- By Sheryl Kraft
(Editor’s note: Next Avenue is republishing this article in recognition of Ovarian Cancer Awareness Month, which begins today.)
Ricki Lewis ignored her belly fat for months, attributing the extra weight and bloat around her middle to aging and menopause.
“I should have paid more attention when a well-meaning woman asked me when I was due — but instead, I just got angry,” the 59-year-old said. “It didn’t even occur to me to see the doctor.”
Lewis, a Schenectady, N.Y., science writer with a Ph.D. in human genetics, finally made an appointment to see her gynecologist when her best friend remarked on the noticeable change in her girth. “When the doctor saw my middle, she literally jumped back several feet,” said Lewis. An ultrasound revealed a 23 cm ovarian cyst. “The technologist said it was the second largest she’d ever seen.”
Fortunately, Lewis’ story had a happy ending: The cyst, which she now affectionately refers to as “Waldo,” weighed in at a whopping 18 pounds and was benign. “When my surgeon came out and said it was not cancer, my husband threw his arms around him,” she said.
But not everyone is so fortunate.
There is a threefold increase in the risk of ovarian cancer for women who are obese.
— Bobbie J. Rimel, M.D.
In The New York Time’s blog Well, Susan Gubar says she “misinterpreted the muted symptoms of ovarian cancer,” like bloating, satiety, fatigue and constipation, which are often ascribed to other conditions like menopause, aging, irritable bowel syndrome and even depression. She writes: “By the time a CT was ordered a year later, the cancer had progressed to an advanced stage that is treatable but not curable. I was furious at myself and upset with my doctor.”
Although the rate of ovarian cancer has been slowly falling over the past 20 years, the American Cancer Society’s latest estimates are that about 21,290 women in the United States will receive a new diagnosis this year, and about 14,180 will die from it.
Ovarian Cancer: Missed and Misdiagnosed
“As women, we never think of ourselves first, so we make up excuses when something is staring us in the face,” Lewis reflects.
Additionally, as in Gubar’s case, some signs of ovarian cancer are similar to those of other conditions.
Carmel Cohen, M.D., a professor of clinical gynecology and obstetrics at Mt. Sinai Medical Center, says that if the symptoms are not “sufficiently suspicious,” a woman may, instead of heading to her gynecologist, visit her gastroenterologist or urologist. She may assume that it is something else — and not get the tests she really needs. A diagnosis of irritable bowel syndrome or a urinary tract infection might be made, when instead the real culprit is ovarian cancer.
A pelvic exam, when your ovaries and uterus are checked for size, shape and consistency, can sometimes detect some reproductive system cancers at an early stage. However, most early ovarian tumors can be difficult — or even impossible — to feel.
Cohen, who is also a member of the American Cancer Society’s Eastern Division Board, says that ovarian cancer can be missed “until the woman who is fearful says to her gynecologist ‘prove to me that I don’t have ovarian cancer.’” This is imperative, since a delay in diagnosis can result in disease progression, making it more difficult to be treated successfully.
Although it’s not uncommon for many women to feel some of these symptoms from time to time, “the hooker here is that the symptoms need to be new, persistent for about one month, occur many times within that month, and be otherwise unexplained,” Cohen says. (For instance, if you chowed down on a highly salted meal of Chinese food the night before, there might be a reasonable explanation for the bloating you feel the next day.)
“Women need to be extremely aware of what is normal for them,” stresses Bobbie J. Rimel, M.D., a gynecologic oncologist in the department of obstetrics and gynecology at Cedars-Sinai hospital in Los Angeles.
About 20 percent of ovarian cancers are found at an early stage; this is when they’re most treatable. When found early and at a localized stage, approximately 94 percent of women will live longer than five years after diagnosis.
If you have any of the following symptoms, and they are persistent or unusual, schedule an appointment with your gynecologist.
- A swollen or bloated abdomen
- Increased girth
- Persistent pressure or pain in the abdomen or pelvic area
- Difficulty eating or feeling full quickly
- Urinary frequency or urgency
- Change in bowel habits (new onset of constipation and/or diarrhea)
- Unexplained vaginal bleeding
Are You at Risk?
Having a risk factor — or even several — is not a guarantee you’ll get ovarian cancer. On the flip side, you can get the disease and not have any risk factors. Nonetheless, it’s important to be aware of the following facts.
- Age. Most ovarian cancers develop post-menopause; it’s rare in women younger than 40.
- Reproductive history. Women who have become pregnant after age 35 (and carried the baby to term) or those who have never been pregnant are at higher risk.
- Obesity. According to studies that have examined the relationship of obesity to ovarian cancer, women with a body mass index of at least 30 are at higher risk. “There is a threefold increase in the risk of ovarian cancer if you’re obese,” says Rimel.
- Family history. If your mother, sister or daughter has had (or has) ovarian cancer, your risk is increased; it gets higher the more relatives you have with ovarian cancer. Risk can also come from your father’s — not just your mother’s — side of the family. Other cancers that run in families, like breast and colorectal cancers, can also increase your risk of ovarian cancer due to their link to an inherited mutation in certain genes.
- Ethnicity. Women of Eastern European (Ashkenazi) Jewish background are at higher risk.
- Endometriosis. Women who have endometriosis (where tissue from the uterine lining grows elsewhere in the body) may be at an increased risk.
- Fertility drugs. Some studies have found that women using the fertility drug clomiphene citrate (Clomid) for more than one year may have an increased risk for developing ovarian tumors, with the greatest risk to women who did not get pregnant while on the drug.
- Estrogen therapy and hormone therapy. Women who used estrogens after menopause have an increased risk of developing ovarian cancer, according to some studies, with a higher risk for women taking estrogen alone (without progesterone) for as many as five to 10 years.
- Personal history of breast cancer. Women who have had breast cancer may be at an increased risk of developing ovarian cancer, especially women with a family history of breast cancer, which may be caused by an inherited mutation of the BRCA1 or BRCA2 genes. These genes account for hereditary breast and ovarian cancer syndrome, which is linked to a higher risk of ovarian cancer. (That is why Angelina Jolie chose to have her ovaries and fallopian tubes removed, known as a preventive salpingo oophorectomy.)