Wednesday, September 26, 2012

New insights into ovarian cancer pathology.

New insights into ovarian cancer pathology.

Sept 2012


Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.


Malignant epithelial tumors (carcinomas) are the most common ovarian cancers and also the most lethal gynecological malignancies. Based on histopathology and molecular genetic alterations, ovarian carcinomas are divided into five main types [high-grade serous (70%), endometrioid (10%), clear-cell (10%), mucinous (3%), and low-grade serous carcinomas (<5%)] that account for over 95% of cases. These types are essentially distinct diseases, as indicated by differences in epidemiological and genetic risk factors, precursor lesions, patterns of spread, and molecular events during oncogenesis, response to chemotherapy, and prognosis.
For a successful specific treatment, reproducible histopathological diagnosis of the tumor cell type is critical. The five tumor types are morphologically diverse and resemble carcinomas of the uterus. Actually, recent investigations have demonstrated that a substantial number of cancers, traditionally thought to be primary ovarian tumors (particularly serous, endometrioid, and clear-cell carcinomas), originate in the fallopian tube and the endometrium and involve the ovary secondarily. This presentation summarizes recent advances in the molecular pathology which have greatly improved our understanding of the biology of ovarian carcinoma and are also relevant to patient management.

Optimal first-line treatment in ovarian cancer.

Optimal first-line treatment in ovarian cancer.

Sept 2012


UCL Cancer Institute, Cancer Research UK and UCL Cancer Trials Centre, London, UK.


Treatment of ovarian cancer remains challenging despite the high complete response rate seen after maximal surgical debulking surgery and platinum-combination chemotherapy. as most patients will relapse and eventually succumb to ovarian cancer, new strategies are urgently required to improve survival. a platinum-taxane combination has been the cornerstone of treatment for >15 years. Better use of these drugs is being explored through scheduling studies, and dose-dense or intraperitoneal (IP) therapies. 

Further improvements in treatment will most likely come from the integration of optimal chemotherapy with one or more of the hundreds of molecular-targeted agents that could be active in ovarian cancer. The greatest experience has been with anti-angiogenic agents. Two large phase III trials in first-line ovarian cancer have demonstrated a positive effect of bevacizumab when administered concurrently with chemotherapy and then as a maintenance treatment. In this review, we discuss the existing treatments for ovarian cancer and highlight areas of recent progress.

The lived experience of ovarian cancer: A phenomenological approach.

The lived experience of ovarian cancer: A phenomenological approach.

Oct 2012


Texas Tech University Health Sciences Center, Lubbock, Texas Texas Woman's University, Denton, Texas.


Purpose: To describe the lived experience of women diagnosed with ovarian cancer using individual interviews.

Data sources: Eleven women who had been diagnosed with ovarian cancer within the past five years were interviewed with open-ended guiding questions. The narrative responses were analyzed for constitutive patterns and relational themes according to Diekelmann and Allen's hermeneutic phenomenological process. 

Conclusions: This phenomenological study gave voice to the women's experience with ovarian cancer. The following six constitutive patterns and associated themes emerged: (a) The Revelation, (b) Jeopardy, (c) On the Lookout, (d) Becoming Normal, and (e) Living Every Moment. 

Implications for practice: An understanding of the common experiences and shared meanings of women with ovarian cancer may contribute to earlier diagnosis and improved quality of life. The women identified symptoms that should generate concern when reported to providers, potentially leading to diagnostic testing. The experiences may also serve to inform the development of interventions aimed at meeting the needs of women diagnosed with ovarian cancer.

