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This remarkable collaboration will help women feel more hopeful, and less scared and alone, when faced with ovarian cancer.
"Combining the latest medical research & Gene Wilder's story of his wife Gilda Radner's courageous, ultimately unsuccessful battle with ovarian cancer, this moving, highly informative book is an essential guide...."
|Ch. 1||Gilda Radner: A Personal Perspective||27|
|Ch. 2||Causes of Ovarian Cancer||33|
|Ch. 3||Prevention of Ovarian Cancer||51|
|Ch. 4||Diagnosing Ovarian Cancer||64|
|Ch. 5||The Thirty Different Types of Ovarian Cancer: The Pathology of Ovarian Cancer||81|
|Ch. 6||The Four Stages of Ovarian Cancer: Stages and Survival||88|
|Ch. 7||Surgery of Ovarian Cancer: What Do I Need to Know?||95|
|Ch. 8||First-Line Chemotherapy of Ovarian Cancer||108|
|Ch. 9||Second-Look Surgery||126|
|Ch. 10||Second-Line Chemotherapy||133|
|Ch. 11||Alternative Therapies from Apricot Pits to Zen Macrobiotic Diet and Touch Therapy||141|
|Ch. 12||Gene Therapy||150|
|References and Bibliography||173|
On Wednesday, March 25, barnesandnoble.com welcomed M. Steven Piver, author of GILDA'S DISEASE.
M. Steven Piver: Fine thank you, thanks for writing.
M. Steven Piver: The answer is that it is easy to read. I wrote every page and Gene Wilder rewrote every page to make certain that the readers would understand it, and that I wouldn't scare the hell out of anyone. Also, he made me put the tables in an appendix in the back of the book so it wouldn't be boring and people would keep reading, and so we did that.
M. Steven Piver: No, GILDA'S DISEASE has all the options, both for the surgery of ovarian cancer and the chemotherapy of ovarian cancer, but it tells the results of the best clinical trials that offer one, the best surgery, and two, the best chemotherapy.
M. Steven Piver: We wrote the book together. Gene and I first met in August of 1989, when he was searching for answers as to why his beloved Gilda died of ovarian cancer, why it took a year for them to make the diagnosis, why none of her doctors ordered the blood test for ovarian cancer CA-125. When he called me in 1989, I told him that I would be his sidekick just as Harrison Ford was in the "Frisco Kid," when Gene was playing a Polish rabbi trying to find San Francisco, and was totally lost and Harrison Ford said he would be his sidekick and get him to San Francisco. Then Gene and I decided we would get the word out on ovarian cancer to help all the Gildas out there. We went on Connie Chung "Eye to Eye" together, I went on "Oprah," "20/20," "Nightline," "The Today Show," "The Jane Pauley Show," and CNN to explain about ovarian cancer. We started a 1-800 Ovarian Hotline, so people could get their answers [about] ovarian cancer, Gene testified before Congress to get more money for ovarian cancer, and we did this from 1989 through 1995. Then Gene decided that he needed to resume his acting career, and he asked me to let him retire from medicine. I said, "You can retire from medicine, but you have to do one more thing for the women of America, you have to write a book on ovarian cancer with me," so I wrote a page to ten pages a day between operations, I would fax them to Gene, Gene would make corrections and fax them back to me with such comments as, "What the hell does this mean? Are you trying to scare the pants off of these people? Please rewrite. Love, Gene." So, in eight and a half weeks, we had over 400 faxes, plus dozens of phone calls. One Friday night close to the end of writing the book, I went home from the hospital early and received a fax the next morning from Gene which he sent Friday night "Dear Sidekick, You don't write, you don't call, you don't fax, what kind of relationship is this? Love, Gene." And that's how we wrote the book.
M. Steven Piver: Ten percent of ovarian cancer is inherited. The gene can be inherited from your mother or your father. So, you can't just look to your mother's side to look for ovarian cancer, you have to look at your father's side to see if ovarian cancer runs in the family. One of the things that Gene and Gilda Radner did not know was that there was lots of ovarian cancer in her family. She knew [about] her mother's sister's daughter, who is a patient of mine and is cured of ovarian cancer, but she didn't know that her mother's aunt also had ovarian cancer. She didn't know that her second cousin had ovarian cancer. She didn't know that her maternal grandmother probably had ovarian cancer, but it was called "stomach cancer" in those days. Gene and I both believe that if Gilda had known that she had three close relatives with ovarian cancer, and if she had known that her mother's breast cancer increased her own risk for ovarian cancer, that the doctors seeing her worldwide would have diagnosed Gilda's cancer probably a year earlier when she was complaining of stomach pain, leg pain, fever, fatigue, constipation, that Gilda might still be alive today because it would have been diagnosed at an earlier stage, but regrettably, when it was diagnosed, it was in stage four, in her liver; if it had been diagnosed a year earlier it would not have been in her liver, most likely, and she might be alive today.
M. Steven Piver: That's an excellent question, and there is a small relationship between endometriosis and ovarian cancer. The small relationship is that some ovarian cancers, when diagnosed, also have endometriosis in the surrounding tissues. What we don't want to do is be an alarmist, because so many hundreds of thousands of women have endometriosis and so few of them develop ovarian cancer. So, although there is a small connection, it should not be overstated, but women should know that there is at least a small connection. But the risk of developing ovarian cancer in endometriosis is exceedingly small, and should never be overstated.
