I never cease to marvel at the wonder of human life. An everyday miracle in some respects, each and every one of us the result of the combination of DNA from our parents, growing and developing. Each one of us with almost limitless potential. Our species have permeated every corner of this planet, and are reaching out towards the stars.
Despite this awe inspiring magnificence, our human form is far from perfect. Despite the centuries and millennia of evolution, illness still stalks us. We reside in a century of unparalleled medical and technological development. Death, however, is so far unconquerable.
There are many cruel things about illness. In my experience, the cruellest diagnosis is cancer. Our own cells, multiplying unchecked by the natural processes of cellular division, develop mutations and cancer takes hold. A disease from within, our own cells turning against us.
Many cancers are conditions of aging or lifestyle. For some however, the very genes that encode everything that makes us who we are contain our own undoing.
Recent news brought to our attention the latest of Angelina Jolie’s prophylactic surgery. The removal of her ovaries and Fallopian tubes in order to prevent cancer is a difficult decision. BRCA 1 and 2 gene faults make breast or ovarian cancer likely in between 45 to 90% of carriers. This means developing cancer is more likely than not. The choice is between no surgery, but with a good chance that you will develop cancer, or the removal of both breasts, ovaries and Fallopian tubes, before the cancer even develops.
Bilateral mastectomy is not an operation to take lightly, with requirement for reconstruction or prosthesis. Removal of ovaries results in a premature menopause, and all of the physical and emotional challenges that may bring.
Ovarian cancer is the fifth most common cancer in the UK. More common in women over the age of 45 years, and its risk is made greater by a family history, increasing age, or endometriosis. Protective factors include breast feeding, past use of the contraceptive pill, or a high number of pregnancies.
In my clinical practice, I’ve met a number of survivors of ovarian cancer. I’ve also met people for whom the diagnosis is too late. The symptoms are often vague. “Doc, I feel a bit bloated after meals”, or “I’ve got this pain down below”. Ovarian cancer is often missed, or found when the condition has spread and treatment options are limited. Telling people, “there’s nothing we can do”, is not easy. I have missed cancers, and will go on to miss cancer, of that I have no doubt.
Looking for any disease is challenging. We rely on our patients to interpret vague physical symptoms and relay them to us. Amongst the confusion of words and feelings, we have to translate that into pathological processes, devise a hypothesis and test it with investigations or trials of treatment. Scans and laboratory tests are merely extensions of our own senses, allowing us to look closer or listen more intently, but they aren’t magic. I hope I don’t miss a diagnosis, but I know I will.
Angelina Jolie has taken a brave decision, no doubt swayed by her very high risk of developing cancer. High profile cases can only serve to improve awareness of ovarian cancer, in our patients, but also in us as clinicians.