Top 50 Cancer Hospitals in the USA

1. Memorial Sloan - Kettering Cancer Center, New York
2. University of Texas, M. D. Anderson Cancer Center, Houston
3. Johns Hopkins Hospital, Baltimore
4. Dana - Farber Cancer Institute, Boston
5. Mayo Clinic, Rochester, Minn.
6. Duke University Medical Center, Durham, N.C.
7. University of Chicago Hospitals
8. UCLA Medical Center, Los Angeles
9. University of Michigan Medical Center, Ann Arbor
10. University of Pittsburgh Medical Center
11. University of Washington Medical Center, Seattle
12. Massachusetts General Hospital, Boston
13. H. Lee Moffitt Cancer Center and Research Institute, Tampa
14. Cleveland Clinic
15. Fox Chase Cancer Center, Philadelphia
16. University of California, San Francisco Medical Center
17. Stanford Hospital and Clinics, Stanford, Calif.
18. University Hospitals of Cleveland
19. Barnes - Jewish Hospital/Washington University, St. Louis
20. Vanderbilt University Medical Center, Nashville
21. University Medical Center, Tucson, Ariz.
22. University of Alabama Hospital at Birmingham
23. University of Minnesota Medical Center, Minneapolis
24. Yale - New Haven Hospital, New Haven, Conn.
25. University of Colorado Hospital, Denver
26. New York - Presbyterian Univ. Hosp. of Columbia and Cornell
27. Hospital of the University of Pennsylvania, Philadelphia
28. University of Wisconsin Hospital and Clinics, Madison
29. Ohio State University James Cancer Hospital, Columbus
30. University of Utah Hospitals and Clinics, Salt Lake City
31. Brigham and Women's Hospital, Boston
32. University of Virginia Medical Center, Charlottesville
33. NYU Medical Center, New York
34. Rush University Medical Center, Chicago
35. Inova Fairfax Hospital, Falls Church, Va.
36. Wake Forest Univ. Baptist Medical Center, Winston - Salem, N.C.
37. University of North Carolina Hospitals, Chapel Hill
38. Harper University Hospital, Detroit
39. University of California, San Diego Medical Center
40. Roswell Park Cancer Institute, Buffalo
41. Sarasota Memorial Hospital, Fla.
42. Dartmouth - Hitchcock Medical Center, Lebanon, N.H.
43. City of Hope National Medical Center, Duarte, Calif.
44. Clarian Health Partners (IU and Methodist Hospitals), Indianapolis
45. F.G. McGaw Hospital at Loyola University, Maywood, Ill.
46. Greater Baltimore Medical Center
47. Baptist St. Anthony's Health System, Amarillo, Texas
48. Henry Ford Hospital, Detroit
49. William Beaumont Hospital, Royal Oak, Mich.
50. Riverside Methodist Hospital - Ohio Health, Columbus

Breast Cancer

The Cause of Breast Cancer

In a study of 150 breast cancer patients by Dr. Rau, in Switzerland, 147 of them had had root canals on the same meridian as the breast cancer. The other 3 also had dental problems on the same meridian, but they were not root canals, they were infections in the jawbone.

Another medical doctor reported a similar experience with his breast cancer patients.

Root canals create a safe-haven for cancer-causing bacteria. These cancer-causing microbes do not originate in the root canals. Rather, the microbe originates in the breasts and then some of them live the "good life" while hiding in the root canal(s), free from any interference of the immune system.

The statistics indicate that the constant reinfection prevents the body from successfully fighting the breast cancer. Apparently, when a woman (or a man in some cases) gets breast cancer, the body is generally able to fight it off, unless the person also had a root canal on the same meridian. The root canal(s) apparantly allow the cancer to win the battle.

What Dr. Rau proved was that a bacteria-type microbe caused breast cancer. This has been known for over a century, but orthodox medicine refuses to acknowledge this proven fact. See the book: Four Women Against Cancer, by Dr. Alan Cantwell, M.D., for even more evidence for this fact.

The point is that it is virtually impossible to totally get rid of breast cancer without removing all root canals.

