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    When you hear ‘ovarian cancer’ you automatically think it’s a killer

    Greta Sheahan was hyper-sensitive about her body and understandably so — the 41-year-old mother of two, who runs a ladies’ shoe shop in Charleville, Co Cork, had been diagnosed with breast cancer in 2006.So in late 2020, after two months of suffering constipation as well as dull ache in her lower abdomen, Greta went to her GP.“I wasn’t happy. I felt something funny was going on. Initially,

    I thought it was just stomach issues,” she says.The GP did a cancer antigen (CA) 125 blood test — ovarian cancer patients may have high levels of this protein. Greta’s levels were slightly elevated.She was referred to a gynaecologist in Cork University Hospital (CUH), who felt her symptoms were down to abdominal issues but ordered an MRI to put her mind at ease.

    “My instincts were telling me there was something sinister going on,” says Greta.Shortly after her 2006 breast cancer diagnosis, she had tested positive for the BRCA gene. Mum to Chloe, 13, and Liam Óg, 11, she opted to have risk-reduction surgery in 2012.

    “I had a total hysterectomy — removal of my uterus, ovaries, fallopian tubes, and cervix.”However, in March last year, the MRI showed up stage three ovarian cancer.“I couldn’t believe it,” says Greta. “When you hear ‘ovarian cancer’ you automatically think it’s a killer but we just had to put on our fighting caps and take it on.

    ”What made the diagnosis even more harrowing was the death of Greta’s sister, Tina, from ovarian cancer just a year earlier.The weeks following her diagnosis for the same cancer were “horrendous”, Greta says.

    “I had to tell my parents, my two brothers, and my brother-in-law, who’d lost his wife just before leaving two small children.”Following a months-long course of chemo, Greta underwent surgery.“When it was finished, the surgeons said they felt they’d got all the cancer at that point. I was elated.”She is now on PARP inhibitor treatment, taking four tablets a day.

    A new targeted treatment, it aims to put ovarian cancer patients in long-term remission.Now back working full-time, Greta feels good.“My biggest issue is tiredness, I think it’s from the tablets, but I’ll take that.”Looking back on the last gruelling year, she feels her sister got her through.“I found strength.

    Given a chance to fight, I took it. Some people aren’t given a chance with this disease because it can be gone so far before it’s found.”Greta is spot on. At 71%, Ireland has one of the highest proportions of women diagnosed at an advanced stage with ovarian cancer, compared with only 13% diagnosed at an early stage, according to the International Cancer Benchmarking Partnership.

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    This is partly due to the vagueness of symptoms and the similarity with other conditions, for example, irritable bowel syndrome (IBS).

    However, IBS rarely presents for the first time in a woman over 50.Unaware of symptoms New research commissioned by the Irish Network for Gynaecological Oncology (INGO) found that 79% of women in Ireland were not confident they’d notice a symptom of ovarian cancer.

    When it comes to recognising warning signs, the first significant research done in Ireland on this cancer shows:94% of respondents couldn’t name change/loss of appetite as a symptom;97% didn’t recognise frequent trips to bathroom/needing to urinate often (changes in toilet habits) as a symptom;57% didn’t think changes in bowel habits could be a sign of ovarian cancer;Only 51% knew persistent pain and bloating were signs of ovarian cancer.CUH-based medical oncologist Dr Dearbhaile Collins specialises in gynaecological cancers.

    She says most patients she meets with new diagnoses of ovarian cancer present with stage three or stage four of the disease.“Women often underestimate their symptoms,” Dr Collins says.

    Greta Sheahan, 41, diagnosed with ovarian cancer last year pictured outside the ladies’ shoe shop she runs in Charleville: Wild Pair Shoes on Main Street. Picture Dan Linehan.

    The most common signs of ovarian cancer are encompassed by the acronym BEAT. They need to be checked out if any of them are being experienced for three weeks or more:

    Bloating that is persistent and doesn’t come and go;
    Eating less and feeling full more quickly;
    Abdominal and pelvic pain you feel most days;
    Toilet changes in urination or bowel habits.

    Explaining that ovarian cancer is one of a group of ‘silent’ cancers with symptoms only presenting at stage two or three of the disease, Dr Collins says women often disregard the signs.“Patients say: ‘I thought it was because I was getting older, I thought bloating was part of the menopause’,” she says.

    She also has patients who visited their GP with symptoms and got a full examination but nothing showed up and the symptoms continued. She warns: “It’s important, if symptoms don’t resolve, to go back to the GP, who can order more comprehensive scanning tests.”Being aware of and vigilant for symptoms is crucial, given there’s no reliable screening method for ovarian cancer.

