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More on ovarian cancer

[00:00:00] All righty. It is September. It's Gynecological Cancer Awareness Month. We're gonna talk today briefly about. My ovarian cancer journey and how I found it because I was incredibly lucky for so many reasons. Which sounds funny to say cuz it was still cancer, but you'll hear why. So ovarian cancer, let us repeat. 

There is no screening test for ovarian cancer. Zero, none, zilch. There is no screening test, no blood test, no ultrasound, no. Sphere. The pap smear is for your cervical cancer screening. There is a screening test for cervical cancer screening. Meaning screening means you walk in no symptoms and you have a test done that will pick up a disease at kind of the preclinical pre-invasive pre-phase where we can actually really alter the outcomes. 

When you have. Symptoms, pap smear, colonoscopy, mammogram screening, cholesterol. These are great examples of screening tests. [00:01:00] Why is there no screening tests for ovarian cancer? Don't they care about women? I mean, the answer might be no, but the answer is actually no. Because the ovaries are sneaky little things. 

They're tucked up in there in our pelvis. They're only about that big, typically, and so in order to find them, you would physically have to have a huge ov. Even then a pelvic exam, meaning when your doctor puts her fingers into your vagina and pushes on your pelvis, that portion of the pelvic exam called the bimanual exam is really found to be a very, not sensitive, I don't mean insensitive. 

Rude, but not sensitive. Meaning not. Able to pick up a disease very easily because your ovary or whatever mass you have would have to be very large for her to feel it, even if you're pretty thin. But studies show that when your BMI is over a certain amount, which most of ours is, I, mine certainly was when I had my ovarian cancer. 

Very, very, very low likelihood that it will be picked up only on the bimanual portion of a pelvic exam, which means when you walk into your doctor's office and you've had your annual exam, it's not [00:02:00] your fault. You unwittingly think, huh, clean Bill of health, I'm fine. And the answer is no. Unfortunately, the screening test that we can do, which is if you're under 35 or 40, a breast exam where your doctor didn't feel anything, but you should still be doing your own breast exams monthly. 

Just to be sure that nothing changes. Yes, there is controversy. Some people would say that a self breast evaluation or breast self-exam or self breast awareness or breast self-awareness, all those different words we use does not matter. I would personally say it does. The data does show that many people do find their own breast cancers. 

Second, you've had a pap smears. You've been screened for cervical cancer. Is it possible you still have it? Yes, but it's very unlikely, and cervical cancer is very slow growing. So if you follow your doctor's guidelines with regard to when you should have your pap smear done anywhere from. Five years, depending on age, risk factors, all those things, you'll likely find cervical cancer early. 

But those pesky ovaries are deep inside, which is why I have to keep saying things to my patients, like bloating or pain, or pressure for more than [00:03:00] two weeks, please call your doctor. Please call us. Please. You guys call your doctors. The real, um, the real vernacular they use is if you have bloating or pain, or pressure for more than 14 days of the month. 

So it doesn't necessarily have to be 14 days straight. Okay? Now, let's say you ate Chinese food and drank wine last night, and you're bloated today. Okay? Don't freak out. But if next week you're still blo. and you're saying, oh, it was the Chinese food, then don't freak out, but call your doctor because all the studies show that the majority of women will wait six to eight months before coming forward because those symptoms are frequent, they're common, they are vague, and we don't know that they are potentially assigned. 

Now, the most important point to know is that the. Majority of time that you have bloating or pain or pressure, even for more than two months. Two weeks, it's not gonna be ovarian cancer or pancreatic cancer or any cancer. It's gonna be some [00:04:00] GI change that is likely due to something you've been doing or eating. 

Or it could be urinary changes. There are very many benign reasons for you to have those symptoms. That said, if we do not have a low threshold to look and a high index of suspicion to look, then we will miss those few people that we can find at stage one and two. It's few. Right now. I want it to be a lot more. 

Two-thirds of women are found at stage three and four, stage three and four ovarian cancer. For anyone who has had it or knows anyone who has it. Even if you are able to extend your life for more than five years, it is a grueling life because it is typically repeated chemo, recurrent disease that you are chasing. 

So if we can find it earlier, if we can find it at stage one and two, we'll all do so much better. That means we need to look for screen. There are companies trying Aspire Women's Health. The one that I'm consulting for is trying to figure out if the blood test that they already have for earlier [00:05:00] diagnosis will work for actual screening. 

Notice I'm using the difference between diagnosis and screening. Um, and I'm sure there are other companies out there, but until then, Here's what you can do if you are a human with ovaries. If you have bloating or pain, or pressure for more than two weeks, you should calmly, proactively, without paranoia, without freaking out. 

When you guys say to me, should I freak out? I've been having pain for more than two weeks. No, never in the history of ever, I always say, has freaking out help. So don't freak out, but calmly call your doctor. What if you have a regular bleeding or spotting? Not often a sign of ovarian cancer, by the way, unless it's very late stage. 

Even though the interwebs will say that it is a sign and it can be. But again, that's a late finding. But if you have a regular bleeding, meaning heavier than usual, longer than usual, or bleeding in between periods, call your doctor. You need an. That's typically looking for other issues like a vaginal infection, and god forbid, cervical cancer, God forbid, uterine cancer. 