Girl, 8, Survives Ovarian Cancer

Girl, 8, Survives Ovarian Cancer

Sept 25, 2012

Written by Alex Crees
On September 22, the third Annual Run/Walk to Break the Silence on Ovarian Cancer will take place in Madison, Conn. The walk’s top fundraising team, Natalie’s Tigers, which has raised more than $7,000, is fronted by little Natalie Cosman – who, at 8 years old, is a survivor of the disease.
“Our goal is to make people realize it can happen to any female at any age,” Natalie’s mother, Melinda Cosman, told “We want to get the word out there about the disease the way it should be out there.”
Natalie’s battle started one year ago, when she started complaining of chronic stomach pain. Doctors brushed it off as a stomach virus or gas buildup – until one day, when the pain became so bad, Natalie’s parents rushed her to the hospital.
Suspecting appendicitis, doctors ordered an ultrasound and found a 7-centimeter cyst on Natalie’s right ovary. A biopsy confirmed the cyst was a tumor, and Natalie was diagnosed with stage II ovarian cancer.
“I was shocked, especially by what kind of cancer it was,” Cosman said. “A 7 year old with ovarian cancer is quite shocking.”
‘A silent killer’
September is Ovarian Cancer Awareness month. Ovarian cancer is known as a 'silent killer' because there is little awareness and high mortality rates associated with the disease. In 2012, there will be 22,280 new cases of ovarian cancer and 15,500 deaths from ovarian cancer, according to estimates from the American Cancer Society.
While ovarian cancer is ranked ninth in prevalence among women – lagging far behind breast and lung cancer – it ranks fifth in women’s cancer deaths. More than half of women diagnosed die within five years.
Children and young women typically develop a rare subtype of the disease – it arises in the germ cell, which is responsible for making eggs, or in the cells that support the eggs, according to Dr. Robert DeBernardo, a gynecological oncologist at UH Case Medical Center in Cleveland, Ohio. This cancer subtype usually remains confined to one ovary and is highly treatable if caught early.

Tuesday, September 25, 2012

Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stageovarian cancer.

Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer.

Oct 2012


From the Departments of Obstetrics and Gynecology and Medicine, Columbia University College of Physicians and Surgeons, the Department of Epidemiology, Mailman School of Public Health, Columbia University, and the Herbert Irving Comprehensive Cancer Center, New York, New York.



 Cytoreductive surgery is associated with extensive morbidity and may delay chemotherapy. We examined the associations among cytoreduction, perioperative complications, and delay or omission of chemotherapy.


 Women aged 65 years or older with stage III-IV ovarian cancer who were treated with surgery from 1991-2005 and recorded in the Surveillance, Epidemiology, and End Results-Medicare database were examined. We estimated the influence of extended cytoreduction as well as the occurrence of major perioperative complications on receipt and timing of chemotherapy and survival.


 Among 3,991 patients, 479 (12%) failed to receive chemotherapy. Of those treated with chemotherapy, 2,527 (72%) initiated treatment within 6 weeks of surgery, 838 (24%) within 6-12 weeks, and 147 (4%) more than 12 weeks after surgery. In a multivariable model, older patients, those with comorbidities, mucinous tumors, and stage IV neoplasmswere more likely not to receive chemotherapy (P<.05). Extended cytoreduction and the occurrence of postoperative complications were not associated with omission of chemotherapy but were associated with chemotherapy delay. For every 14 patients who underwent one extended procedure and for every 13 who had two extended procedures, one patient had a delay in receipt of chemotherapy. For every 14 patients who had one complication and for every four who had two complications, one patient had a delay in receipt of chemotherapy. The occurrence of more than two perioperative complications (hazard ratio 1.31, 95% confidence interval [CI] 1.15-1.49) and initiation of chemotherapy more than 12 weeks after surgery (hazard ratio 1.32, 95% CI 1.07-1.64) were associated with decreased survival.


 Extended cytoreductive surgery and perioperative complications significantly delay initiation but do not increase the chance of omission of chemotherapy for women with ovarian cancer.

Cytokine Use And Survival In The First-Line Treatment Of Ovarian Cancer: A Gynecologic Oncology Group Study.

Cytokine Use And Survival In The First-Line Treatment Of Ovarian Cancer: A Gynecologic Oncology Group Study.

Sept 2012


Indiana University School of Medicine, Indianapolis, IN 46202. Electronic address:



Granulocyte colony stimulating factor (G-CSF) and erythropoietin stimulating agents (ESA) may be used to support patients during chemotherapy. We assessed whether G-CSF or ESA were associated with progression or death in patients with ovarian cancer.


