Facing Her Toughest Job-Ovarian Cancer
When diagnosed with ovarian cancer, Lynn Gilliland had to put the career she loved on hold to focus on the job of getting well.
Over the summer and fall of 2003, Lynn Gilliland was on the road constantly, doing the job she loved as alumnae director of Mary Baldwin College. "I kept having this nagging back pain," she recalls, "which I credited to stress and traveling all the time. Every couple of months, I'd have terrible cramps that really knocked me out, but I attributed it to pre-menopause."
It was the following winter before Gilliland, a Staunton mother of two, finally saw her gynecologist. A pelvic exam followed by a vaginal ultrasound revealed the presence of a mass outside her uterus. Her doctor scheduled an immediate hysterectomy.
Making Time to Fight
"I don't have time right now," Gilliland remembers saying. "You don't have a choice," was her doctor's reply. When she awoke from surgery, the news was bad, although it could have been worse: Clear-cell carcinoma, but still confined to the ovaries. "As soon as you are able to drive, we're sending you to Laurel Rice," she was told.
Two weeks later, Gilliland was meeting with Laurel Rice, M.D., director of University of Virginia Health System's Division of Gynecologic Oncology. "Laurel has been just wonderful," Gilliland says. "She's very straightforward, doesn't try to hide anything. She said, ‘you're young, you're healthy, you've got a bad kind of cancer, and we're going to fight it.'"
Tackling a Tough Cancer
Ovarian cancer is known as the "disease that whispers" because its symptoms are usually vague or undetectable. Gilliland is fortunate, as the vast majority of patients are diagnosed with ovarian cancer after it has already spread outside of the ovaries. While the overall five-year survival rate for ovarian cancer patients is 44 percent, this drops to 25 percent for patients in whom the cancer has spread outside of the pelvis.
Despite this harsh reality, Rice remains encouraged by the prospects for improved treatments and diagnostics. "We are seeing people live longer, with an improved quality of life," she says.
Surgery is the first line of defense, Rice explains, and studies have shown that women whose surgery is performed by a gynecologic oncologist fare better. Women who are at higher risk for ovarian cancer may benefit from a screening blood test for a tumor "marker" called CA-125, but the test is not sensitive or specific enough to be generally useful. However, for patients in remission from ovarian cancer, a CA-125 test can signal recurrences, which develop in 80 percent of cases.
A significant family history of breast or ovarian cancer leads some women to consider genetic testing to learn if they inherited a copy of the so-called breast cancer genes, BRCA1 and BRCA2, which increase the risk of ovarian, as well as breast cancer. Although doctors emphasize that a positive result provides information only about a person's risk of developing cancer-not whether or when they will develop it-some carriers of the faulty gene decide as a precaution to have their ovaries removed.
A significant advance in the treatment of ovarian cancer was made in the 1980s, when platinum-based chemotherapy became standard. Soon after, the highly active drug paclitaxel (Taxol) was added to the regimen. That combination is still the gold standard today, although newer drugs and combination therapies are currently being investigated (see "Where UVa May Take Us").
Last year, the UVa Cancer Center treated 279 women with newly diagnosed gynecologic cancers, including 70 ovarian cancers. A key component of treatment at UVa is a team-based approach. "We are totally committed to each patient having one doctor and a nurse who work as a team," Rice explains. "In addition, our entire gynecologic cancer team-made up of gynecologic oncologists, pathologists, radiation therapists, pharmacists, radiologists, clinical trial coordinators, and nurses-meets weekly to discuss cases. This helps ensure that we bring the experience of many experts to each case-and that treatment plans consider the well-being of the whole person-not just the status of her tumor."
Becoming a Survivor
A whole-person approach to patient care made a world of difference to Gilliland. At the time of her diagnosis she had expected to maintain her demanding work schedule throughout treatment. "I had this superwoman complex before this happened," Gilliland recalls. Several rounds of chemotherapy and more surgery finally made her realize that she couldn't do it all. "One of the hardest things for me was letting other people help me, and that is so critical to cancer treatment. But Dr. Rice is very driven. She understood my personality type so well and was able to say, ‘Look, your job right now is to get well-and that is your only job.'"
