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Ovarian Cancer Awareness Month

[00:00:00] All right, girls. Do you guys know that? It's September and it's ovarian Cancer awareness month, which I still find interesting. Like who comes up with these months? I don't know. I feel like every month should be every month for every awareness, everything, but it's also nice for us to kind of focus on a couple things each time. 

So I think it's actually in. Gynecological Cancer Awareness Month. But today we're gonna talk about ovarian cancer, which is a personal favorite of mine because it's something I really dislike because it's something I had four years ago, so I shouldn't say it jokingly. I don't know how many of you know who have been following me for a while that. 

Four years ago I was diagnosed with ovarian cancer. So this is a very apropo for me to be talking about it, not just as a gynecologist, but as the patient who had it. The misconceptions about ovarian cancer are pretty, um, robust and pretty across the board. Just everyone thinks these things that they shouldn't [00:01:00] think about it. 

One. Ovarian cancer is the silent killer. I'm gonna say why it's not two. You find out about ovarian cancer from your pap smear, right? I'm gonna say, why not three? Ovarian cancer is something that we can never find, so these are three misconceptions. Ovarian cancer, luckily is not very common. It's not as common, for example, as breast cancer. 

It's not as common as uterine cancer. That said, it is unfortunately typically found very late. Our ovaries are tucked, as we know, deep inside our pelvis, so they're really hard to reach. So there's no test that is gonna allow us to kind of scrape them or touch them or do anything where we're gonna be able to detect early enough that someone has ovarian cancer. 

That's the definition of a screening test. It's something that we can actually use to find out that someone has an early, early stage of a cancer before they actually have symptoms. We don't have that for ovarian cancer, [00:02:00] so let's debunk these myths. Can you do a pap smear or any screening test for ovarian cancer? 

The answer is no. There is no screening test because again, we can't reach the ovaries. It's not because scientists have not been trying, they're looking for blood tests, they're looking for markers in our blood, but there is no physical way to actually detect ovarian cancer as a screening test. Okay? That means that when you go for your pap smear and your doctor says, Hey, your pap smear is normal, that's great. 

That means that you didn't have any abnormal cervical cells. It has nothing to do with your. Okay. Two. What about, is it the silent killer? And I'm gonna tie two and one together, which is, and three in fact, about whether or not we can find it. The way we're gonna find ovarian cancer is if people are very proactive about thinking about their symptoms and telling us their symptoms. 

You might have heard me say terms like proactive, not paranoid, because I want people to actually think [00:03:00] about the symptoms, know their symptoms, not freak out, and yet contact their doctor so that they can have the. Diagnostic test, meaning you have a symptom and then there's a test. That's a diagnostic test, as opposed to asymptomatically walking into your doctor's office for a screening test that again, we do not have for ovarian cancer. 

The reason people use the term silent killer is because statistically speaking, 66% of ovarian cancers are found at stage three or. Which is more concerning. That does not mean that people do not survive with even stage three or four ovarian cancers nowadays, even more than before, because there are improved chemotherapies, improved immune therapies. 

If you carry one of the genes like the BRCA gene, your ability to have medication that can actually help you with ovarian cancer is better than it used to be. So it's. something that every single person will pass from, but obviously finding it earlier than stage three or four is [00:04:00] even better. Why do they call it the silent killer? 

Well, because unfortunately for women, The symptoms tend to be very persistent, very vague, and very common, but many people think it just sneaks upon them. So the term silent killer has been used, and I hate it because, a, it's not true. And B, it invokes a huge amount of fear and we know how much I hate fear. 

So I implore that all of us as women do not call it the silent killer if you need to use some term. How about subtle? Because the symptoms can be subtle. If you have bloating or pain or pressure that is in this area, meaning down in your pelvis, anywhere below your ribcage, let's say bloating, pain, pressure that lasts for more than two weeks, it's prudent to calmly say to. 

Hmm, something's going on. It's likely not anything terrible, but I'm gonna contact my doctor. And in the case of it being in the lower pelvis, meaning below your belly button, bloating pain, pressure for more than two weeks, please contact your [00:05:00] gynecologist. Not because internists are not brilliant, they are, but they're gonna think of so many things that sometimes the pelvic ultrasound. 

A mo, uh, gets missed and the only way we're gonna find ovarian cancer is through a pelvic ultrasound. So it might go something like this. Hi, I wanna talk to Shiva because I'm having some pain and bloating and pressure for more than two weeks. And then the secretaries are either gonna say, great, you can talk to her, or, I know what she's gonna say. 