Patients with ovarian cancer following surgery, were on a protocol to evaluate bevacizumab with chemotherapy. Guidelines for administering G-CSF and ESA were specified in the protocol. Overall survival (OS) was analyzed with landmark procedures and multivariate, time-dependent hazard models.


Eighteen-hundred-seventy-three women were enrolled, with no differences in clinical and pathologic variables among treatment group. Performance status, hemoglobin, and white cell counts were associated with G-CSF and/or ESA usage during treatment. Nine patients received no protocol directed therapy, leaving 1,864 patients for this review. One-thousand-one-hundred-twenty-five patients received neither ESA nor G-CSF; 311 received G-CSF but no ESA; 241 received ESA but no G-CSF; and 187 received both. Median survival following a five month landmark from the start of treatment was 34 versus 38 months for those who did versus did not receive ESA (multivariate hazard ratio: 0.989; 95% confidence interval: 0.849-1.15) and 40 versus 37 months for those who did versus did not receive G-CSF (multivariate hazard ratio: 0.932; 95% confidence interval: 0.800-1.08).


Neither ESA nor G-CSF had a negative impact on survival after adjustment of prognostic factors among patients with ovarian cancer receiving chemotherapy. ESA may appear to be associated with shorter survival in univariate analyses because factors prognostic for ESA use are also prognostic for progression-free survival.

A randomized phase II study evaluating the combination of carboplatin-based chemotherapy with pertuzumab versus carboplatin-based therapy alone in patients with relapsed, platinum-sensitiveovarian cancer.

A randomized phase II study evaluating the combination of carboplatin-based chemotherapy with pertuzumab versus carboplatin-based therapy alone in patients with relapsed, platinum-sensitiveovarian cancer.

Sept 2012


CRUK Department of Medical Oncology, The Royal Marsden Hospital and The Institute of Cancer Research, Surrey.


Pertuzumab, a humanized monoclonal antibody targeting human epidermal growth factor receptor (HER)-mediated signalling, has shown activity in ovarian cancer in preclinical models and in the clinic. This randomized phase II study evaluated efficacy and safety of pertuzumab in combination with carboplatin-based chemotherapy in patients with platinum-sensitive, recurrent advanced ovarian cancer.

Patients and methods
Patients were randomized to receive six cycles of chemotherapy (carboplatin and either paclitaxel (Taxol) or gemcitabine) with or without pertuzumab. The primary end point was progression-free survival (PFS) as determined by Response Evaluation Criteria in Solid Tumors and/or by CA 125 measurements. Secondary end points evaluated the response rate, safety profile, duration of response, time to progression and overall survival for both treatment arms.

A total of 149 patients received either chemotherapy with pertuzumab (arm A, n = 74) or chemotherapy alone (arm B, n = 75). There was no significant difference either in median PFS or in the secondary end points between the two arms. No differences were seen in an exploratory biomarker analysis of HER3 mRNA expression between the two arms. Pertuzumab was well tolerated, with no increase in cardiac adverse events compared with chemotherapy alone.

The addition of pertuzumab to carboplatin-based chemotherapy did not substantially prolong PFS in unselected patients with platinum-sensitive ovarian cancer.

New Chemotherapy Strategy Emerges in Ovarian Cancer

New Chemotherapy Strategy Emerges in Ovarian Cancer

Sept 23, 2012

Anita T. Shaffer

A study evaluating first-line chemotherapy dosing strategies for treating patients with advanced epithelial ovarian cancer has delivered practice-changing findings, and ongoing trials are likely to provide further clarity on the comparative benefits of routes of administration, according to Jonathan S. Berek, MD, MMS.

The noteworthy results stem from Japanese Gynecologic Oncology Group (JGOG) trial 3016, which established a significant survival benefit for patients who received dose-dense weekly paclitaxel plus carboplatin versus the conventional dosing schedule for those two drugs.1
“It’s a very important study,” said Berek, professor and director, Stanford Women’s Cancer Center at Stanford Cancer Institute in California, in an interview. “This trial demonstrates, at least within the context of this large, well-performed, prospective randomized trial, that the dose-dense (every week) intravenous chemotherapy regimen is preferable to the standard (every 3 weeks) intravenous regimen. Therefore, it is, as we say, a game-changer.”

