September is nationally recognized as Gynecologic Cancer Awareness Month, but for Meigs County cancer survivor Dawn Riffle, raising awareness of early detection of one of several gynecological cancers — ovarian cancer — isn’t limited to just one month per year.
It has become her mission.
This disease is often referred to as “A Silent Killer.” Why? Only about 20 percent of ovarian cancers are found at an early stage. When ovarian cancer is found early, about 94 percent of patients live longer than five years after diagnosis. In 2018, there will be approximately 22,240 new cases of ovarian cancer diagnosed and 14,070 ovarian cancer deaths in the US. Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system, according to the American Cancer Society (ACS).
After presenting to four different physicians and making several visits to emergency rooms for symptoms that had begun three years prior and mimicked other diseases, including painful menstruation/clotting, bloating, feeling full quickly upon eating, pain during sex and nausea, and after having a hysterectomy and surgical removal of tumors, Dawn finally was diagnosed at age 47 in February 2016 with Stage 3B ovarian cancer.
Per the ACS, this staging means that cancer was in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer and it has spread or grown into organs outside the pelvis. The deposits of cancer are large enough for the surgeon to see, but are no bigger than 2 cm (about 3/4 inch) across. (T3b). It may or may not have spread to the retro-peritoneal lymph nodes (N0 or N1), but it has not spread to the inside of the liver or spleen or to distant sites (M0). Dawn’s cancer is a rare form presenting in only 10 percent of all ovarian cancer cases.
Unfortunately, Dawn does have a family history of ovarian cancer in her mother (also diagnosed in her 40s), maternal aunts and an older sister. A risk factor is anything that changes your chance of getting a disease like cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed. But having a risk factor, or even many, does not mean that you will get the disease. And some people who get the disease may not have any known risk factors.
Factors that increase your risk of ovarian cancers include: Getting older; Being overweight or obese; Having children later or never having a full-term pregnancy; Using fertility treatment; Taking hormone therapy after menopause; Having a family history of ovarian cancer, breast cancer, or colorectal cancer; Having a family cancer syndrome; Hereditary breast and ovarian cancer syndrome; Having had breast cancer; Smoking and alcohol use.
Factors that can lower risk of ovarian cancer include Pregnancy and breastfeeding; Birth control; A hysterectomy (removing the uterus without removing the ovaries) also seems to reduce the risk of getting ovarian cancer by about one-third.
Can Ovarian Cancer Be Found Early? With regular women’s health exams and during a pelvic exam, the health care professional feels the ovaries and uterus for size, shape, and consistency. A pelvic exam can be useful because it can find some female cancers at an early stage, but most early ovarian tumors are difficult or impossible to feel. Pelvic exams may, however, help find other cancers or female conditions. Women should discuss the need for these exams with their doctor. As Dawn and the ACS point out, the Pap test is effective in early detection of cervical cancer, but it isn’t a test for ovarian cancer. Rarely, ovarian cancers are found through Pap tests, but usually they are at an advanced stage.
See a doctor if you have symptoms. Screening tests and exams are used to detect a disease, like cancer, in people who don’t have any symptoms. Screening tests for ovarian cancer include TVUS (transvaginal ultrasound) and the CA-125 blood test, which measures the amount of a protein called CA-125 in the blood. Many women with ovarian cancer have high levels of CA-125. Better ways to screen for ovarian cancer are being researched, but currently there are no reliable screening tests. Hopefully, improvements in screening tests will eventually lead to fewer deaths from ovarian cancer.
Meanwhile, Dawn’s cancer journey, like so many other survivors, hasn’t been easy. She had a good recovery following her robotic surgery and she does not take pain medication except an occasional partial Tylenol. Dawn made the decision to donate removed diseased tissue for research and teaching purposes. She was only able to tolerate three of six scheduled chemotherapy treatments as ordered in March 2016 because she experienced “chemo brain:” a common term used by cancer survivors to describe frustrating and debilitating side effects of cancer and its treatment that involve thinking and memory problems that can occur after cancer treatment. Dawn recalled having dark dreams, bone pain and insomnia as a result of her initial chemo treatments.
At 12-14 months post-surgery and diagnosis, Dawn’s doctor declared her to be cancer free. She still underwent monthly lab tests and follow-up exams. Then, in the spring of 2017, Dawn began not feeling well. Two doctors she really liked retired. By April 2017, nodules were detected in her abdominal lining and her CA-125 began to rise. By July/August 2017, the cancer began to spread and, by fall, her doctor wanted her to begin chemo again, but she was fearful from her previous experience. In Jan. 2018, Dawn began having difficulty breathing and, consequently, visited the emergency room three-four times. A nodule was detected in her lung, which is being monitored for change. A pet scan was ordered to determine cancer metastasis and Dawn was told that surgery was not an option due to tumor location. She again refused chemo, but opted to receive a second medical opinion in Feb. 2018. Participation in a clinical trial was suggested, but she opted to decline because the study required her to take untested medications from which she could have had a life-threatening reaction. It was at this time, Dawn first asked the doctor for his opinion about her life expectancy, which was 3-5 years survival with chemo and 1-3 years without chemo. Dawn and her husband and greatest supporter, John, cried all the way home.
After 2-3 chemo treatments were cancelled because of extenuating circumstances, Dawn and John decided to enjoy life by traveling, camping and spending quality time with their grandchildren. In June/July 2018, pain returned Dawn to the emergency room. There was a concern of tumors pressing against her lungs and because she was only able to eat a few bites of food before getting full.
As a result, Dawn felt the timing now was right to decide about further treatment. She underwent a pet scan and chest x-rays on Aug. 28, just a day after sitting down to tell me her story so I could share it with you readers. The news she received was not good: the cancer has spread throughout her body (including her lung) and she will begin chemo in the near future. You cannot tell from Dawn’s appearance that she is battling cancer and she encourages people not to judge others by what’s on the outside because it isn’t an accurate reflection of what they are going through on the inside.
In my opinion, Dawn is an amazing woman of faith, strength and courage. Even though there isn’t a facet of her life that cancer hasn’t touched (including the type of clothing she now wears for comfort due to surgery), she has made the conscious decision to remain hopeful and positive and to rely on Jesus, who she describes as “contagious,” to fight her battles. Her mantra is “This too shall pass.” She has chosen to follow the advice of the Apostle Paul in Romans 12:2: Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is — his good, pleasing and perfect will. She and her husband pray for and support other cancer survivors and receive the same in return wherever they go.
If you are out and about and find a business-size card from Dawn that reads as follows, think of her and say a prayer; heed these warning signs, ladies, and schedule an appointment with your doctor; and help Dawn spread the message of early detection by passing this information on to someone you love.
Signs and symptoms include: Tummy Bloat; Low Back Pain; Energy Zapped; Indigestion/heartburn; Abdominal Pain; Feeling need to pee often; Loss of weight; Eating less, feeling fuller.
If you are un/underinsured, please contact the Southeastern Ohio Breast and Cervical Cancer Project at 1-800-23-NOBLE or the Ohio University Heritage College of Osteopathic Medicine’s Community Health Program at 1-800-844-2654 to schedule a pelvic exam.
Courtney Midkiff is the administrator at the Meigs County Health Department.