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Ovarian Cancer: How Three Courageous Women Are Fighting This Disease

All three women experienced vague symptoms – like bloating and gas that most of us have from time-to-time.

Each, Jennifer Lupo, Ann Kleinhans and Kathy Strojek, initially thought it nothing to worry about.

They questioned themselves as to what they might have eaten.

But their symptoms became frequent and persisted over months, and each felt something wasn’t quite right.

Lupo, 42, who was not yet menopausal, also, often had abdominal pain.

She said, “I never really had cramps when I was younger, but here I was doubled over, taking Midol and Aleve and using heating pads. I was often in pain and it was even worse when I had my period.”

All three were blindsided when told they had ovarian cancer.


“Ovarian cancer is a silent cancer,” said Dr. Al Elbendary, a gynecologic-oncologist on staff at Missouri Baptist who treated all three women. Gyn-oncologists are gynecologists who are trained to manage the complexities of cancer care.

“Unfortunately, it is often diagnosed in the advanced stages, because symptoms are vague. Women often think they have a gastrointestinal problem. Sometimes they’ll feel a mass or lump.”

Ninety-five percent of patients report bloating, fatigue, gastrointestinal disturbances, urinary symptoms, menstrual irregularities, abdominal or pelvic pain.

Strojek, 65, was diagnosed with Stage III cancer three years ago. “The symptoms were too easy to blame on something else. I thought it was a gastrointestinal problem as I had been on a prescription for acid reflux.”

“I’m grateful the GI doctor was sharp in seeing that there was more going on,” she said. He ordered some tests and referred her to Dr. Elbendary.

Lupo believes she’s fortunate; hers was caught in Stage I. “It’s a sneaky thing; most women don’t realize they have it,” she said.

She asked her first ob/gyn about her symptoms and was told not to worry. That answer didn’t satisfy her as things got worse. She just knew something wasn’t right.

“It was not going away, so I went to another ob/gyn.”

“When I did exercises, such as jumping jacks, I could feel a lump. It was different than a pregnancy lump,” said Lupo, who has an 18, 13 and eight-year-old.

“When I would lie on my stomach, I could feel something in there that didn’t belong. Even intercourse was painful.”

The ob/gyn ordered a CAT scan and tested her urine and blood, also ordering a CA-125 blood test, which measures cancer antigens in the body. She, also, was referred to Dr. Elbendary.

Kleinhans’ cancer, like Strojek’s, was caught at Stage III.

“My nephew is a doctor in St. Louis and after I was diagnosed with ovarian cancer, he told me I should see Dr. Elbendary for treatment,” said Kleinhans, 84, who travels from Texas for her appointments.

“I knew something was wrong,” said Kleinhans, who experienced about eight months of pain in her stomach before finding a physician who finally pursued an answer. “I was worn out and felt bad all the time, but I had no idea I had cancer.”

While Kleinhans is the first in her family to be diagnosed with ovarian cancer, cancer is not new to her mother’s side. Her sister had breast and lung cancer, her brother throat cancer and her mother cervical.


Gyn cancers, like endometrial and cervical cancers, are generally caught early because of pap smears and recognizable symptoms. Both have high survival rates. Bleeding, spotting or discharge, usually alert women that something is wrong.

Unfortunately, there isn’t a screening test for ovarian cancer. It is difficult to diagnose, even with an ultrasound.

“Always tell your doctor about any symptoms of bloating, constipation, appetite changes or back pain,” said Kate Burch, WHNP, women’s healthcare nurse practitioner and board-certified menopausal clinician at Dr. Elbendary’s office. “Those things may happen to all of us at some time, but an increase in frequency, severity, or symptoms that persist, should be evaluated.”


Treatment plans are based on the cancer’s “stage.”

“In early Stage I, surgery alone can sometimes ‘cure’ the patient,” said Dr. Elbendary. “Or, sometimes, depending on the type of cancer cell, surgery and an abbreviated course of chemotherapy are enough.”

More advanced stages, though, generally require surgery and more extensive chemotherapy.

While Lupo’s tumor was confined to her ovaries, surgery removed her ovaries, fallopian tubes and uterus because microscopic cancer cells were found in these locations.

Her final chemotherapy treatment is to be completed in early fall.

“The pain went away after surgery and I can lie on my stomach now,” said Lupo. “Sometimes I tire quickly with chemo and I need plenty of sleep.”

Strojek, on the other hand, will have chemo the rest of her life as she has little tumors in her upper abdomen that have metastasized.

After Kleinhans had her surgery, she stayed in St. Louis for five months for chemotherapy. She now is on two different rotating oral medications that she will take for the rest of her life to help keep the cancer from growing.

She comes to St. Louis to see Dr. Elbendary about every three months.


Ovarian cancer is a potentially curable disease in one-third of women. And, thanks to recent advances in treatment, 46% of women with ovarian cancer are beating the five-year survival rate.

Recent medical studies show that your doctor’s qualifications can make the difference. Women treated by gyn-oncologists who specialize in ovarian cancer, have consistently “superior outcomes” than those treated by non-specialists.

