The Question:
My 47-year-old sister, a mother of three school-aged children, has a golf-ball-sized mass on one ovary, found during an annual ultrasound she has done due to a history of fibroids. Surgery is required to diagnose cancer but the date she's been given is eight weeks away. They are trying to move the date up. Ovarian cancer does not have a great cure rate so we are extremely concerned the wait will make things worse. Can you comment on the length of the wait, if it's normal, and on private insurance options?
The Answer:
Your sister is in a very difficult, anxiety-provoking situation. Since her cancer is being diagnosed through a biopsy, done at the time of the operation, she can't know what her disease status is now.
According to Mark Heywood, president of the Society of Obstetricians and Gynaecologists of Canada, doctors typically try to calculate the chance of malignancy and place patients in categories of low, medium or high risk.
"We look at ultrasound features of the mass, the age of the patient and a marker called CA125," said Dr. Heywood, a gynecologic oncologist in Vancouver, "and we use that to try and figure out if somebody is at significant risk or not."
CA125, a protein found in blood, is present in elevated concentrations in women with ovarian cancer. It works better in postmenopausal women, compared to pre-menopausal women such as your sister. However, it can be used along with other factors to help paint a picture of cancer risk.
Other physical features also raise a surgeon's index of suspicion: if the mass has cystic and solid areas, whether there is fluid in the abdomen, and disease in the omentum, a fold of fatty abdominal tissue where ovarian cancer often spreads.
Surgeons have created a benchmark, or goal, by which 90 per cent of cases should be done. They are not necessarily a maximum or unsafe if not met, but are important targets just the same. Patients would want to be treated within the benchmarks.
In cases where a mass is suspected of being malignant, patients should get surgery in four weeks and where a malignancy is unlikely, 12 weeks. For those with cancer, it's within two weeks.
While those targets don't vary much from province to province, the ability to deliver on them does.
Your sister needs to find out from her surgeon where she is on the risk scale.
If her mass is suspicious for cancer, she should ask to be moved up the surgery list either in her city with that surgeon or, if not possible, another surgeon elsewhere. This is not a provocative request; patients are moved up wait lists all the time based on suspicions about their disease status. If her mass is not deemed suspicious for cancer, she is well within that benchmark.
Before checking into private insurance, sort out her status first. This is a crucial time and you don't want her to fall through the cracks.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com .