The Gray Area: Women's Cancer Uncertainties

Cancer isn’t black and white, nor is it predictable. A diagnosis and the subsequent treatment of the many varieties of this complex disease can be challenging because of gray areas and uncertainties. This is especially true for rare subtypes, such as primary peritoneal cancer, which affects mainly women. The very low number of these cancers makes it harder to understand their biology and define the optimal treatments.

In every 1 million people, fewer than seven cases of primary peritoneal cancer will occur. The rare relative of ovarian cancer starts in the peritoneum, which is the thin layer of tissue lining the inside of the abdomen. However, it can be challenging to distinguish this cancer between cancers of the ovaries and fal­lopian tubes.

Similar to the more common gynecologic can­cers, primary peritoneal cancer may cause vague abdominal symptoms, such as bloating, constipa­tion and feeling fuller sooner than usual when eating. Such was the case for Joanne Wilson, who attributed her weight gain to menopause. Within these pages, you will read how she soon learned that her fatigue, constipation and excess pounds were caused by something much direr: stage 3C primary peritoneal cancer.

This rare cancer serves as a reminder that tis­sues from one site in the body, such as an organ, can show up in an entirely different area. For instance, breast cancer can arise in an accessory nipple, more commonly referred to as a third nipple, that is gen­erally located well below the breasts. In the case of primary peritoneal cancer, it is believed that it involves ovarian tissue that is left over from the formation and development of the embryo and remains as small remnants throughout the abdominal cavity and its lining, the peritoneum. That helps explain why risk-reducing salpingo-oophorectomy, which is the removal of the ovaries and fallopian tubes and usually conducted for women who harbor the BRCA1 and BRCA2 mutations, may lower the possibility of developing ovarian cancer by 90 to 95 percent but not 100 percent.

Although Wilson’s tumors showed up on a computerized tomography scan, health care professionals must be suspicious yet cautious in who and how often they scan because of the commonality of the symptoms associated with primary peritoneal cancer. Like ovarian cancer, better tools and tests, such as those that use blood, are needed to aid diagnosis. As outlined in the feature article, the medical treatments and overall strategies are similar to those used for ovarian cancer, but relapses frequently occur. Hope lies in continued research that will perhaps one day advance not only diagnostics but also the field for all women’s cancers. Newer biological drugs are available, and the trend is expected to continue.