While soaking your root canal teeth in 3% food grade hydrogen peroxide (i.e. putting 3% food grade hydrogen peroxide in your mouth so that your root canal teeth are soaking in the solution for 2 or 3 minute at a time), twice a day can kill microbes inside the root canal teeth, most root canal teeth also have a crown which does not let liquids inside the tooth except at the bottom of the crowns. So be careful about depending on the hydrogen peroxide solution if your root canal teeth have crowns.

Issues With Brain Cancer and Alternative Cancer Treatments

Brain cancer is one of the trickiest types of cancer for alternative medicine to treat. While it is easy to kill the cancer cells in a brain cancer patient (many alternative cancer treatments easily penetrate the blood-brain barrier), it is not easy to safely kill the cancer cells. The problem is that the debris from dead cancer cells can be very difficult to safely remove from the brain.

Other problems are inflammation and swelling. Before a cancer cell dies it gets sick. The problem is that once the cancer cell gets sick the immune system recognizes the cell as being sick and attacks it and this causes inflammation and swelling. This is not good to happen inside the skull.

One category of alternative cancer treatments that do not cause dangerous inflammation and swelling are treatments that build the immune system and then let the immune system kill the cancer cells safely. These treatments are generally used in conjunction with a product like Vitalzym, which strips the protein coating around the cancer cells so the immune system has an easier time killing the cancer cells.

The problem with these treatments is that they typically work very slowly and many brain cancer patients do not have enough time left to live to use slow-working alternative cancer treatments.

Fortunately, there are two treatments have been developed which work quickly and do not cause any type of brain swelling or inflammation. They are recommended in this article for the most dangerous kinds of brain cancer. For more typical brain cancer patients, there are more options to consider (including the two treatments for the most dangerous kinds of brain cancer).

Issues With Brain Cancer and Orthodox Cancer Treatments

While radiation may be necessary in cases of dangerous swelling and inflammation, using radiation to treat cancer is almost guaranteed to be useless. Let me start with the observations of one person familiar with brain cancer treatments:

• "Orthodox treatment for brain cancer, especially Children's, is absolutely appalling. Chemotherapy and radiation treatment cause horrific side-effects and permanent retardation. Very few survive for five years with this treatment. Their quality of life is ghastly, constantly sick from the chemotherapy/radiation treatments, their immune system wrecked by this barbaric treatment."
  http://www.cancerinform.org/kids1.html

I wanted to emphasize the concept of permanent retardation. The wife of a good friend of mine developed brain cancer. She had radiation therapy that bascially made her mentally retarded. It was only after this happened that the radiologist admitted to my friend that radiation probably didn't do any good. Needless to say his wife died.

• "As a rough estimate, neurosurgeons do well to cure one in every 1,000-brain cancer patients they operate on. Radiation therapy slows the growth of adult tumors, gaining perhaps one month of life, and may result in a cure of only one in 500-1,000 patients. Similarly, chemotherapy, despite 30 years of clinical trials, has not resulted in the development of a single drug or drug combination that elicits more than an occasional transient response in primary brain tumors."
  Dr. Robert Burdick, oncologist and professor at the University of Washington Medical School

Brain cancer and brain tumors are somewhat unique because of the "blood-brain barrier," which severely restricts the types of substances in the bloodstream that are allowed by the body into the brain. While the blood-brain barrier (BBB) is great for protecting the brain from danger, when the brain has cancer cells, the BBB can be a problem.

While there are new chemotherapy drugs which can penetrate the blood-brain barrier, because chemotherapy is worthless in the rest of the body, why would someone think that chemotherapy would do any good running around among the extremely delicate brain cells?

Recommended Primary Treatment - Tony Isaacs Oleander Protocol

The use of oleander as a treatment for cancer has come a long way since the days when you had to go out and cut oleander plants and make an "oleander soup," though some people still do that.

Today, the protocol is based on oleander pills which are prepared with a safe yet effective dose of the oleander plant. The only potential problem with this protocol is shipping the pills from South Africa.

The oleander protocol is also a protocol for AIDS, so you can expect this protocol to deal with any infections you have in your body.

This protocol is a complete protocol designed to kill cancer cells, rebuild the immune system, and do everything else needed to treat the cancer successfully.