Berek, who served as the discussant of the JGOG 3016 trial results at the American Society of Clinical Oncology (ASCO) annual meeting in June, said there are at least four prospective trials under way worldwide that should shed further light on whether the chemotherapy regimen is best delivered through intravenous (IV) or intraperitoneal (IP) administration.

Lead investigator Noriyuki Katsumata, MD, PhD, of the Department of Medical Oncology at the Nippon Medical School, Musashikosugi Hospital, Kawasaki, Japan, presented the JGOG 3016 follow-up data at ASCO. (The trial also is known as the NOVEL study).

The long-term results involve the experiences of 631 patients with stage II–IV epithelial ovarian, fallopian tube, or primary peritoneal cancers.

Participants were randomized to receive either the dose-dense regimen of carboplatin AUC 6.0 on day 1 and paclitaxel 80 mg/m2 on days 1, 8, and 15 versus the standard regimen of carboplatin AUC 6.0 and paclitaxel 180 mg/m2 on day 1. Treatments were repeated every 21 days for six cycles, with patients who responded eligible for three additional cycles.

After 6.4 years’ follow-up, the 312 patients who received dose-dense therapy achieved a median progression-free survival (PFS) of 28.2 months versus a median PFS of 17.5 months for the 319 patients who received the standard regimen (HR = 0.76, 95% CI [0.62-0.91]; P = .0037).

The median overall survival (OS) had not yet been reached in the dose-dense group, while the OS among those treated conventionally was 62.2 months. At five years, the survival rate was 58.7% in the dose-dense group, compared with 51.1% in the standard-treatment group (HR = 0.79, 95% CI [0.63-0.99]; P = .039).

A subgroup analysis indicated that patients with clear-cell and mucinous carcinomas, who made up 15% to 17% of patients, did not show a statistically significant advantage with either treatment strategy. More than 80% of the patients in each arm had serous adenocarcinomas and other types.

“Neither dose-dense nor conventional treatment seemed effective against clear-cell or mucinous ovarian cancers, which suggests that other treatment strategies are needed,” Katsumata said in his presentation.

While the study provides insight into dosing strategies, questions remain unanswered about the impact of the route of administration, Berek indicated. Participants in both groups in the JGOG 3016 study received IV chemotherapy.

In 2006, the National Cancer Institute recommended a combination of IV and IP chemotherapy following surgical debulking for women with advanced ovarian cancer after the Gynecologic Oncology Group (GOG) study 172 found the combination more effective than the standard regimen delivered via IV.2

Berek, however, noted that a dose-dense regimen of paclitaxel was used in the IV/IP arm of GOG 172. He said that made it difficult to determine whether it is adose-dense regimen, the route of administration, or both that result in superior outcomes.

“If you look at the survival data from the dosedense carboplatin/paclitaxel, which is intravenous, not intraperitoneal, the survivals are very similar to the survivals seen in the intraperitoneal regimen. So one might argue that it might not be because it’s given directly into the peritoneal cavity. It might be because the paclitaxel is given more frequently,” said Berek. 

“Future studies will hopefully answer the question: How does intravenous dose-dense carboplatin-paclitaxel compare to intraperitoneal chemotherapy using cisplatin or carboplatin plus paclitaxel?”

Berek said a dose-dense regimen given intravenously offers a good option for patients in light of issues that have arisen with IP regimens. “The adoption of intraperitoneal therapy is not universal,” he said. “In fact, probably fewer than half of patients have been treated with that anyway for a variety of reasons. And so this [dose-dense regimen] represented a suitable alternative to intraperitoneal therapy.”

While clinical trials continue, Berek believes that clinicians should discuss the treatment options with their patients. He said there might be valid reasons for certain patients to receive conventional therapy but that “what we don’t recommend as a routine, as a standard, any longer is the every-third-week regimen.”

