From St. Louis Post-Dispatch, October 11, 2004 by Kay Quinn

If you have an annual pap smear, or even one every few years, you probably think you''re doing all you can to catch gynecologic cancer before it starts.

That''s what Julie Rhodes of south St. Louis County thought. She''d been having annual exams.

At 28, when she began feeling fatigued, when her waistline expanded in spite of regular exercise, and when she felt full after eating just part of a meal, the last thing she suspected was cancer.

Eight months after her symptoms started, after being treated for what her internist thought was anxiety and depression, Rhodes became one of the 25,580 new cases of ovarian cancer diagnosed annually in this country. The disease strikes one in every 57 women, according to statistics on the Ovarian Cancer Web site, www.ovariancancer.org.

Other statistics on the site reveal the following:

• Ovarian cancer is the deadliest of the gynecologic cancers, the fifth leading cause of cancer death among U.S. women.
• About 50 percent of the women diagnosed with ovarian cancer die from it within five years.
• Only 25 percent of ovarian cancer cases in the United States are diagnosed in the early stages.

Rhodes'' story is one every woman should hear, because it underscores the difficulties women and doctors face in detecting this disease. The warning signs are not only vague, they often mimic other health problems, such as irritable bowel syndrome. No good general screening test exists, so two-thirds of cases are caught after the cancer has spread from the ovaries to other organs.

Subtle warning signs are a hallmark of this disease. "It whispers . . . so listen!" is a slogan used by the National Ovarian Cancer Coalition as part of a campaign to educate women about how to recognize the symptoms. Dr. David Mutch, a gynecologic oncologist at Siteman Cancer Center in St. Louis, breaks them down this way:

• About 80 percent of women with ovarian cancer report abdominal discomfort or pain prior to diagnosis.
• About 70 percent have abdominal bloating.
• Roughly 60 percent experience early satiety, or a feeling of fullness before finishing a meal.
• Nearly 40 percent have vaginal bleeding.

The Ovarian Cancer National Alliance lists other symptoms, including unexplained weight loss or weight gain; ongoing, unusual fatigue; unexplained changes in bowel or urinary habits; and shortness of breath.

According to Mutch, a woman bothered by one or more of these symptoms for a week or two should not jump to the conclusion that she may have ovarian cancer. But he advises any women who may have them for a more extended period of time to report them to a doctor for further evaluation.

Rhodes, 31, wishes she had had that information in 2001, the year symptoms her doctor thought were depression turned out to be a life-threatening cancer.