The study, published in the October 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, found women who received both chemotherapy and radiotherapy reported the most severe and prolonged fatigue.

Fatigue is a common complaint in the general population and, anecdotally, common among cancer patients. Comparative fatigue studies between the two populations, however, have been marred by methodological shortcomings, such as poorly matched controls and patient populations. The studies do not consistently agree whether or not fatigue is a more common complaint among cancer patients compared to the general population.

Dr. Paul Jacobsen from the Moffitt Cancer Center in Tampa, Florida and co-investigators followed 221 women with non-metastatic (early stage) breast cancer treated with either radiography (n=121) or a combination of chemotherapy and radiography (n=100) and 221 age- and geographically-matched healthy women (i.e., controls) at two, four, and six months after treatment.

The authors expected to find the greatest difference in fatigue scores just after treatment, diminishing with time. Surprisingly though, they found that breast cancer patients, had a significantly greater number of days with reported fatigue at each of the four assessments, and that even at the six-month follow-up assessment, a statistically significant and clinically meaningful group difference in fatigue duration was still evident. They studied further and found that the difference was attributable primarily to heightened fatigue in those women who received both chemotherapy and radiotherapy.

These findings provide strong evidence that women with non-metastatic breast cancer treated with adjuvant chemotherapy are at significantly greater risk for severe fatigue. The next step, explains Dr. Jacobsen, is to ???explore whether interventions administered during or at the end of treatment are effective in preventing or limiting fatigue in the post-treatment period.??? They point in particular to the role of exercise, which has been shown to reduce fatigue in breast cancer survivors.

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Symptoms do exist. Bloating, pelvic or abdominal pain, difficulty eating, feeling full quickly, and frequent or urgent urinating are shown to be more common in women with ovarian cancer. These arevague symptoms and often mistaken for gastrointestinal problems. But if they persist for several days, get checked out by your gynecologist. ???You can explain away these symptoms to yourself. But the only way to be sure it's nothing is to go get a pelvic exam,??? says J. Rebecca Liu, M.D., assistant professor of obstetrics and gynecology at the U-M Medical School and a gynecologic oncologist at the U-M Comprehensive Cancer Center. There is no screening test for ovarian cancer, like a Pap smear or mammogram. The CA125 blood test measures the amount of a certain protein that's often elevated with ovarian cancer. But the test is not foolproof. ???There are a lot of benign conditions that can cause higher levels of CA125,??? Liu says. Early detection is a key area of research. U-M researchers are looking for markers in the blood that indicate ovarian cancer, an approach that could in time lead to a blood test to screen for ovarian cancer. All women need yearly pelvic exams. Maybe your doctor says you don't need a Pap smear every year, but Pap tests just check for cervical abnormalities. A pelvic exam is not the same thing. In particular, older women should not discontinue their yearly gynecology visit as ovarian cancer is more likely to occur in women older than 60. ???A pelvic exam is key because it's the best screening we have right now,??? Liu says. Survival rates are significantly better when ovarian cancer is diagnosed in an early stage. With stage I ovarian cancer, the earliest stage, 95 percent of women are alive five years after diagnosis. Only 30 percent of women with stage III or IV ovarian cancer survive five years. More than 22,000 women will be diagnosed with ovarian cancer this year and more than 15,000 will die from the disease. Some 70 percent of women have advanced disease when they are diagnosed. Ovarian cancer is difficult to treat because it's often resistant to current treatments. It may respond to chemotherapy drugs initially, but when it recurs ??“ which it usually does ??“ the cells will no longer be killed by that drug. Researchers are focusing on new molecularly targeted therapies that hone in on and destroy the cancer cells, and they hope this will overcome the resistance. A new clinical trial recently opened to patient accrual at U-M looking at whether the drug Avastin, which has been successful for colon cancer, can improve survival in ovarian cancer. It's most common in older white women. Most patients are older than 60 and post-menopausal. Women who have not had children are at higher risk. Women who have taken birth control for a number of years lower their risk. A small number of ovarian cancers are hereditary. It's linked to the same genes that are linked to breast cancer, BRCA1 and BRCA2. If ovarian cancer runs in your family, particularly on your mother's side, and if family members were diagnosed at a young age, you might consider genetic testing. The best person to treat ovarian cancer is a gynecologic oncologist. These specialists are skilled in the comprehensive management of female reproductive cancers, including surgery and chemotherapy. Studies have shown gynecologic oncologists are two to three times more likely to provide surgical care consistent with national guidelines. Women with ovarian cancer treated by gynecologic oncologists have 10 percent to 25 percent better survival rates than women treated by general oncologists or gynecologists. While your regular gynecologist can perform diagnostic tests, if you are diagnosed with ovarian cancer, you should see a gynecologic oncologist.

Symptom check-list:

Bloating Pelvic or abdominal pain Difficulty eating or feeling full quickly Urinary symptoms (urgency or frequency) Symptoms are persistent and represent a change from the normal

Women who experience these symptoms almost daily for more than a few weeks should visit their regular gynecologist.

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