As with every cancer treatment on earth, a good "cancer diet" is necessary. There are several levels of cancer diets ranging from simple to highly complex. The level of complexity is a function of the danger of the situation.

Adenocarcinoma - Important Notice

One of the problems in researching this kind of cancer is that in most cases when a person has a cancer of the gland tissue, the cancer is not described as adenocarcinoma, it is described as: lung cancer (adenocarcinoma is the most common type of lung cancer, making up 30-35% of all cases), liver cancer (liver cancer is primarily adenocarcinoma, with 2 major cell types: hepatocellular and cholangiocarcinoma), etc.

Do you see the problem? Cancers can be described in terms of their location, such as lung cancer or liver cancer; or in terms of the type of cancer cells, such as adenocarcinoma. I suspect that cancers involving the gland tissue are seldom actually refered to as adenocarcinoma or adeno carcinoma.

In using the "type of cancer" treatments on this website, such as this article, if you have a liver cancer which is an adenocarcinoma use the liver cancer article!! In other words, if there is an article on the primary location of you cancer, choose the article by location rather than this article.

If your adenocarcinoma is located in more than one location, such as in the lungs and the liver, then pick the article which involves the most dangerous location of your adenocarcinoma.

See the "Stage IV" article to find out where the most dangerous locations for a cancer are located (hint: brain cancer (due to swelling), lung cancer (due to congestion) and bone cancer in the spine (due to several reasons) are typically the most dangerous locations for a cancer.

Also if the cancer is in more than one location, take into account where the largest concentration of cancer cells are in the case.

In other words, do not use this article unless the cancer does not involve a major organ or there is no specific article for where your cancer is located.

Skin Cancer - Frankincense and Other Essential Oils

Here is a testimonial for Frankincense Oil:

• " just wanted to share more about Frankincense. My Dad tried it for his COPD and was very surprised with the effects. We were talking about what he called cancer on his face and top of ears and he was saying that he'd have to go have it cut off again. I just mentioned that he try some of his Frankincense. It's been about a week and half, and last night he started telling me how he was telling his friend that he had these things on the side of his face and on top of his ears. THEN, he said "I started putting my oil on them and one is gone and the other I can barely feel" he is starting to trust and believe in the oils. He is a very cautious man so I was a little surprised he even tried it. Sometimes we just have to be patient.
  http://stopcancer.com/EssentialOilsTestimonies.htm

I have seen several testimonials for frankincense oil. Whenever you talk about "essential oils," the first manufacturer that should come to mind is "Young Living." They create therapeutic-grade essential oils, not the perfume-grade oils normally found in retail and wholesale distribution.

(Note: Some health practitioners import high quality essential oils made in other countries.)

The current protocol for treating skin cancer is the following (using a 1/2 and 1/2 mixture of the two oils):

1) Frankincense with Idaho Balsam Fir (3 days);
2) Frankincense with Tsuga (3 days);
3) Frankincense with Ledum (3 days);
4) Frankincense with Lavender (3 days);
5) Frankincense with clove, which may make the skin burn, so skip this step for cancer on the face (3 days);
6) Frankincense with Sandalwood (3 days); 7) Repeat cycle as needed.

The exact number of times the oils should be put on the skin cancer is up to the patient and their situation, but may range from 3 to 12 times a day.

Skin Cancer and Vitamin C

Vitamin C Treatment

When Vitamin C comes into contact with a skin cancer or external tumor (e.g. basel cell carcinoma), it hardens the tumor and forms a crust, such that the scab falls off in 2 weeks or so depending on how big the tumor is and how aggressive you get with the Vitamin C.

The solution is made by adding 1/8 tsp (teaspoon) of pure Vitamin C crystals to 1 tsp of water (a ratio of 1:8). Add any more and the Vitamin C won't dissolve. This should make enough solution to last all day. If more is made than is needed you should store it in a closed container in the refrigerator.

Even better, put 1 or 2 ounces of water (30-60 ml) in a small glass bottle and add 1 tsp of Vitamin C for each ounce of water (that is a 1:6 ratio). If after mixing you don't see any crystals on the bottom then add more Vitamin C until the water won't dissolve anymore. This insures a saturated solution of Vitamin C.

