Facing Her Toughest Job—Ovarian Cancer

When diagnosed with ovarian cancer, she had to focus on the job of getting well

Over the summer and fall of 2003, Lynn Gilliland was on the road constantly, doing the job she loved as alumnae director of Mary Baldwin College.

I kept having this nagging back pain,” she recalls, “which I credited to stress and traveling all the time. Every couple of months, I’d have terrible cramps that really knocked me out, but I attributed it to pre-menopause.”

It was the following winter before Gilliland, a Staunton mother of two, finally saw her gynecologist. A pelvic exam followed by a vaginal ultrasound revealed the presence of a mass outside her uterus. Her doctor scheduled an immediate hysterectomy.

Making Time to Fight

“I don’t have time right now,” Gilliland remembers saying. “You don’t have a choice,” was her doctor’s reply.

When she awoke from surgery, the news was bad, although it could have been worse: Clear-cell carcinoma, but still confined to the ovaries. As soon as she was able to drive, she was sent to UVA.

Two weeks later, Gilliland was meeting with UVA's doctors, who told her they would help her fight the cancer.

Tackling a Tough Cancer

Ovarian cancer is known as the “disease that whispers” because its symptoms are usually vague or undetectable.

Gilliland is fortunate, as the vast majority of patients are diagnosed with ovarian cancer after it has already spread outside of the ovaries. While the overall five-year survival rate for ovarian cancer patients is 44 percent, this drops to 25 percent for patients in whom the cancer has spread outside of the pelvis.

Despite this harsh reality, UVA's doctors are encouraged by the prospects for improved treatments and diagnostics. Surgery is the first line of defense, and studies have shown that women whose surgery is performed by a gynecologic oncologist fare better.

Women who are at higher risk for ovarian cancer may benefit from a screening blood test for a tumor “marker” called CA-125, but the test is not sensitive or specific enough to be generally useful.

However, for patients in remission from ovarian cancer, a CA-125 test can signal recurrences, which develop in 80 percent of cases.

A significant family history of breast or ovarian cancer leads some women to consider genetic testing to learn if they inherited a copy of the so-called breast cancer genes, BRCA1 and BRCA2, which increase the risk of ovarian, as well as breast cancer.

Although doctors emphasize that a positive result provides information only about a person’s risk of developing cancer — not whether or when they will develop it — some carriers of the faulty gene decide as a precaution to have their ovaries removed.

A significant advance in the treatment of ovarian cancer was made in the 1980s, when platinum-based chemotherapy became standard. Soon after, the highly active drug paclitaxel (Taxol) was added to the regimen. That combination is still the gold standard today, although newer drugs and combination therapies are currently being investigated.

Treatment at UVA

Last year, the UVA Cancer Center treated 279 women with newly diagnosed gynecologic cancers, including 70 ovarian cancers.

A key component of treatment at UVA is a team-based approach. The entire gynecologic cancer team — made up of gynecologic oncologists, pathologists, radiation therapists, pharmacists, radiologists, clinical trial coordinators, and nurses — meets weekly to discuss cases. This helps ensure that they bring the experience of many experts to each case — and that treatment plans consider the well-being of the whole person — not just the status of her tumor.

Becoming a Survivor

A whole-person approach to patient care made a world of difference to Gilliland.

At the time of her diagnosis she had expected to maintain her demanding work schedule throughout treatment.

“I had this superwoman complex before this happened,” Gilliland recalls.

Several rounds of chemotherapy and more surgery finally made her realize that she couldn’t do it all.

“One of the hardest things for me was letting other people help me, and that is so critical to cancer treatment.” 

Three years later, she is back at work as executive assistant to the president at Mary Baldwin. She continues to find check-ups an anxious time.

She is almost, but not quite, able to think of herself as a cancer survivor. “I don’t think we’re quite to the point of using the word cured yet, but each visit gets a little easier,” she says.

A former exercise-hater, Gilliland now walks in the early morning and finds it improves her physical, mental and spiritual well-being.

At every opportunity, she repeats the message that she knows can save lives: “Stop and listen to your body. Pain is telling you something.”

She is grateful for the love and support of family, friends, her church, and the skill and compassion of her doctors. Patience comes easier to her than it used to.

“My thinking now is that every day is a gift,” she says, “and life is lived one day at a time.”

Am I at Risk?

For epithelial ovarian cancer, the most common type, factors that raise the risk of developing the disease include:

• Family history: Having first-degree relatives with ovarian, breast, or colorectal cancer
• Personal history of breast cancer: Having breast cancer raises the risk of developing ovarian cancer
• Age: Most women diagnosed with ovarian cancer are postmenopausal
• Reproductive history: Women who have never had a full-term pregnancy, began to menstruate before age 12, or reached menopause after age 50, are at increased risk
• Obesity: May increase the risk of certain types of ovarian cancer

How Can I Reduce My Risk?

• Oral contraceptives: Using birth control pills for several years is linked to a 30-50 percent lower risk of ovarian cancer
• Breastfeeding: Women who breastfeed for at least a year are at slightly reduced risk
• Diet: Several studies link diets high in vegetables to reduced risk
• Oophorectomy, tubal ligation, hysterectomy: Removal of the ovaries, tying the fallopian tubes after childbearing, and removal of the uterus all reduce the risk of ovarian cancer to varying degrees. However, none of these procedures is recommended for that purpose alone, except in women with a strong family history of ovarian and/or breast cancer.