no reason
What's scary is that all these same symptoms can also occur with many things like benign cysts, uterine fibroids, Irritable Bowel Syndrome and diverticulitis. Women may also feel pelvic pain when they have chronic problems like endometriosis, interstitial cystitis (chronic bladder inflammation), painful periods or painful sex. And any severe or persistent pelvic pain can cause nausea and vomiting.
Whether benign or cancerous, ovarian pain becomes worse when the ovaries become enlarged, or are bumped/pinched during sex or when having a bowel movement. The left ovary sits right next to the colon and, when it is enlarged from a benign or follicular cyst, it can be bumped as the colon moves when we are passing gas or getting ready to go poop. Both benign or malignant cysts can pop and bleed or they can flip over and block their own blood flow, which is called torsion.
Getting back to 'square one'…..how can we know if we have ovarian cancer? Uterine cancer and cervical cancer cause abnormal bleeding, and breast cancer causes lumps or breast retractions, but ovarian cancer is so silent.
It may be helpful to know that ovarian cancer is very rare, with less than 1% of women getting it. We are more likely to die of heart disease, lung cancer, breast or skin cancer.
Certain risk factors may make some women more likely to get cancers (ask your doctor for specific tests along with the annual exam and Pap smear):
- Menopause, although due to the increase of hormone use and growth hormone in our food we are seeing cancer at younger ages; we are seeing an increase in breast and ovarian cancer as early as 22 years old when it was unheard of 20 years ago
- Never having had children
- Not breastfeeding
- Taking fertility drugs for many years
- Family history of ovarian, breast, thyroid or colorectal cancer or any cancer yourself
- Note: Birth control pills and hormone replacement therapy, because they rest your ovaries, can actually reduce the risk of ovarian cancer
If you ask for an ultrasound along with specific blood tests called tumor markers, it can help diagnose early cancer. The ovary should not show any cyst and a blood test called a CA-125 should read in the normal range. If either one are abnormal, then further testing should be done. Tests like CT scans, Doppler flow studies, or MRI can see the ovaries better and define any growth. They can also see the lymph nodes to evaluate them for cancer as well. Other blood tests include CBC, Chemistry panel and Tumor markers such as LH, CEA, FSH, and HCG, plus estradiol and testosterone. Tumor markers test for the different types of cancer - whether ovarian or not. The blood tests for cancer are becoming more sophisticated and specific every year.
The different types and classifications of tumors are:
- Epithelial cell tumors that start from the cells on the surface of the ovaries; these are the most common type of ovarian tumors
- Germ cell tumors that start in the cells that produce the eggs and can either be benign or cancerous
- Stromal tumors originate in the cells that produce female hormones
Treatment really depends on the type of cancer and how early or late it is discovered. It is up to the Cancer Specialist to make the decision as to whether chemotherapy, radiation, surgery, or a combination of these would be most helpful.
So, to summarize, it is comforting to know that Ovarian Cancer is rare, but the difficulty in screening and lack of symptoms can make it hard to detect early. Most are found at an advanced stage, and that is why most women do not survive, not because it can't be cured.
Some women will notice an increase in vaginal discharge with a hormone active cyst or when a large cyst ruptures. Since the vagina likes to maintain a slightly acidic or low pH, any increase or change in vaginal discharge can change the normal flora and raise the pH to a more alkaline environment.
This can cause unwanted odors, and most abnormal vaginal odors won't go away with bathing. The worst thing to do is douche, as this can further disrupt the vaginal environment and make it harder/longer to heal. Never wash inside your vagina with soap either. If you feel you need to clean inside the vagina, only use plain water, as it will not disrupt the natural self-cleaning ability.
WaterWorks is a natural, easy way to accomplish feminine hygiene every day, inside and out. It can be used after your period, after sex, or everyday to rinse out discharge and erase unwanted odors. Since it is FDA cleared to help remove vaginal odor, it is the best way to stay feeling confident and fresh without the use of medicine or chemicals. If you think you have an infection, you need to see your doctor for cultures and for that you may need medicine. It is still safe to use WaterWorks while you are being treated for infection.
Hope you all have a safe, happy weekend :)
Dr. Susan L. Boyd, MD