The treatment is to apply the mixture (using a cotton swab or Q-Tip) to the tumor. This should be done 2 or 3 times a day. It is best to put a bandage or other cotton covering over the tumor after each treatment, if possible.

On the skin cancer the bandage is just to keep the lesion wet with Vitamin C until the next treatment. If there is an infection you should change the bandage more often. Ascorbate is also anti-infective and is used topically and IV for burn patients. You would therefore be curing the cancer and infection at the same time.

Melanoma and Squamous Cell Carcinoma

Melanoma and Squamous Cell Carcinoma (SCC) do not spread like other kinds of cancer. While most types of cancer spread by the cancer cells dividing, these two types of cancer spread by a different mechanism.

While there are microbes inside of all cancer cells, it appears from the evidence that microbes come out of the cancer cells in these two types of cancer and move through the bloodstream and burrow into normal cells in another location of the body, making these cells cancerous. This is why these cancers can spread like a wild fire to highly diverse parts of the body.

For this reason, to stop the spreading of these kinds of cancers, it is critical to deal with ALL microbes in the body.

In short, treating melanoma or squamous cell carcinoma involves two key issues.

First, is the issue of killing the stationary cancer cells. Like most cancers, the main melanoma and squamous cell carcinoma cancer cells are stationary.

Second, stop the spreading of this cancer. While most cancers spread by cell division, these two types of cancer spread via the bloodstream by microbes. Thus, it is necessary to make sure all microbes in the bloodstream are killed at least once every 12 hours.

Understanding Colon and Stomach Cancer

The first thing a colon cancer or stomach cancer patient needs to understand is that the "cure rate" of orthodox medicine for these two kinds of cancer is virtually zero. Even the "cure rate" for alternative cancer treatments is significantly lower than for most other kinds of cancer.

The reason the cure rate is so low, in my opinion, is because of the damage caused by surgery and chemotherapy to the colon and/or stomach.

Surgery on the colon and/or stomach damage the body's ability to digest foods and extract the nutrients from foods. Chemotherapy, for any reason, can damage the lining of the stomach and/or colon, thus interfering with the body's ability to process the nutrients in foods and supplements.

Because the body cannot digest foods properly, and cannot extract nutrients from the foods and supplements (because of surgery and chemotherapy), the cancer cells are not able to be killed by any cancer treatment and the non-cancerous cells are not properly protected and nurished by the foods and supplements that are consumed.

When you think about colon and stomach cancer you need to think about two different concepts:
1) The cancer cells (which need nutrients to be killed),
2) The non-cancerous calls (which need nutrients to keep the cancer patient alive).

THESE TWO ITEMS ARE OF EQUAL IMPORTANCE TO ANY CANCER PATIENT, BUT BOTH OF THEM ARE ESPECIALLY IMPORTANT TO STOMACH AND COLON CANCER PATIENTS BECAUSE OF THE DAMAGE DONE BY SURGERY AND CHEMOTHERAPY.

Surgery and chemotherapy damages the ability of the body to properly digest the foods they eat and thus their cancer cells are not adequately killed, their non-cancerous cells are not adequately protected and their immune system has not been adequately nourished.

In addition, due primarily to surgery, many advanced colon and stomach cancer patients cannot eat very much and of course what they can eat is not digested properly.

But there is yet another reason getting rid of cancer cells quickly is critical.

First, cancer cells steal both glucose and nutrients from non-cancerous cells. It is bad enough that the person may not be able to eat much, and cannot digest much, but the cancer cells are stealing glucose and nutrients from the non-cancerous cells.

It gets worse. Cancer cells also create lactic acid. Lactic acid can further block nutrients from getting to the non-cancerous cells.

But perhaps even more important, lactic acid is converted to glucose in the liver. In other words, the cancer cells consume glucose (in fact they steal glucose from non-cancerous cells) and in turn create lactic acid. The lactic acid goes to the liver and the liver converts the lactic acid into glucose, which then goes back to the cancer cells.

This cycle is called the "Lactic Acid Cycle" or the "Cachexia Cycle." It sounds harmless, but it is not. At both ends of the lactic acid cycle enormous amounts of energy are consumed by the body and cells. This further steals energy from the non-cancerous cells.