“We’ve made great advances in treating ovarian cancer,” said Dr. Elbendary, who has devoted his career and medical practice to treating the disease. “Women’s survival, quality of life and outcomes are enhanced by specialized care that launches our arsenal of medical treatments at the cancer, while supporting women emotionally and keeping them physically strong.”

Kleinhans, Lupo and Strojek were all greatly encouraged by Dr. Elbendary, his staff and, unexpectedly, by the patients they met there.

Kleinhans said, “When I went into chemotherapy, all these ladies were sitting around the room and all had cancer. They have become good friends.”

Burch also encourages patients to enroll in STAR, a rehabilitation therapy program which helps cancer survivors live with minimal side effects from cancer treatments (see www.MissouriBaptist.org/STAR for more information).

“This great rehab/exercise program helps cancer patients fight fatigue and chemo brain. It can energize and improve depression, stress and reduce risk for other diseases,” said Burch.


Only 10% of gyn cancers are hereditary.

“If two first-degree relatives have had cancer, it’s a just-do-it for genetic testing,” said Burch, referring to the fact that most insurance companies would cover it.

If a BRCA-1 or -2 mutation is found, risk of cancer jumps to 35-65%.

Dr. Elbendary said, “Genetic testing is an expensive procedure. The question we ask before testing is ‘Are you willing to do something about it?’ If not, there is no real point in knowing.”


When Lupo was diagnosed with her ovarian cancer, Dr. Elbendary encouraged her saying she couldn’t go through life worrying about it.

Lupo believes the best advice she can give other women is to not believe everything people tell you. “People have the best intentions, but listen to your doctor. And, live life.”

Why did Dr. Elbendary became a gyn-oncologist? “In med school, I envisioned myself as a happy obstetrician delivering happy babies, but one of my professors encouraged me to look at gyn-oncology because I showed talent for complex surgeries. Often, a general surgeon does not have the long-term relationship with patients that a gyn-oncologist does. I’m grateful that I can really make a difference in my patients’ lives. This field gives me that opportunity.”

Kleinhans, who has five children, 10 grandchildren and 15 great grandchildren, credits Dr. Elbendary with saving her life. “I’m not planning on going anywhere. I have too much to be here for.”

Her advice for women with ovarian cancer comes from some advice her grown grandson gave her: “Why don’t you join the ‘BBC’ club,” he said, when she was down about losing her hair with chemotherapy.

She asked him what that meant. He said ‘bald by choice.’

So, that she did. “Shaving my head made things much easier. And one of my friends at chemotherapy wore a cute little hat. I asked her where she got it. I went and bought several.”

Lupo, who is glad she trusted her instincts said, “I know there are hypochondriacs, but if something doesn’t feel right — get it checked out!”

Strojek said, “Cancer taught me not to stress the little things. Look at the flowers, the clouds. Appreciate it. Live your life every day.”

Al Elbendary, MD, is board-certified in gynecologic-oncology and on staff at Missouri Baptist Medical Center. He received his medical degree from Loyola University of Chicago and completed a combined internship/residency in obstetrics/gynecology at the University of Chicago Medical Center. He then completed a fellowship in gynecologic-oncology at Duke University Hospital.

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STL Mag Feature

Dr. Al Elbendary and staff offer comprehensive care for women with gynecologic cancers and precancerous conditions in a comfortable office setting. When you need a specific type of care, it’s reassuring to know the physician and staff are experts in this area.

Dr. Elbendary serves patients with newly diagnosed gynecologic cancers; patients with dysplasia, premalignant gynecological lesions, pelvic masses, or postmenopausal bleeding; and patients requiring complex gynecologic surgery or reconstruction.

A practicing specialist since 1996, Dr. Elbendary is board-certified in gynecology and gynecologic oncology. He treats women with precancerous and cancerous gynecologic conditions and also performs laparoscopic, or minimally invasive surgery, and pelvic reconstruction surgery.

Gynecologic oncology is a subspecialty of gynecology that focuses on the diagnosis and treatment of female pelvic cancers, such as cancers of the ovaries, uterus, cervix, or vulva, as well as precancerous conditions.

Dr. Elbendary is supported by Kate Burch, a women’s healthcare nurse practitioner (WHNP) and board-certified menopausal clinician (MC). She provides well-woman consults and health screenings, contraceptive counseling, and hormone therapy, as well as genetic testing.

Chemotherapy services are provided at the office by specially trained nurses through Missouri Baptist Medical Center’s Cancer and Infusion Center. The center is dedicated to treating women with gynecologic cancers. Although privacy is respected, many patients enjoy the intimate setting, sharing their experience with others going through similar treatment, and having a staff that knows them well.

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House Call: Know the early warning signs for ovarian cancer

Ovarian cancer is a rare, gynecologic malignancy that can affect women as they age. In the United States, it is estimated that 22,240 women will be diagnosed with ovarian cancer and more than 14,000 women will die from the disease. This makes ovarian cancer the most lethal gynecologic malignancy.

