Dear Dr. Pat,
My sister was just diagnosed with ovarian cancer. She is 56 years old and could not have children due to endometriosis. She was still having regular periods when she was finally diagnosed after a year of increasing symptoms that were always attributed to endometriosis. Before the diagnosis she continued to have very painful periods but also developed pressure in the pelvic area, and against the bladder with lots of urinary frequency, painful intercourse when the penis pushed against the top of the vagina and the cervix. And, over the last three months, she’s had change in bowel function, some loss of appetite, the inability to eat normal portions of food, and abnormal bleeding patterns, which she attributed to perimenopause and terrible fatigue. She saw her gynecologist about nine months before she became so sick that she was hospitalized and was told that the symptoms she was having early on were consistent with her known diagnosis of endometriosis. She had a pelvic sonogram that was consistent with a cyst that looked like endometriosis. The doctor did offer a hysterectomy with removal of tubes and ovaries for treatment of the presumed endometriosis but my sister, who had always been terrified of having a hysterectomy, thought she could just wait for menopause and then the symptoms would disappear. She did not return to see her doctor, as she was asked to do, until her symptoms had really progressed. I am a nurse but I live across the country from her and did not really understand how sick she had become until she was hospitalized. She has been transferred to a large medical center where there is a specialized group in ovarian cancer care. She will need chemotherapy first to shrink the tumors. If all goes well, she will have surgery and then more chemotherapy. In those many months before the diagnosis was finally made, she had seen a gastroenterologist and a urologist in addition to her gynecologist for her annual exam. How could this have happened?
Sara
Dear Sara,
Your sister had nearly all of the symptoms that we associate with ovarian cancer, but those symptoms could have been due to worsening endometriosis as well. Then there was always the possibility of hormonal change causing the alteration in menstrual bleeding. Ovarian cancer is notoriously difficult to diagnose early but your sister’s fear of surgery and clearly her fear of the diagnosis of something serious seem to have added to the difficulty of making an earlier diagnosis.
As a reminder these are the symptoms of ovarian cancer:
- Abdominal bloating, indigestion or nausea
- Changes in appetite, such as a loss of appetite or feeling full sooner
- Pressure in the pelvis or lower back
- A more frequent or urgent need to urinate and/or constipation
- Changes in bowel movements
- Increased abdominal girth
- Tiredness or low energy
- Changes in menstruation
Because these signs and symptoms of ovarian cancer have been described as vague or silent and may be symptoms of other conditions, only approximately 19 percent of ovarian cancer is diagnosed in the early stage.
I am so sorry to hear about your sister’s diagnosis, Sara. However, I am glad to hear that she is cared for by a specialized team that can offer her the most advanced treatment available. I have asked Dr. Melissa Frey, a gynecologic cancer surgeon, an assistant professor of obstetrics and gynecology at Weill Cornell Medical College and a member of our Medical Advisory Board, to discuss ovarian cancer with our readers.
Dr. Pat