Sunday, September 23, 2012

Ovarian cancer detection made easy with simple symptom survey

Ovarian cancer detection made easy with simple symptom survey

Published: Saturday, Sep 22, 2012, 20:57 IST 

A simple three-question paper-and-pencil survey, given to women in the doctor’s office in less than two minutes, can effectively identify those who are experiencing symptoms that may indicate ovarian cancer, a new study has revealed.
The study by researchers at Fred Hutchinson Cancer Research Center represents the first evaluation of an ovarian cancer symptom-screening tool in a primary care setting among normal-risk women as part of their routine medical-history assessment.
Early detection of ovarian cancer is key to survival. Cure rates for those diagnosed when the disease is confined to the ovary are approximately 70% to 90%. However, more than 70% of women with ovarian cancer are diagnosed with advanced-stage disease, when the survival rate is only 20% to 30%.
The researchers evaluated the effectiveness and feasibility of several different symptom screening surveys.
After a few tweaks to formatting and content, the version that proved most effective contained three questions that asked whether a woman was currently experiencing one or more of the following symptoms, all of which have been identified previously as potentially indicative of ovarian cancer.
The symptoms were abdominal or pelvic pain, feeling full quickly or unable to eat normally and abdominal bloating or increased abdomen size.
The survey also asked about the frequency and duration of these symptoms: how many days a month and for how long.
“Symptoms such as pelvic pain and abdominal bloating may be a sign of ovarian cancer but they also can be caused by other conditions. What's important is to determine whether they are current, of recent onset and occur frequently,” M. Robyn Andersen, lead author of the study, said.
Previous research by Andersen and colleagues has found that about 60% of women with early-stage ovarian cancer and 80% of women with advanced disease report symptoms that follow this distinctive pattern at the time of diagnosis.
“Women with symptoms that are frequent, continual and new to them in the past year should talk to their doctor, as they may be candidates for further evaluation with ultrasound and blood tests that measure markers of ovarian cancer such as CA-125,” she said.
“Recent research indicates that approximately one in 140 women with symptoms may have ovarian cancer. Aggressive follow-up of these symptoms can lead to diagnosis when ovarian cancer can be caught earlier and more effectively treated,” she said.
The study involved 1,200 women, age 40 to 87, who were seen in a Seattle women's health clinic. More than half of the study participants reported being postmenopausal and approximately 90% were white.
About half of the clinic visits were for a current health concern or for follow-up of a health problem reported at an earlier visit. The other half were for routine appointments such as mammography screening.
Of those surveyed, 5% had a positive symptom score that indicated the need for further testing. Of this group of about 60 women, one was diagnosed with ovarian cancer shortly thereafter.
Of the 95% of women who tested negative on the symptom survey, none developed ovarian cancer during a 12-month follow-up period, which attests to the accuracy of the screening tool.
Those who reported current symptoms on the questionnaire or reported other medical concerns scored higher than those who did not. Non-white women were also about twice as likely to receive a positive symptom score as compared to white women.
“If ovarian cancer screening using symptoms is widely adopted, maximising the specificity of screening programs will be important,” the authors wrote.
“Until better biomarkers are identified and tested, collecting information about symptoms appears to have promise,” they added.
The bottom line, Andersen said, is that the screening tool can be used easily in a primary-care setting, is acceptable to patients and providers, and identifies women with symptoms that are worthy of concern with minimal false-positive results.
The study has been published online in the Journal of Obstetrics and Gynecology.

Saturday, September 22, 2012

Induction of apoptosis in human ovarian cancer cells by new anticancer compounds, epothilone A and B.

Induction of apoptosis in human ovarian cancer cells by new anticancer compounds, epothilone A and B.