For a colon cancer patient there are many things that can cause a loss of appetite. But the two main reasons are pain and cachexia. Pain can cause a lack of appetite because surgery, radiation or chemotherapy may have damaged the stomach or colon, thus making it painful to eat.

The second major reason for a loss of appetite is cachexia. Because the patient may not be able to digest foods the cancer cells may thrive greatly thus creating cachexia.

A Transatlantic Bridge for Cancer Research

A new exchange program brings young researchers of the University Hospital in Essen/Germany and the University of Pittsburgh Cancer Institute (UPCI) closer together in cancer research: The Pittsburgh-Essen-Partnership-Program (PEPP) was designed to build a transatlantic bridge for cancer research, as the UPCI is one of the most renowned cancer institutes worldwide. An official contract for the cooperation was signed in Essen.

The program enables five postdoctoral fellows of the medical faculty of the University Duisburg-Essen per year to spend 18 to 24 months in the UPCI-research facilities with a PEPP-grant, conducting studies in tumour-immunology and tumour-biology. Young researchers from Pittsburgh are welcome to make use of the exchange program as well, spending time at the University Hospital in Essen, where cancer research is one of the main research areas.

“Both sides can profit immensely from this exchange program. The Pittsburgh Cancer Institute runs one of the leading cancer research programs in the USA, is extremely well connected to other institutes and has state of the art research laboratories. In addition to that, the UPCI is well known for its excellent educational programs for young researchers”, notes Professor Dr. Stephan Lang of the University Hospital Essen, who developed the idea for the PEPP-scholarship with Prof. Dr. Theresa Whiteside of the UPCI and UPCI-chairman Dr. Ronald Herberman. On her recent visit to Essen Prof. Theresa Whiteside stressed how useful the input of the young researchers from Essen is for her institute. “We are looking forward to this close encounter with the research fellows from Germany”, Whiteside stated.

According to Professor Lang, the patients at the University Hospital Essen will profit from this exchange program as well. Lang is director of the Clinic for Otorhinolaryngology at the University Hospital of Essen and coordinates international programs of the medical faculty.

The PEPP-scholarship-grant will be provided by the medical faculty of the University of Essen and by the clinical institutions where the scholar is based as a postdoctoral fellow. American scholars who visit Essen will be financed by the University of Pittsburgh. Cancer research fellows of all departments and institutes at the UK Essen are welcome to take part in the new PEPP-adventure.

Markey Cancer Center Facilities

Phone: 859-257-4488

Address: 800 Rose St.
Lexington, KY 40536-0293

Directions Directions to Markey Cancer Center >

Maps: Map of Lexington
UK Chandler Hospital campus
UK Chandler Hospital first floor

Established in 1985, Markey Cancer Center utilizes the resources of 28 departments, eight colleges and 150 faculty members throughout UK to further the prevention, treatment and cure of cancer.

The Role of Nephrectomy in Advanced Disease

Nephrectomy has become an integral part of the management of patients with metastatic kidney cancer. In the past, nephrectomy was performed in this setting only in certain circumstances – mostly to relieve pain or as a response to intractable bleeding. But indications that some patients had spontaneous regression of their metastatic disease following nephrectomy, and the fact that the primary tumor rarely, if ever, responded to systemic therapy, prompted more widespread integration of nephrectomy into the management of patients with metastatic disease.

Performing nephrectomy in patients with advanced kidney cancer is not without risk, however. The very real chance of significant metastatic disease progression during the postoperative period or complication before or during surgery that may prolong postoperative recovery could potentially delay or prevent the administration of systemic therapy in the postoperative period. Patient selection for surgery remains critical for success. Patients should be good candidates for surgery, and have a relatively small tumor that can be impacted significantly by surgery. Patients with complicating factors, including extensive metastases to the liver, brain, or bones, may not be good candidates for surgery because of their poor overall prognosis.

Telephone Information Service

Our telephone information service (Nurse Hotline) may be accessed directly by calling +1 503 215 7921. The nurses can answer most questions about the treatment of kidney cancer, including the management of side effects from therapies for advanced disease. They can also provide referrals to expert physicians in the United States.