Our best chance to control and cure ovarian cancer rests with early diagnosis when the cancer is still confined to the ovaries. For example, women diagnosed with stage 1 of the disease have a 90 percent cure rate, whereas only 18 percent of those with stage 4 ovarian cancer survive.

Unfortunately, ovarian cancer has few symptoms in its early stages making early diagnosis very difficult.

Survivors of ovarian cancer say the disease “whispers” early on in its course and does not offer clear warning signs. Among the more common early symptoms are bloating, vague persistent abdominal pain or increase in abdominal girth.

Unfortunately these symptoms are not specific to ovarian cancer and often are dismissed by women as aging or another medical issue. As the cancer advances, women may experience reduction in appetite, feeling full quickly, constipation, shortness of breath and increasing abdominal pain.

Many of my patients ask about screening tests for this disease. Specifically I get asked about ultrasounds and tumor markers such as CA125 or OVA1.

Unfortunately, ovarian cancer is too rare of a disease and current tests are not effective screeners.

Regarding tumor marker CA125, many benign conditions such as endometriosis, infections, fibroid tumors and pregnancy can cause false readings.

Genetic testing for the BRCA1 and BRCA2 gene mutation is an effective way to identify a very small subset of women who have a specific gene mutation that will predispose them to developing breast and ovarian cancer. Women with BRCA mutations have a 60 percent risk of developing ovarian cancer, and even higher risk for breast cancer. In this subset of women, screening and early intervention may help early detection or prevent it altogether.

The treatment of ovarian cancer is complicated. Several studies have found that when treatment is orchestrated by a gynecologic oncologist, women had significantly better outcomes and survival rates.

In a small subset of patients with stage 1 cancer, surgery may be sufficient treatment. For the majority, however, aggressive surgery and chemotherapy are the mainstays of treatment.

In conclusion, ovarian cancer remains an elusive disease to diagnose at an early stage. However, with aggressive surgical treatment and chemotherapy, the prognosis, cure rates and quality of life have been significantly improved.

Women should listen to their own bodies and trust their instincts, particularly as they approach menopause. If medical symptoms persist, don’t ignore them and consult your physician.

Dr. Al Elbendary is board-certified in gynecologic oncology and on staff at Missouri Baptist Medical Center. He received his medical degree from Loyola University, completed his internship and residency at the University of Chicago, and completed a fellowship in gynecologic oncology at Duke University. To make an appointment, call 996-LIFE (5433).

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House Call: Women must take active role in detection of cervical cancer

Cervical cancer is a leading cause of cancer death for women worldwide and the fourth cause of gynecologic cancer deaths in the United States. Unlike many other cancers, cancer of the cervix has a well defined, typically long premalignant phase known as dysplasia — a precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix, the opening between the uterus and the vagina.

Among American women, more than 640,000 are diagnosed annually with advanced forms of dysplasia. Screening for and treating dysplasia is the most effective way to prevent and treat cancer of the cervix. Unfortunately, most women do not avail themselves to screening. In fact, over half who develop cervical cancer have not been screened in 10 years.

Nine-five percent of cervical cancer cases are linked to the sexually transmitted virus human papillomavirus (HPV). Other factors that predispose women to developing the disease include intercourse at a young age, having multiple sexual partners and tobacco use.

While the disease is still in its premalignant or dysplastic phase, it does not cause symptoms. It’s not until the disease reaches its cancerous stage that the patient will start to notice symptoms. Common symptoms are abnormal vaginal bleeding and abnormal vaginal discharge. Bleeding can range from occasional spotting to severe bleeding — or it could be limited to bleeding after intercourse. Some patients will also develop back pain or pain that shoots to the leg — a sign of very advanced cancer.

Clearly, women who have any of the above symptoms should see their gynecologist immediately for evaluation.

All women should visit their gynecologist for a screening, which includes a thorough pelvic exam and a pap smear. Typically, screenings for cervical cancer begin at age 21.

Although the exact frequency of screening is somewhat controversial, most experts would recommend an annual exam, including a pap smear, for low risk, sexually active women. Most experts would also agree that monogamous, low risk patients who have had three normal pap smears should be screened less frequently for cervical cancer. Many recommend screening every three years. Women who are at high risk for developing dysplasia and cervical cancer should be monitored more frequently.

Testing for HPV is now commercially available and may help identify women who are at high risk for developing cervical cancer. Women should ask their gynecologist if they would benefit from HPV testing and if it should be incorporated into their individual screening program.

Two vaccines are now available for HPV. Studies have shown that these vaccines are very effective in preventing viral infection. The hope is that by preventing the HPV viral infection, the incidence of both cervical dysplasia and cancer can be reduced. However, to be effective, vaccines should be given to people before they become sexually active — before they are exposed to the HPV virus.

Now more than ever, we have many weapons to prevent, detect and fight cervical cancer but women must take an active role in their healthcare to keep from becoming a statistic.

Dr. Al Elbendary, obstetrics and gynecology, is on staff at Missouri Baptist Medical Center. For referral to a physician on-staff at Missouri Baptist Medical Center, call 314-996-LIFE.

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