Currently there is no early detection test for ovarian cancer. Until such a test exists, raising awareness
about the signs and symptoms of ovarian cancer is essential to early diagnosis. If diagnosed and treated early, ovarian cancer survival rates are over 90%.
As part of Ovarian Cancer Awareness Month,
Carolyn Kirschner, MD, Gynecologic Oncology, answers questions on ovarian cancer, from things you can do now to reduce your risk to the early symptoms you just might overlook.
What are some early signs of ovarian cancer that might be overlooked or ignored? How do you know when it is time to see a doctor?
Abdominal pain, bloating, being full after eating a little, new constipation or diarrhea, urinary frequency, fullness in the pelvis, low back pain, nausea/vomiting, fatigue are all possible symptoms of ovarian cancer—but are vague and may be symptoms
of other problems. If symptoms occur several times per week for a month, medical care should be sought. Start with a good primary care physician who can do an exam and then possible imaging studies.
What is the most cost-effective screening test for early detection of ovarian cancer?
Most experts would say that screening should only be performed on women who are at increased risk of ovarian cancer, for example those with a BRCA gene or a strong family history of ovarian cancer. These people may be screened with ultrasound and serum
(blood) CA125. Unfortunately, there may be false positives, especially in younger women, which may result in unnecessary tests or even surgery.
Is it possible to mistake ovarian cancer for fibroids on both a transvaginal ultrasound and a pelvic MRI?
Yes, mistaking ovarian cancer for fibroids can happen. Fibroids are common and ovarian cancer is not. Fortunately, imaging has greatly improved, so this mistake does not happen commonly these days. If there are any questions or concerns about a diagnosis, a
woman who undergoes ultrasound and/or MRI imaging can and should request a disc with the images on them and get a second opinion.
If there is a family history of the disease but no BRCA gene mutations, is your risk for developing ovarian cancer still higher? What can you do to reduce that risk?
Most ovarian cancer is not hereditary, so risk should be the same as the general population, which is less than 2%. While never having children seems to be associated with an increased risk of ovarian cancer, I would never recommend getting pregnant just to
decrease the risk. If you are premenopausal, oral contraceptives may decrease your risk. Birth control is protective because it prevents ovulation. It is theorized that breaks in the surface of the ovary, which occur with ovulation, may result in injuries
that can lead to cancer. Vitamin D may also be protective.
Diet is important. Cancer risk is increased with obesity. I recommend a plant-based, whole-grain diet. Limit saturated fats, white flour and refined sugar. I am a firm believer in exercise for weight control and sanity.
Keep in contact periodically with the genetics staff, in case there is a breakthrough in this area. NorthShore has a high-risk clinic through Division of Gynecologic Oncology, and this may be a good way of staying on the "cutting edge.”
What is the best scan for ovarian cancer? CT, MRI, ultrasound or PET?
Each has its advantages. The ultrasound is the least invasive, least expensive and does not use radiation. The CT and MRI look at anatomy. The PET looks at function. For screening, the ultrasound is best.
When the fourth biopsy in four years revealed some of the cancerous cells were now more aggressive than during the previous four years of active surveillance, I found it very hard to accept that the other shoe had actually dropped. I'd been sailing along
with a Gleason 3 + 3, the least aggressive prostate cancer category. I hoped/believed the numbers would stay that way as I lived through the rest of my 70s and into my 80s and who knows how long from there. After all, my father had lived with prostate cancer
and died from unrelated issues at 86.
As with so many other men, I had the first biopsy after a PSA test suggested a possible problem. In my case the PSA had risen slowly over a decade from 1.4 to 3.7, but being 67 at the time and research changing some of the previous thinking about PSA levels
in older men, the initial urological surgeon and I decided a biopsy was a reasonable option.
My fears after getting the news from the fourth biopsy were:
Navigating My Treatment Options
The urologist who had been following me urged surgery (he performs robotic prostatectomy) and I provisionally scheduled the operation for six weeks hence. I needed time for the biopsy site to heal, digest the diagnosis, and collect and process more
As a dentist turned health reporter, my almost 40 years as a health journalist turned out to be a mixed blessing as I tried to intelligently navigate the daunting amount of often contradictory and confusing information, even for a health professional. I
discovered one of my greatest strengths as a reporter—the ability to thoroughly and unemotionally research virtually any health topic—failed me dismally because this time I was too emotionally involved. I would read the same sentence or paragraph over and
over or talk at great length to trusted sources and come away even more confused. Yes, get the cancer out. No, you can safely keeping watching. Surgery? Robotic or open? Radiation? But what type? Or perhaps one of the less tested treatment options? You can
imagine the toll this emotional roller coaster took on my family: Arline my wife of 41 years and my two sons.