Lyn Glenn, MN, FNP, AOCN
Manager/Nurse Practitioner

Roxanne Payne, FNP, AOCN
Nurse Coordinator

Sarah Linehan, RN, OCN

Brendan Curti, MD
Medical Director, Biotherapy Program and Genitourinary Research Program

Providence Cancer Center
Biotherapy Program
4805 N.E. Glisan
Portland, OR 97213

Cancer Prevention Tips

Look and Feel Younger

Here are some strategies which not only reduce your risk of cancers, but can also protect against heart disease, stroke, diabetes, other diseases … and keep you looking and feeling younger!

Don’t smoke or if you do smoke, quit!
Smoking is the leading cause of preventable death in the United States and is a major contributor to cancers of the lung, head and neck, bladder and other organs.
Use of smokeless tobacco is not a safe substitute for smoking cigarettes. So-called spit tobacco is linked to cancers of the mouth and pharynx.

Protect yourself from the sun.
Avoid sunlight during the hours between 10 a.m.-2 p.m., when rays are strongest. Wear protective hats and clothing. Use broad-spectrum sunscreen (protects against UVB and UVA rays) with a sun protection factor (SPF) of at least 15. Avoid tanning and sunlamps.

Maintain a healthy body weight.

Get moving!
Be moderately active at least 30 minutes on five or more days each week. To reduce the risk of breast or colon cancer, even more exercise may be better. But the most important change you can make is to move from sedentary to incorporating even a little activity into our daily routine.

If you choose to drink alcohol, do so in moderation.

Diagnosis of Cervical Cancer

If a Pap smear reveals abnormal cells, further diagnostic tests are performed to determine a diagnosis. Irregular cells could indicate:

• Human Papillomavirus Infection
• Cervical Intraepithelial Neoplasia (CIN): See the next page for details on this pre-cancerous condition.
• Cervical Cancer

Further tests are necessary to make a diagnosis. Additional tests that may be performed include:

• Colposcopy - the use of a lighted instrument to more closely examine the cervix. Vinegar (acetic acid) may be swabbed on the surfaces to be examined. The acid solution makes abnormal tissues turn white and therefore they are easier to see. A camera may be attached to the instrument.
• Biopsy - removal of a small sample of tissue for examination by a pathologist. The procedure is typically done without anesthesia and is associated with minimal pain or bleeding. It is possible to perform the biopsy during a colposcopy.

If the diagnostic tests indicate the presence of cancer, additional imaging (CT, MRI, etc.) may be performed to determine the location and extent of the disease.

When Cancer Recurs

When cancer recurs, or comes back, treatment options expand significantly. Gone are the days when we had little to offer these women. Topotecan, Doxil, Gemzar, Hycamptin, Vespid and Tamoxifen are just a few of the drugs in our arsenal. Unfortunately, though there are many choices, the chances of success begin to decline significantly. The chances of response to chemotherapy after the initial surgery approach 75-80%. Second-line agents all have response rates on the order of 15-25%, with none clearly superior to the others. Frequently, the most effective agents are the ones given initially, usually Taxol and Paraplatin. The longer the period of remission, the greater the likelihood of a second remission. Second remissions are usually shorter than the first, and almost invariably are followed by another recurrence. Surgery is occasionally of benefit, especially when the disease seems to be relatively limited in extent on a CT scan and the chances are great for removing all grossly evident (i.e., to the naked eye) tumor growths or when patients have signs and symptoms of intestinal obstruction (an inability to eat or drink without vomiting). Most patients lose their strength slowly over the course of several months and at the end, slip into a restful sleep.

Research into new drugs, approaches and technologies continues. The standard therapy for this disease has already changed in the last decade. As more information becomes available, we will hopefully make inroads in both the diagnosis and management of this disease.

Who gets ovarian cancer?

The simple answer is anybody. More specifically, post-menopausal women (about 51 years of age in the U.S.), women who have never been pregnant, women who have never used birth control pills (yes, oral contraceptives are protective), women who have a first- or second-degree relative with ovarian cancer, and women who have a personal or family history of breast or colon cancers are prone to this disease.