Sept 2012


Department of Thermobiology, Institute of Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland. Electronic address:


Epothilones are a new group of compounds with action mechanisms similar to taxanes. The aim of this study was to compare the effects of epothilone A (Epo A) and epothilone B (Epo B) on ovarian cancer cell line SKOV-3 with those of paclitaxel (PTX), a classic taxane. We evaluate glycoprotein P (P-gp) activity in the ovarian cancer cell line. Apoptotic and necrotic cell levels were measured by double staining with Hoechst 33258 and propidium iodide (PI) as well as Annexin V staining. The production of reactive oxygen species (ROS) and changes in mitochondrial membrane potential (ΔΨm) in cells exposed to Epo A, Epo B and PTX were studied using specific fluorescence probes, DCFH(2)-DA (2',7'-dichlorodihydrofluorescein diacetate) and JC-1 (5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolcarbocyanine). The cytotoxic activity of the drugs was determined by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide) test. All probes were analyzed in both the presence and absence of the antioxidant N-acetylcysteine (NAC). The results obtained demonstrated that the antiproliferative capacity of Epo A and Epo B in SKOV-3 cell line (measured as IC(50) after 72h continous treatment) was six and five times greater than that of PTX's respectively. Epothilones induced timecourse-dependent apoptosis and necrosis. Apoptotic and necrotic events were partially blocked by NAC, indicating ROS played a substantial role in epothilone-induced apoptosis. Cell death was also associated with a decrease in mitochondrial membrane potential, which was more pronounced after treatment with epothilones as compared to paclitaxel.

New insights into the pathogenesis of ovarian carcinoma: time to rethink ovarian cancer screening.

New insights into the pathogenesis of ovarian carcinoma: time to rethink ovarian cancer screening.

Oct 2012


From the British Columbia Cancer Agency, Vancouver, British Columbia, Canada.


Recent discoveries about the pathogenesis of ovarian cancer have suggested that it can no longer be thought of as a single entity, but that the histologically defined ovarian cancer subtypes are different diseases, with different precursor lesions and distinct biomarker expression profiles. Most serous carcinomas probably arise from the fallopian tube. Clear cell and endometrioid carcinomas are associated with endometriosis and likely originate from ectopic endometrium. The focus of large ovarian cancer screening trials has been detection of macroscopic ovarian abnormalities by ultrasonography and detection of serum biomarkers associated with the most common (serous) subtype of ovarian cancer. The only completed and phase three randomized controlled trial failed to achieve the objective of reducing ovarian cancer mortality and was not able to demonstrate a stage migration effect of the screening. Future screening strategies have to incorporate our growing understanding of each subtype of pelvic (ovarian or fallopian tube) cancer, its organ of origin, and disease-specific biomarkers. We review how our current understanding of pathogenesis should prompt a reexamination of data from ovarian cancer screening studies and discuss potential designs for future screening strategies.  

Gene tests don't solve breast and ovarian cancers

Gene tests don't solve breast and ovarian cancers

The last week of September is National Hereditary Breast and Ovarian Cancer Week. Science has identified gene mutations that place women at higher risk of breast and ovarian cancer--but to me, this information alone is not nearly enough.

By Pamela Grossman

{WOMENSENEWS}--In a few days, I will pick up the results of genetic testing that I was strongly urged to have done. This will determine whether I carry a gene mutation that increases a woman's risk of developing breast and ovarian cancer--by a huge amount. If my test is positive, which is likely, I will almost certainly remove my ovaries at some point; and very possibly my breasts too, down the line.

I am no fan of preventive removal of healthy body parts, especially when those parts heavily influence quality of life.

I said as much to the high-risk oncologist I sought out 10 years ago, when I learned through a relative's test results that one such mutation--known as BRCA2--is in my family.

Unfortunately, this information was not surprising. Ovarian cancer took the lives of my mom and her sister, at ages 51 and 48, respectively. The Dana Farber Cancer Institute tells us that 75 percent of ovarian cancers are diagnosed at later stages. Partly as a result of this, survival outcomes for the disease are poor, just as they were when my mother was diagnosed in 1979.

My doctor suggested regular ovarian screening--the scans are not highly reliable, but they do at least provide some information. However, eight years after we began the ovarian checks, I discovered a lump during a breast self-exam.

At age 40, as a vegetarian yoga-doer with an annoyingly healthy lifestyle (yes, thanks for asking, I do mind if you smoke), I was diagnosed with breast cancer.