Schedule an ultrasound. You'll schedule a pelvic ultrasound. We will look at the ovaries through the pelvic ultrasound. What is the likelihood of your pelvic pain, bloating, or pressure being ovarian cancer Pretty. Right, but our choices are either, let's just assume everyone with those symptoms doesn't have it, which we know how that goes. 

We're gonna miss it some of the time. Or anyone with bloating, pain, and pressure for more than two weeks in their pelvis should be evaluated. Does that lead to more ultrasounds than is necessary? It depends on what you mean by that question. Meaning does it mean there's, the majority of ultrasounds are going to [00:06:00] yield no ovarian cancer diagnosis? 

Yes. Does it mean that they're gonna. Some frustrating examples, which we see every single day of women who have what look like completely benign cysts that might not have even been the reason for their pain. That now beget another follow-up ultrasound, and that's frustrating and sometimes costly to the system or costly to the patient if insurance doesn't cover it. 

Yes, that's true, but that is the only opportunity we have to look for ovarian cancer. Should we use the CA 1 25 blood test to try to screen for ovarian cancer? No, because there can be a lot of false positives with things like fibroids, endometriosis issues with someone's liver. And there can be some false negatives. 

So it is not a sensitive screening exam. It is only to be used in people who have had ovarian cancer as a way to measure whether or not their cancer has come back. I get that test done every three months. I didn't use it as a screening test. I didn't even have it done before I had my surgery. . Is that all frustrating? 

Yes, it's [00:07:00] very frustrating. What are some other symptoms that can come along that might not be exactly bloating, pain, and pressure? Well, one for example is a patient who consistently thinks she's having urinary tract infections, and after one or two episodes of thinking it's a U t I. , but having a negative urine culture, but still having burning and pressure when she pees, that is a sign that she should probably go see her gynecologist, because occasionally it means there is something sitting on her bladder that's causing that discomfort. 

That is not a urinary tract infection. What if all of a sudden you're having a. Trouble with bowel movements where you feel like you have something pushing down on your rectum and you're unable to have a bowel movement. Well, then I would go get a pelvic ultrasound and I would see your gastroenterologist because we don't know. 

Is that something to do with your ovaries or your bowels? The likelihood is it's neither. But you have to check it out. In my particular case, I had several months of intense pain during my period, and I had had a history of endometriosis, so I very strongly suspected [00:08:00] that it was my endometriosis that had returned, because at the time I was 46, I was not on birth control pills. 

I was no longer pregnant, and that's often a time. Without anything suppressing ovulation, the pain can come back. I was right that when we did an ultrasound, it looked like an endometrioma, which is where you have endometriosis in your ovary, and my ultrasound tech said to me, I know that you would tell a patient to have an mri, so please go have an mri. 

So I did, even though in my mind I was fairly certain it was a benign endometrioma because the vast majority of endometriosis is benign as far as turning into anything cancerous like ovarian cancer. Nonetheless, I did the pelvic mri and lo and behold, I got a phone call saying it looks irregular. It doesn't look just like typical endometriosis. 

It might be something. Let's just consider it, and I was in so much pain at that point that I agreed to have surgery because I needed it. I went into surgery assuming it was benign, but [00:09:00] prepared to know that it could be ovarian cancer, and low and behold it was. So I went through six months of chemotherapy after my surgery, and now I'm fine because it was caught early at stage two. 

The ovarian cancer that comes from endometriosis tends to be found a little bit earlier because the symptoms are not subtle. I am a teaching point to you guys. Please, please, please bloating, pain, pressure if it happens for more than two weeks. Do not be paranoid. Paranoia leaves to nothing good. Never in the history of ever has freaking out or paranoia helped us. 

But be proactive. Call your doctor. Feel free to say, I watched this crazy girl on Instagram and she says, I need an ultrasound. Okay, will there potentially be false positives where you have a CS that your doctor then has to tell you to follow up on? And you might say things like, but don't you think it's benign? 

And the doctor's gonna say, yeah, I do, but we have to look again. And that's frustrating, but that's something that we have to take along with the ability to [00:10:00] catch this early. If we can find ovarian cancer at stage one or. We will have far more people with fewer surgeries and they will be surviving at far more rates. 

Okay, so proactive, not paranoid, bloating, pain, or pressure For more than two weeks, please get your ultrasound. I am a good example of many of us are gonna go through stuff, we're gonna go through some bad shit, and we're still gonna be okay in the end. Okay. One day I'll tell you the whole story of my whole surgery and everything else that happened so that you can really understand how much we can all be okay if things are found early, even when we go through surgeries, complications, things like that. 

Okay. Happy Ovarian Cancer Awareness Month and to all the others of you out there who have had it and are either still battling it or are past it. I am sending you my biggest love.