Ovarian cancer and the art of medicine
Ovarian cancer is the second most common gynecologic cancer in women, the second deadliest gynecological cancer in women, and the fifth leading cause of cancer death for all women.
Yet, there isn’t a screening test for it.
“We have pap smears and mammograms to screen for cervical and breast cancers, respectively, but we don’t have a screening test for ovarian cancer,” said Jennifer Allen, a certified nurse midwife at UCHealth Women’s Care Clinics in Steamboat Springs and Craig. “There seems to be a lag in general education about ovarian cancer. Most diagnoses occur when the cancer has progressed to later stages where we can’t help as much. We can do better than that.”
Below, Allen describes symptoms of ovarian cancer, the importance of listening to your body and how strong relationships with medical providers can help women detect cancer early.
Ovarian cancer used to be known as a “silent killer,” with many women not being diagnosed until the cancer has grown and spread to lymph nodes or other organs. That’s likely because symptoms of ovarian cancer are easy to ignore.
“It’s common for women to complain of abdominal bloating, indigestion or feeling full after eating, but it’s not often that they think there could be something medically related to those symptoms,” said Allen. “Instead, they blame the symptoms on a recent meal, needing to pass a bowel movement or even that their pants are too tight – which all could be possible, but the symptoms could also signal ovarian cancer.”
Listen to your body
Allen encourages women to share any concerning symptoms with their provider right away in the same way that women have learned to be open about lumps in their breasts.
“With some conditions, providers may take a ‘watchful waiting’ approach, waiting until health starts to decline for a diagnosis or disease to declare itself,” said Allen. “With ovarian cancer, once it declares itself, it can be lethal. It is so important for women to not only listen to their bodies, but share those findings with their provider.”
Constipation and pain are signals to seek help
As ovarian cancer symptoms progress, women may experience gastrointestinal issues, such as more constipation than diarrhea, and pain may become more present.
“Once you start to experience pain, it can be due to the cancerous mass getting so big that it’s starting to compress other parts of the body,” said Allen. “That tells you how big something has to get for it to be the thing that brings a woman in for an exam.”
Risk factors and screening methods
Screening for ovarian cancer is not indicated in low-risk, asymptomatic women. Women at higher risk may benefit from screening. They include women with a family history of ovarian, breast or colorectal cancer, those whose first full-term pregnancy was after age 35, those who never carried a pregnancy to term and those who take hormone therapy after menopause.
“Transvaginal ultrasound and a blood test to look for a certain tumor marker are the best tools we have to screen for ovarian cancer,” said Allen. “Pelvic exams can be done as well, but none of these are wholly sufficient, which is why we’re still missing the majority of these cancer diagnoses until they’re stage three or greater.”
Build a relationship with your provider
Because ovarian cancer is so hard to detect, Allen leans on the art of medicine.
“The most successful diagnoses can come from a good relationship between a patient and provider,” she said. “It comes from the patient believing herself and acknowledging what her body is experiencing and sharing that openly with her provider.”
Allen encourages patients to be transparent and truthful when answering questions during health histories and evaluations. This includes not only the physical aspects of their life, but the psychosocial aspects, too.
“Knowing our whole patient, rather than simply the physical patient in front of us, is an important part of health care,” said Allen.
If providers detect ovarian cancer, they will refer patients quickly to a gynecologic oncologist. As with all cancers, early detection leads to better outcomes.
“Our patients deserve to have access to and receive personalized health care,” said Allen. “When we’re able to develop trust and a relationship with our patients, their health is the beneficiary.
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