M. Steven Piver: That too is an excellent question. When Gilda was going through her agonizing symptoms for well over a year, which started in October of 1985, when Gene and Gilda were filming the movie "The Haunted Honeymoon," researchers had just recently published that there was a blood test for ovarian cancer called CA125. The sad part back in 1985 was that doctors were told it was only a blood test for women already diagnosed with ovarian cancer. After Gilda died, that made absolutely no sense to Gene Wilder, who asked the very obvious question to Lawrence Altman, a science writer for The New York Times, as to why, when he was writing about ovarian cancer, he didn't write that it should be used in women whom a doctor might suspect had ovarian cancer, rather than after the diagnosis was already made. Therefore, Gene rightly surmised that if doctors had been told you can use this blood test if you suspected ovarian cancer, that Gilda might have been diagnosed a year earlier. So that's one major breakthrough since Gilda was struggling with her symptoms. Another breakthrough since Gilda was treated is the discovery of a new chemotherapeutic drug, Taxol. Taxol was not available when Gilda was treated for her ovarian cancer; however, she did have the benefit of the most important drug for ovarian cancer, Platinol. Today, the main treatment for ovarian cancer is the combination of Platinol plus Taxol. The other advances since Gilda was diagnosed is that in 1985 it was not readily known that ovarian cancer could be inherited. Sally Squires, a writer for the Washington Post, wrote an article on May 30, 1989, ten days after Gilda died, with the title, "Ovarian CancerDoctors Don't Know Who's at Risk or Why." In the article she stated that M. Steven Piver, MD, has a registry in Buffalo, New York, in which he has collected 300 families in which ovarian cancer has been inherited, and she stated, "For more information, contact Dr. Piver at Roswell Park Cancer Institute, Buffalo, New York." That was the first time people across the country learned that ovarian cancer could be inherited, so, if that discovery of mine had come out earlier, and Gilda had known her family history, then doctors would have probably, again, been able to diagnose her cancer earlier, and she might still be alive today. So, I would say that since Gilda's diagnosis, the main things that have come out, CA125 can be used when the physicians suspect that women might have ovarian cancer, that a new drug has been discovered, Taxol, since her diagnosis, and that it is now recognized worldwide that 10 percent of ovarian cancer is inherited.
M. Steven Piver: The odds are not very high that you will develop ovarian cancer in the remaining ovary; however, the risk factors for developing ovarian cancer are as follows One, the most important risk factor is a family history of ovarian cancer. A second risk factor is being infertile. A third risk factor is never being pregnant. Therefore, if your endometriosis causes you to be infertile, and never becoming pregnant, then the risk for your developing ovarian cancer in the remaining ovary goes up. On the other hand, if your endometriosis is successfully treated, and if you decide to have children and become pregnant, then the risk of developing cancer in the remaining ovary is very slight and you should not be overly concerned about it.
M. Steven Piver: Taxol and Platinol are successful in the treatment of ovarian cancer. Unlike almost any other abdominal cancer that has spread within the abdomen, Taxol and Platinol for ovarian cancer achieve the highest five-year survival rate. Approximately 25 percent of women who present with ovarian cancer that has already spread to other organs within the abdomen will be alive at five years. However, that's clearly not good enough. We need probably newer types of treatment that are different than chemotherapy, which works by actually killing the cancer cells. These new therapies that we are working on include primarily gene therapy, where we can get a modified gene into the cancer cell that will stop the cancer cell from dividing. That's what we hope to achieve in the next five years.
M. Steven Piver: It is true that Gene Wilder and I decided that we would not take any royalties for the book, that they would go to Gilda's Club in NYC, which is a psychological support group for women and their families with ovarian cancer, and to the Gilda Radner Familial Ovarian Cancer Registry, which I am the founder and director of, which is based at Roswell Park Cancer Institute in Buffalo, NY. THe address for GIlda's Club is 196 Houston St., New York, NY. The Gilda Radner Familial Ovarian Cancer Registry was originally called the Familial Ovarian Cancer Registry, but a year after Gene and I decided to get the word out on ovarian cancer, I asked Gene what he thought about renaming the registry in her honor, and renaming it the Gilda Radner Registry, and his response was, "That's wonderful, and I am very moved, I am sure Gilda would be very proud." And that's the history of it.
M. Steven Piver: The answer is sadly no. The reason is that there are over 200 different cancers, all of which have different causes, 30 percent of which are caused by smoking, which not only includes lung cancer that everyone knows is caused by smoking, but cervix cancer, some bladder cancers, throat cancers, and other cancers, and I don't believe we'll ever stop people from smoking. Even with that pessimistic overview, there are things that we can do Stop smoking, not be around and have second-hand smoke get into our lungs, lower the amount of fat in your diet, because many cancers are related to a high-fat diet, ovarian cancer being one of them. Cancer frequently is a disease of the elderly -- because of modern science, people are living into their 80s, 90s, and even 100s. So, besides lifestyle changes of not smoking and a low-fat diet, screening will allow us to detect cancers at an earlier stage, and thus [they will] be more curable. For example, for the male, getting the PSA test for prostate cancer, the hemocult for detecting blood in the stool for colon cancer, mammography and Pap smears for women, the blood test CA125, and pelvic ultrasound for ovarian cancer will at least allow us to diagnose these cancers in their earliest stages, when we can still cure a majority of people. Environmental factors, such as asbestos, need to be eradicated, other environmental factors such as radon in one's house -- most people know that lung cancer is caused by smoking, but most people don't know that the second most common cause of lung cancer is radon in one's house. So there are things that people can do, but I doubt that we'll ever eradicate cancer in our lifetime. And that saddens me.
M. Steven Piver: I want to thank everyone for their questions, and I want to especially thank Gene Wilder for helping all the other Gildas out there.