Three years later, she is back at work as executive assistant to the president at Mary Baldwin. She continues to find check-ups an anxious time. She is almost, but not quite, able to think of herself as a cancer survivor. "I don't think we're quite to the point of using the word cured yet, but each visit gets a little easier," she says.
A former exercise-hater, Gilliland now walks in the early morning and finds it improves her physical, mental and spiritual well-being. At every opportunity, she repeats the message that she knows can save lives: "Stop and listen to your body. Pain is telling you something."
She is grateful for the love and support of family, friends, her church, and the skill and compassion of her doctors. Patience comes easier to her than it used to. "My thinking now is that every day is a gift," she says, "and life is lived one day at a time."
"Caring for women with ovarian cancer is challenging and rewarding in every possible way. These women are fighting a battle, and as their physician, I strive to provide cutting-edge medical care, along with all the emotional support they need. On a daily basis, I see women with ovarian cancer display the type of grace and dignity, combined with tenacity of spirit, that I hope I could muster if I was diagnosed with the same disease. I feel remarkably fortunate to care for these women, many of whom are role models for me. It is an honor." - Laurel Rice, M.D., UVa gynecologic oncologist
Where UVa May Take Us
To give women a better chance of beating ovarian cancer, University of Virginia researchers are seeking more effective ways to find and treat the disease. In the future, chemotherapy will probably be combined with agents that help our bodies recognize and fight cancer, slow or stop its spread, or repair cells damaged by chemotherapy or radiation. These immune-based therapies include vaccines that work to harness the body's natural defenses as well as monoclonal antibodies, artificial antibodies produced in the laboratory, that are designed to seek out and disrupt cancer cell growth. Promising approaches being studied at UVa include:
Screening: Amir Jazaeri, M.D., is investigating whether saliva can provide a simple diagnostic test for ovarian cancer. Although the research is preliminary, Jazaeri explains, it appears that certain proteins are selectively present in the saliva of ovarian cancer patients. Samples are easy to obtain, but the analysis performed by UVa cancer pathologist Kristen Atkins, M.D., is "very high tech, very cutting edge," Jazaeri says. "The next year or two will be really critical in determining the effectiveness of a saliva test to diagnose ovarian cancer."
Willie A. Andersen, M.D., and Susan C. Modesitt, M.D., are investigating other approaches for improved screening for ovarian cancer, as well as exploring the value of removing the ovaries in women at high risk for developing ovarian cancer. UVa is participating in a national trial combining ultrasound, physical exam and CA-125 blood testing in women who have a significant family history of breast and/or ovarian cancer.
Vaccine: Craig Slingluff, M.D., director of UVa's Human Immune Therapy Center, has been researching an experimental vaccine for use against ovarian cancer. So far, research has provided evidence that the vaccine is safe and produces an immune response in ovarian cancer patients. A more advanced study is in development.
Immunotherapy: Peyton Taylor, M.D., medical director of the UVa Cancer Center, has been the principal investigator for OvaRex, an artificial antibody that shows promise of extending remissions for some advanced-stage ovarian cancer patients. It is designed to help patients fight recurrences of the disease. In initial clinical trials, some women who received OvaRex were in remission for twice as long as those who did not.
How Can I Reduce My Risk?
Oral contraceptives Using birth control pills for several years is linked to a 30-50 percent lower risk of ovarian cancer
Breastfeeding Women who breastfeed for at least a year are at slightly reduced risk
Diet Several studies link diets high in vegetables to reduced risk
Oophorectomy, tubal ligation, hysterectomy Removal of the ovaries, tying the fallopian tubes after childbearing, and removal of the uterus all reduce the risk of ovarian cancer to varying degrees. However, none of these procedures is recommended for that purpose alone, except in women with a strong family history of ovarian and/or breast cancer.
Am I at Risk?
For epithelial ovarian cancer, the most common type, factors that raise the risk of developing the disease include:
Family history Having first-degree relatives with ovarian, breast, or colorectal cancer
Personal history of breast cancer Having breast cancer raises the risk of developing ovarian cancer
Age Most women diagnosed with ovarian cancer are postmenopausal
Reproductive history Women who have never had a full-term pregnancy, began to menstruate before age 12, or reached menopause after age 50, are at increased risk
Obesity May increase the risk of certain types of ovarian cancer