    Contrary to common misperception, ovarian cancer is not detectable through cervical screening.Dr Collins says the CA 125 blood marker can be associated with ovarian cancer but she has seen cases with no raised CA 125.“Appendicitis and endometriosis can also cause high CA 125.

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    And in some women it’s naturally raised anyway. It’s not a good screening tool,” she says.Regular ultrasounds don’t identify ovarian cancer with any great accuracy either. “They cause women a lot of stress when abnormal cysts are picked up. Gynaecological surgeons have ways to identify more suspicious-looking cysts, but sometimes they aren’t correct. What looks like a benign cyst might need follow-up.

    Equally, when you remove very nasty-looking cysts they can turn out to be entirely benign.“Ultrasound and blood tests have not helped pick up more ovarian cancers earlier,” she says.Yet early diagnosis can significantly improve survival. Of patients diagnosed with stage one ovarian cancer, 83% are alive five years post-diagnosis compared to 16% of those diagnosed with stage four.

    Dr Collins says even diagnosing patients early in stage three can make a huge difference. “Stage three means the cancer has gone outside the ovary, causing fluid build-up in the abdomen.

    One of the most important treatments is surgery and if the surgeon can remove all of the cancer that’s visible to him/her, patients do much better.

    ”New technology Ireland has one of Europe’s highest death rates from ovarian cancer. Approximately 400 women here are diagnosed with the disease annually and almost 300 die from it.

    However, there is hope on the horizon. Dr Collins points to new technology capable of identifying biomarkers in circulating tumour cells or tumour cell fragments that can be found in the blood — including those of ovarian cancer.

    This technology is being used for research in clinical trials in Ireland and elsewhere.“We’re starting to see some early results with this technology, suggesting we may be able to diagnose cancers like ovarian cancer at an earlier stage.

    But we still don’t have concrete proof that it can detect cancers better in a larger population,” she says.However, “it probably does offer the key to diagnosing ovarian and other cancers,” she adds.If the technology lives up to the hope, Dr Collins believes it’ll be 10 years before it’s available to all women.What is available are PARP inhibitors that target a type of enzyme that helps repair DNA damage in cells, which is offered to women with advanced ovarian cancer and is a game-changer in patient survival.

    “These work exceptionally well at preventing ovarian cancer from relapsing for much longer. They need to be taken for up to two years after surgery. The vast majority of advanced ovarian cancer patients are eligible to receive them,” she says.

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    As co-chair of Gynae-Cancer (disease-specific sub group) Cancer Trials Ireland, Dr Collins strongly recommends ovarian cancer patients discuss clinical trials with their oncologist.“It’s really exciting — the amount of new drugs currently being developed for ovarian cancer.

    The hope is to turn advanced ovarian cancer into a chronic disease that patients live with but don’t die from.”Meanwhile, in Charleville, Greta is “fighting the good fight” and urges women to listen to their bodies, even if their doctor thinks nothing is wrong. “If your body is telling you something, follow it up. The body doesn’t lie,” she says.

    INGO is campaigning to highlight BEAT (ovarian cancer symptoms) and to encourage women experiencing symptoms for three weeks or more to contact their GP. On May 8, World Ovarian Cancer Day, 20 buildings countrywide will light up in teal, the international campaign colour.

    400 women diagnosed annually. Ovarian cancer is the leading cause of death in gynaecological cancers.
    In Ireland more than 400 women present with ovarian cancer annually – most cases occur in women aged over 50. It is the sixth most commonly diagnosed cancer in women in Ireland, accounting for 3.4% of new cancer cases.

    Ovarian cancer is the fourth leading cause of cancer death in women in Ireland, after lung, breast and colorectal cancer.
    Overall, five-year survival here for ovarian cancer is 37%.
    About 20% of ovarian cancers are in women with family history of the disease/women with BRCA 1 or 2.

    Getting older is a risk factor. “In most cases, getting ovarian cancer is just bad luck and due to a chance mutation,” says medical oncologist Dr Dearbhaile Collins, who estimates the time span, from when an ovarian cell becomes cancerous to advanced ovarian cancer, at one to two years.

    Artist/fashion designer Helen Steele and Wexford Town Poet Laureate Sasha Terfous have joined the campaign to help spread awareness of ovarian cancer symptoms. Steele has designed an eye-catching tote bag and postcard, using repetition of the word BEAT, while Terfous has written/performed a powerful spoken word piece entitled BEAT.

    Check out personalised online resource www.thisisGO.ie for women impacted by gynaecological cancers.

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