Finding My Advocate: A Six Week Journey
As the six weeks dwindled to two, I still felt uncertain—and frightened—about my decisions and options. While agonizing on the phone one night with my older son he said, “Stop it, Dad! More than most, you are in a position to find one voice you can trust who
can guide you to a decision that you and mom can live with. Find that voice."
I did: Dr.
Charles Brendler, Co-Director of Northshore's John and Carol Walter Center for Urological Health. I was referred to Dr. Brendler by a close personal friend of mine, who is also a physician and serves as a department head at a major Chicago medical center.
He told me Dr. Brendler was the person he would see if he were in my position. Now I understand why.
During the nearly two hours Dr. Brendler spent with Arline and me, he painstakingly reviewed my medical records, gently and carefully examined me, and, for most of the two hours, engaged with us in heartfelt conversation. He reassured both of us, spoke caringly
about our feelings on the personal and intimate issues unleashed by prostate cancer and its treatment, and offered compassionate understanding and objective advice.
Three decisions emerged from our meeting. Two involved additional confirmation of the status of my prostate cancer, one via MRI (Dr. Brendler supported my desire to have the scan) and the other through a second opinion of the interpretation of my four biopsies.
The third and most important was the deciding to accept Dr. Brendler’s recommendation to see a urologic surgeon, who, because of his unparalleled skill in performing open prostatectomies, would be the best fit for me.
When Arline and I exited Dr Brendler's office and walked through the parking lot, we looked at each other and breathed the first sigh of relief in more than a month because we knew we had found peace with my prostate cancer journey. We followed through on
each of the decisions and three weeks after our fateful meeting my prostate was removed by the surgeon Dr. Brendler recommended. The cancer was locally contained and completely removed.
Thanks to active surveillance, I had four years without treatment. And thanks in large part to Dr. Brendler, I remain totally continent and am on the road back to sexual function seven months post-surgery. I’m grateful beyond words that when my son urged
me to find the one voice I could trust, the voice I heard was Charles Brendler's.
Many typically associate cancer with a specific part of the body, like the breast, prostate or colon; however, it can develop
and affect more just a part of the body. Approximately 43,000 people are diagnosed with leukemia each year. Leukemia is a cancer of the blood and bone marrow. Blood cells, both white and red, are made in bone marrow. With leukemia, bone marrow produces an
abnormal amount of white blood cells, which cannot function like normal white cells. As the disease progresses, the accumulation of these abnormal cells can cause anemia, bleeding, infections and eventually could spread to other areas of the body.
Leukemia can develop in both children and adults, and is the most prevalent cancer found in children under 14 years old. Depending on the type of leukemia, symptoms may become apparent almost immediately or gradually develop and become more noticeable over
the course of months or even years. Treatment plans will vary depending on the type of leukemia, as well as your age and current health.
Alla Gimbelfarb, MD, Hematology at NorthShore, identifies some of the signs and symptoms of leukemia that many overlook :
Has leukemia touched someone in your family? During National Leukemia/Lymphoma Month help raise awareness about its signs and symptoms.
Practicing multiple days during the week. Competing in tournaments on the weekend. Participating in rigorous training camps
and leagues in the off-season. Playing the same or multiple sports year round. Does this resemble your child’s sports schedule?
Youth sports are becoming more competitive at younger ages, often requiring participation beyond the normal season to make the cut and see more starting time during games. As the pressure to participate increases and youth sports become more “professional,”
your child’s risk for injury increases too. Sports are a great way to keep your child involved and active, but year-round practices for the same sport can lead to some health concerns as well, including stress fractures, ligament tears and musculoskeletal
Eric Chehab, MD, a NorthShore affiliated orthopaedic surgeon, offers some tips to help keep your kids active and injury-free:
For additional information about sports injuries, including sports-specific tip sheets, visit the Stop Sports Injuries website:
What do you to keep your kids active? How do you make sure they aren’t overdoing it?
According to the Centers for Disease Control, suicide was the 10th leading cause of the death in the U.S. in 2009. That
year there were 37,000 suicides, with one million reported attempted suicides. In the same year, suicide was the third leading cause of death for young people between the ages of 15 and 24.
Suicide is a major health issue but it’s also a potentially preventable one. While there are several risk factors for suicide, any person who expresses suicidal thoughts or the intent to commit suicide should be taken seriously. Risk factors for suicide
Knowing and acting on the signs of suicide exhibited by others could save thousands of lives each year. If someone appears depressed and/or expresses suicidal thoughts, it's important to listen closely and take that person seriously. It's especially important
to be concerned if someone exhibits any of these signs and has also attempted suicide in the past, as most successful suicides were preceded by one or more attempts.
Benjamin Shain, MD, PhD, Psychiatry at NorthShore, shares some of the warning signs of suicide and discusses what you can do to help a person
who might be contemplating suicide:
What should you do if you notice these behaviors in a friend or family member?
