Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

My sister is 45 years old and never had children, by choice. She is a nurse who lives only 30 minutes away from me. We are very close.  I saw her at Christmas last year and she was fine: great appetite, energy, and so much fun.  She was a bit overweight and did like her nightly drinks but was otherwise healthy. She joined a gym and was working out several times a week. I saw her in February and she seemed tired. She said she was working too hard. She cancelled family dinner in March because she said she “had pulled a muscle in her abdomen from the exercise and didn’t feel well enough to drive over to dinner.” My husband and I were away for April. When I saw her the first of May, I knew something was wrong.  She had no appetite.  She had clearly lost weight but had some new weight around her abdomen. I’m no medical person but I started asking her questions about when she had seen a doctor last. She told me that she had everything under control. She said she had some kind of bowel trouble. Three weeks later she was too weak to go to work and I took her to the doctor myself.  The awful news is that she has stage IV ovarian cancer.  She is taking chemotherapy now and will have an operation after the cancer has decreased in size. I am so afraid for her, and frankly, I’m angry too.  How could a medical professional, who knows about the symptoms of ovarian cancer, ignore her symptoms for so long? I know that you cannot give me medical advice but could you give me some information about the symptoms of ovarian cancer?

Peggy

Dear Peggy,

I am sorry to hear about your sister. Medical professionals are not immune to denial of symptoms and the symptoms of ovarian cancer are often explained away just as your sister chose to do. Denial is a powerful antidote to fear and healthcare workers know all too well how lethal many cancers are and may chose to find plausible reasons for new and persistent symptoms that still allow them to carry on as if everything is generally fine.

Here are some facts:

1. Approximately 1.3 percent of women will be diagnosed with ovarian cancer at some point during their lifetime, based on 2012-2014 data.

2. In 2017, an estimated 22,240 women will be diagnosed with ovarian cancer, and 14,080 women will die of the disease. The high mortality associated with ovarian cancer is due largely to the inability to detect the disease early and the lack of effective therapeutics for women with recurrent disease.

3. In the United States, the overall ovarian cancer 5-year survival rate is 46.2%, resulting in more than 14,000 deaths annually, according to the National Cancer Institute Surveillance, Epidemiology, and End Results Program.

4. The poor prognosis associated with this malignancy is largely attributable to the fact that almost 75% of women have stage III or stage IV of the disease at the time of diagnosis.

Ovarian cancer is usually associated with vague, nonspecific symptoms as it progresses, which contributes to delayed diagnosis and increased mortality. Your sister’s story is a common one. Even though she was a nurse and was aware of the symptoms of ovarian cancer, she found explanations for her vague symptoms: fatigue, abdominal pain, loss of appetite, weight loss and increase in abdominal girth. Medical professionals are just as good at denial as other people. We just know more diagnoses to explain away symptoms that should be evaluated.

Up until recently, ovarian cancer was considered to be completely asymptomatic until it had spread throughout the abdomen. It was labeled as a “silent disease.”  Since 2000, studies have demonstrated that women with ovarian cancer may have symptoms for up to one year prior to diagnosis of the disease. The symptoms are often subtle. September’s Ovarian Cancer Awareness Month is a good time to review these symptoms as we know that many of them may be ignored by both women and their physicians.