The very strongest risk factor is family history, but only 5% or 1 in 20 women with a cancer of the ovary will have one of the genetic variants. This means that, for most patients, there is nothing in their family tree to alert concern.

Symptoms

For years, many believed that there were no symptoms associated with ovarian cancers in their early stages. The truth of the matter is that the symptoms are so vague and non-specific that oftentimes both patients and doctors attribute them to other causes. Heartburn and early satiety (fullness after eating) are blamed on the spicy foods they had for dinner.

An increase in abdominal girth is middle-age spread and too many rich meals. The pain in the lower abdomen is a muscle pull from moving the lawn. Or frequent urination is a fallen bladder. It is of little surprise then, that three-quarters of patients with ovarian cancer have a metastatic, advanced stage of the disease when they are diagnosed.

Diagnosis

Diagnosis is made at surgery for most patients. Usually there is evidence on an ultrasound or CT scan of abnormalities in the ovaries. Oftentimes, there is free fluid or ascites present in the abdomen. Many times, a woman's pelvic examination is abnormal. CA-125 is a blood test that is often elevated in women with advanced-stage epithelial ovarian cancer (80%), though only half of the women with cancer confined to the ovary will have an elevation of this test. In post-menopausal women with evidence of a mass on examination, ultrasound or CT scan, a CA-125 can predict, with great accuracy, whether there is a cancer present.

Advances in Research/ Screening/Genetic Testing

With such a devastating disease that presents in advanced stages so often, research efforts have focused on ways of diagnosing the disease early through screening. Unfortunately, there is no screening test or combination of tests that has proven of benefit for the average patient. In women considered to be high risk, recent evidence suggests that screening transvaginal ultrasound may be of benefit. But, even in this carefully screened and evaluated group of patients, cancers eluded the investigators and were diagnosed within a year of their evaluation. In women who come from families where cancers of the breast, ovary, endometrium, and colon cluster, genetic testing can sometimes be of benefit. Testing requires a blood or tissue sample from the woman with the cancer to determine if a variant of the BRCA 1 or 2 gene exists, and if so, what it is. When this information is available, then the blood of other family members can be tested to determine if they carry the same abnormal gene. A mother has a 50% chance of transmitting the gene to her children (both boys and girls) and a 25% risk of transmitting it to her grandchildren. In some families where the expression of the gene is strong, women who carry the abnormal gene have a 40% lifetime risk of developing ovarian cancer. Many would recommend that such a woman foregoes imperfect screening tests and simply have her ovaries removed when her childbearing is completed.

Surgical Treatment

Once a mass has been identified and examined radiographically, surgery is necessary to make a complete diagnosis. Surgery provides the opportunity to define the disease and resect (surgically remove) it. When cancer is ostensibly confined to the ovary, a systematic exploration of the abdomen and pelvis with biopsies of some 15-20 different sites is performed (a staging laparotomy).

When, as is so often the case, the disease is scattered widely throughout the abdominal cavity, a resection of as much cancer as possible is performed, occasionally requiring the removal of portions of the intestine. Ovarian cancer has a characteristic spread pattern it sprinkles and studs the inside of the abdominal cavity, a "salt and pepper" effect. It is important for the operating surgeon to be aggressive in his or her approach to the management of this disease, since many studies have shown a correlation between the amount of residual cancer and the chances of a patient responding to chemotherapy and living longer. Those patients with the smallest amount of residual disease have the very best prognosis.

Prognosis

Prognosis is clearly related to several key features of a woman s cancer, most importantly stage and grade. Stage defines the extent of disease. For the overwhelming majority of women with ovarian cancer, the disease is advanced. Survival for Stage III or IV disease is 15-20% at five years. When fortunate enough to find the disease when it s confined to the ovary, survival for Stage I disease is 80-85%. Grade describes the pattern of growth as seen under the microscope. Grade 1 cancers have a pattern of growth similar to that of normal tissues, and these cancers grow more slowly and are more likely to do well. Grade 2 and 3 cancers have a very disordered pattern of growth and consequently, are more unpredictable in their behavior. The woman who has Stage 1 Grade 1 disease is likely to be cured by surgery alone.