First, discuss your observations or concerns with the person and/or other friends or family members. Make sure to listen to the person’s concerns and what might be stressful for them. It's essential to urge the person to speak to their primary care physician
and/or a mental health professional. If you believe they are an immediate risk to themselves, call 911.
“How are you feeling?” is probably one of the first questions your doctor will ask during your annual visit. If you haven’t
needed to see your doctor between physicals, your answer will most likely be, “Fine.” It won't be until later that you remember all the miscellaneous symptoms, heath issues, and aches and pains from the last year.
Don’t miss another opportunity to maximize your time with your doctor. By planning and preparing beforehand, you ensure that you’ll remember to ask the correct questions during the limited time you have with your primary care physician.
Curtis Mann, MD, Family Medicine at NorthShore, offers some tips on how to make the most of your time with your doctor:
Do you have a yearly physical? How do you make the most of your annual visit?
Kidney stones can cause pain that ranges from mild to excruciating; however, stones typically do not cause symptoms until they move from the kidney into the ureter (the tube that connects the kidney to the bladder). So how do they form? Kidney stones develop
when urine consists of more crystal-forming substances than the urine can dilute. Often there is no single definitive cause of kidney stones but there are factors that increase one’s risk for developing them. Determining the type of kidney stone can be helpful
in determining its cause and preventing recurrence.
Main kidney stone types:
Amanda Macejko, MD, Urologist at NorthShore’s Jon and Carol Water Center for Urological Health, answered several questions about kidney
stones, including hereditary risk factors, and how best to treat and prevent recurrence:
If there is a family history of kidney stones, are you at an increased risk for developing them at some point?
Stones can certainly have a hereditary component. So, yes, if there is a family history one could be prone to developing stones. One of the best things you can do to decrease your risk is to make sure you drink plenty of water (2.5-3 liters of water daily).
Is there a particular group of people who are at higher risk of developing kidney stones?
Peak incidences of stones occur in people between the ages of 30-60. Caucasians and people who live in warm, dry climates are at higher risk of developing stones. Additionally, people with higher body mass index (BMI) are also at increased risk.
Aside from drinking a lot of water, what other preventative measures can be taken to avoid recurrence of kidney stones?
The stone prevention diet includes: limiting salt intake, avoiding foods high in oxalates and limiting consumption of animal protein. Salt intake increases calcium in the urine so we recommend avoiding canned, processed and fast foods which contain a lot of
For people with calcium oxalate stones, foods high in oxalate should be avoided, which includes tea, spinach, nuts, and, I’m sorry to say, chocolate. Animal protein, including red meat, chicken, fish, should also be limited. It is important to note that
calcium restriction is not recommended.
I've had multiple stones over the years, do I need further tests?
For someone with multiple stones or a strong family history of stones , I highly recommend a metabolic work up. This involves blood work and a 24-hour urine collection (48 hours the first time). This helps your physician figure out what your specific risk factors
are for stone formation, as well as look for possible underlying medical conditions. We perform this service in the Stone Clinic which is staffed by myself, Dr. Park (urology) and Dr. Sprague (nephrology).
Can kidney stones cause renal failure?
Nonobstructing stones in general should not cause renal (kidney) failure; however, untreated obstructing stones may eventually cause renal impairment.
Should you always go to the hospital for kidney stones?
This is really important. If your pain is tolerable with pain medication, whether over the counter or prescription, then you can probably follow up with your primary care doctor or urologist in the office to work out a plan. However, if your pain is not well
controlled or you have significant nausea/vomiting, you will need to go to the emergency room. Typically they will be able to control your pain and/or nausea and you can return home. Most importantly, if you have fever (higher than 100.5˚ F.) or shaking chills,
you need to go to the emergency room immediately. An obstructing stone associated with an infection is very serious and can be life-threatening.
If someone has a kidney stone but would rather attempt to pass it at home, what can he or she do to ease the pain from home?
Most patients take some form of pain medication whether it be over the counter or a prescribed narcotic while they are passing a stone. Additionally, we often prescribe an alpha-blocker. These are the same medications used to increase the flow of urine through
an enlarged prostate. These medications have been shown to help relax the ureters and increase the rate of stone passage.
What can be done for larger stones that cannot be passed on their own?
Kidney and ureteral stones that are too large to pass often require treatment. Common outpatient treatments include shock wave lithotripsy or ureteroscopy. Shock wave lithotripsy is a procedure performed under anesthesia in which we break the stone using sound
waves. After the procedure you then pass the fragments. In ureteroscopy, a small scope is passed through the urethra and bladder and into the ureter. The stone is broken up with a laser fiber and the fragments are subsequently removed with a tiny basket.
Have you ever had a kidney stone? What do you do to prevent them?