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Ovarian Cancer

Girl, 8, survives ovarian cancer

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    Natalie Cosman, shortly after starting chemotherapy. Courtesy Melinda Cosman

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    Natalie Cosman (L) at last year's Run/Walk to Break the Silence on Ovarian Cancer. Courtesy Melinda Cosman

On September 22, the third Annual Run/Walk to Break the Silence on Ovarian Cancer will take place in Madison, Conn. The walk’s top fundraising team, Natalie’s Tigers, which has raised more than $7,000, is fronted by little Natalie Cosman – who, at 8 years old, is a survivor of the disease.

“Our goal is to make people realize it can happen to any female at any age,” Natalie’s mother, Melinda Cosman, told FoxNews.com.  “We want to get the word out there about the disease the way it should be out there.”

Natalie’s battle started one year ago, when she started complaining of chronic stomach pain.  Doctors brushed it off as a stomach virus or gas buildup – until one day, when the pain became so bad, Natalie’s parents rushed her to the hospital.

Suspecting appendicitis, doctors ordered an ultrasound and found a 7-centimeter cyst on Natalie’s right ovary.  A biopsy confirmed the cyst was a tumor, and Natalie was diagnosed with stage II ovarian cancer.

“I was shocked, especially by what kind of cancer it was,” Cosman said. “A 7 year old with ovarian cancer is quite shocking.”

‘A silent killer’

September is Ovarian Cancer Awareness month.  Ovarian cancer is known as a 'silent killer' because there is little awareness and high mortality rates associated with the disease. In 2012, there will be 22,280 new cases of ovarian cancer and 15,500 deaths from ovarian cancer, according to estimates from the American Cancer Society.  

While ovarian cancer is ranked ninth in prevalence among women – lagging far behind breast and lung cancer – it ranks fifth in women’s cancer deaths.  More than half of women diagnosed die within five years.

Children and young women typically develop a rare subtype of the disease – it arises in the germ cell, which is responsible for making eggs, or in the cells that support the eggs, according to Dr. Robert DeBernardo, a gynecological oncologist at UH Case Medical Center in Cleveland, Ohio.  This cancer subtype usually remains confined to one ovary and is highly treatable if caught early.

“In young girls and women who haven’t gone through menopause, the type of ovarian cancers we see are very, very uncommon and generally have an excellent prognosis,” DeBernardo, who did not treat Natalie, told FoxNews.com.  “As terrible as it is to see a 7 year old with cancer, with treatment, these girls tend to do very well.”

In Natalie’s case, doctors had to remove her right ovary and her right fallopian tube. She was prescribed three different types of chemotherapy, which she began immediately after the surgery to prevent the cancer from spreading.  

“Ovarian cancer used to be universally deadly, but we’ve found particular drugs are so effective they can cure young girls,” DeBernardo said.  “Between surgery and chemotherapy, 95 percent of girls can be cured.”

The experience took its toll on Natalie and her family – she was frequently sick and had to miss multiple days of school.  The chemotherapy also caused her hair to fall out.

“It was hard for everybody, especially for her,” Cosman said.  “She had to stop being a kid for a year.  She was in the hospital every two weeks and over her breaks from school – we had to go in to make sure the chemotherapy was working.”

But Natalie was determined to keep her spirits up, according to Cosman.

“As sick as she was, she still kept a smile on her face through everything she lost at her age, due to the cancer,” she said.  

Cosman added it was difficult to explain to Natalie the ramifications of her cancer – and what removing an ovary could potentially mean for her future.  

“She didn’t really understand,” Cosman said.  “We explained to her what was going on as much as we could for a 7 year old, but I don’t know if she gets how important her ovaries are.”

Preserving fertility is a major concern for doctors, DeBernardo agreed.  Removing one ovary reduces fertility rates by approximately 10 to 15 percent. And while some types of chemotherapy can impact a person’s reproductive system, the types used on Natalie did not.

“[The girls] can still have children in the future, but it may be a little more difficult to get pregnant,” DeBernardo said.

Today, Natalie is cancer-free.  She goes in for routine testing every month, and every three months undergoes a complete scan to ensure it has not returned.

Screening difficulties

Although Natalie’s cancer was caught relatively early – in a treatable stage – many others aren’t as fortunate, DeBernardo said.  

Unlike young girls, older women develop a subtype of ovarian cancer that tends to start in the epithelial – or outside – covering of the ovary.  This type of cancer is much harder to detect and treat, so the mortality rate is much higher.

“The problem with screening is, unlike breast cancer, there is no easy way to examine the ovaries like a mammogram,” DeBernardo said. “…Because most ovary cancers start in the epithelial, or skin of the ovary, we believe it’s already flicking off and traveling through the abdomen while it’s still relatively small, so screening tests can’t pick it up [soon enough].”

According to DeBernardo, only 10 to 20 percent of ovarian cancer cases are caught in stage 1.  The majority aren’t detected until stages III or IV.

As with Natalie, symptoms include stomach pains, nausea, vomiting or bloating, which can help the cancer go unnoticed until it’s too advanced to treat.  

“The symptoms are very generalized, so patients don’t realize,” DeBernardo said. “In all the years I’ve been practicing, I haven’t had someone come in and say, ‘You know what, my ovary is bothering me.’

“I try to tell patients: Everyone gets nausea and bloating, but if it persists and doesn’t go away, you have to go to the doctor and get evaluated.”