Clearly, I should have been having breast screenings as well as ovarian screenings all along; the possibility of being a BRCA2 carrier put me at high risk for both cancers.

The doctor had made her screening recommendation based on my family history. If we could go back in time, I would ask more questions; she would expand on what she advised.

Suffice it to say for now, if you are a woman with an increased likelihood to be BRCA+ (whether or not you have been tested), ask your doctors about receiving both breast and ovarian screening, and find out what medical guidelines best apply to you.

Aggressive Cancer

The breast cancer I had was aggressive. We learned from a biopsy that it had already spread to two lymph nodes, which were palpable under my skin. I remember brushing my fingers over the nodes, after I'd learned what they meant. I have no words for that feeling.

I underwent chemotherapy before surgery; my doctors wanted to get a system-wide jump on the disease. That's when I learned that the chemo could very possibly put me into early, and permanent, menopause. I hadn't yet had children, wasn't sure that adoption agencies would look favorably on a cancer history and didn't have time to harvest eggs before chemo. I'd never imagined cancer making any decisions for me about having a family. Cue many, many tears.
I did the chemo. I was bald, I was tired and I was queasy. (This, though, was nothing like the horrific nausea my mom faced. Chemo is still miserable, but in anti-nausea medication there has been big progress). On some days I was scared, and on many days I was profoundly sad. I told friends I was a walking collection of qualities that had been rejected for the Seven Dwarves, like Dizzy, Weepy and (slightly) Pukey.

But finally, my surgery revealed that the chemo had worked and all but eliminated the cancer. Radiation and post-treatment "don't get cancer again" pills, targeted to the pathology of the disease I'd had, did the rest.

Thoughts of Egg Harvesting

Here I am, several years out from my diagnosis, cancer-free and doing well (knock on every piece of wood). To my joy, I did not go into permanent menopause from chemo, and my thoughts again turned to harvesting eggs. (For a pregnancy I'll carry when I'm done with the preventive meds? For a surrogate to carry? Unclear; first things first.)

But you can't harvest eggs during or immediately after radiation and you can't harvest them while on the don't-get-cancer-again drugs. I've been waiting to arrive at "the right time" for harvesting, while also facing related complications that one of the don't-get-cancer drugs has caused (a long and aggravating story in itself).

Meanwhile, since my cancer diagnosis, my own genetic testing for BRCA has seemed unavoidable. I had originally chosen surveillance rather than testing because I knew I would not be willing to have preventive surgeries at that time; surveillance was the only other option. But my cancer diagnosis changed the picture. Assuming my results are positive, I'll be in intense and immediate negotiations with my doctors over my ovaries.

If I can't keep them forever--and, given the current ovarian cancer landscape, doing so would never be advised--I at least want to get some eggs from them first.

Did you know that a woman can carry a pregnancy, with implanted embryos, after her ovaries are removed? I didn't, until I saw a fellow-survivor friend do just that, giving birth to a healthy and beautiful son.

A Differing Attitude

Lots of women, I hear, are grateful for the knowledge that BRCA testing brings; information is power, they figure. And that also seems to be the attitude that many clinicians expect of me.

For me, the information does not feel empowering, given the medical state of things.

To begin with, no one knows yet how to fix BRCA mutations. Even so, the information would be of huge use if there were better early detection for ovarian cancer and if young women with dense breast tissue had more reliable breast-screening tools.
But none of this is the case, and therefore preventive removal of breasts and ovaries is the norm.

Far from feeling grateful for what the BRCA test will tell me, I feel more like the character who, at the end of Shirley Jackson's "The Lottery," learns that a revered town tradition in which she has been "chosen" is about to result in her death by stoning.

Her last words on the matter (or any matter): "It isn't fair. It isn't right." I know BRCA testing is supposed to help prolong life, not end it. But still, I feel, this whole process isn't right; and it's incredibly far from fair.

I want to live, and I'll do what I have to do. But the long life I hope to gain through my efforts will always include noisily advocating for better. Better detections, better treatments, a fix for BRCA--and while we're at it, a cure for cancer.

When I see those things come to pass, then, yes, I will indeed be grateful.