But again, anything irregular, calmly say to yourself, I'm gonna call my doctor. That crazy girl on the internet said, call my doctor. And if your [00:06:00] doctor doesn't say you should do an ultrasound. Ask about it. There are many reasons for doctors not to offer an ultrasound, and it's not because they're being lazy necessarily. 

Sometimes they might be, sometimes they might be hedging their bets that the likelihood is you're fine. And what they really should say is, we don't need an ultrasound yet. But if. If X, Y, Z doesn't happen, then we will order one because they don't say that. The assumption is that you're okay on your end, and their assumption is on their end that you'll call back if you're not okay. 

And that's just not always the case I've found. So I want you to be explicit to your doctor and say, I'd like an ultrasound. Now, why wouldn't a doctor order an ultrasound? It's just an ultrasound. It's not radiation. All true, but insurance will not cover it as a screening test, which means if you have a high deductible like me, 13,000. 

Your ultrasound will not be covered. It will be covered up until you hit your 13,000 deductible and then you pay, then they pay. But in other words, it'll lead into your deductible, which means you may pay anywhere from two to $600 depending on where you have it done. And that's very [00:07:00] real for you as a pro, as a patient and for us as providers. 

Cuz then we have to talk to you guys about it and that sucks. All that said, and yes, I am speaking a little bit from a degree of privilege. , you should get your tests done. Now, the good news is that companies like Medicaid are very willing to pay for pelvic ultrasounds because those patients do not have high deductibles. 

So please, please, please ask your doctor. Now, my story in a nugget, cuz we'll review it more later, is I had not bloating, but terrible pain and pressure and it was increasing over the course of actually a couple of weeks to months because mine was an unusual type of ovarian cancer that came from my endometriosis, rarely ovarian cancer. 

The endometriosis in the ovary that has transformed that is not. Don't go freaking out if you have endometriosis or have it in your ovary, but it is appropriate, especially if it's in your ovary, to have it surveilled to be sure that nothing becomes unusual. So I had a lot of pain. I initially chalked it up to my endometriosis, which made sense. 

I was 45 to [00:08:00] 46 years old, and then when it got worse, I astutely said to myself, because my partners are my doctor's book, God forbid I actually tell them anything. I said I should get an ultrasound. I had my ultrasound and my amazing sonographer in my office. Karen, you know who you are, said this looks like a four centimeter endometrioma, but you would tell your patients to have an MRI to follow up, to confirm it's nothing else, at which point I. 

I don't have time for an mri. I'm a doctor. I work a lot , but I did it so that I could put my money where my mouth is and say to you guys, look, I did it. I know it's annoying. I had to pay my deductible. Nobody gives us a discount as doctors. It's actually against the stark laws they call them. It's the rub. 

High deductible cuz we're a small business. No discounts because we're doctors. Go figure. But I did it and guess what? It was flagged as something more irregular than Justin Endometrioma. I fully admit that I did not actually believe the radiologist, despite the fact that he's amazing and very astute. 

But I thought, I'm in pain. I need to have this [00:09:00] removed though I do not think it's going to be cancer. . I pushed myself to go see my GYN oncology surgeon, who I adore now retire Dr. Iris Walheim, who trained me, not because I thought it was cancer, but because I didn't wanna burden my partners with a big surgery when they're B, they've been working and I might have scarred tissue. 

And it's a good thing that I did because as it turns out, my, what we hoped was a benign endometrial turned out to be ovarian cancer. So I got full staging. This is where Aspire women. The company that I am now consulting for really comes in that there's a beautiful test that they have, um, helped spearhead that has many different biomarkers, five to seven different biomarkers, which are chemicals, proteins that are in our bloodstream that can be checked. 

So nowadays, cuz this was five years ago when I got diagnosed, if I had my ovarian. My doctor could have sent me for the over one plus blood test and it would've said, you have a high risk of cancer, please go see a GYN oncologist. And that's important for you to know cuz a lot of [00:10:00] doctors haven't learned about it yet. 

I am trying to get the word out as much as I can with the company, but you can say to your doctor if you have an ovarian cys. That is going to go to surgery. Can you send me for this over one blood test? I've heard about it. You also coming out in October can do an oval watch blood test, which is just for when you have findings on your ultrasound that aren't even thought to be something concerning where you aren't going to the operating room. 

So again, we have lots of exciting things coming out, but in my case, Had I not seen the gynecology oncologist and only had my general OBGYN partners do it, who are wonderful, they would've found out during my surgery that it was cancer and we would've had to call in a specialist, or I would've had to wake up and have an interval surgery later, and that's not ideal. 

So first and foremost, bloating, pain, pressure. If it lasts more than two weeks, please call your doctor, ask for an ultrasound. Second of all, if you're going to the operating room, please ask your doctor if they know of the oval one plus blood. Aspire Women's Health, it's an excellent test. If they haven't heard about it, [00:11:00] you can always tell them to watch my videos. 

Third is this. I am here and I'm here because of early detection. Mine was stage two. Please do everything you can to tell anyone in your life who has ovaries, your mother's, your sisters, your best friends. Any person with ovaries spread the word that they need to be proactive about their health without being paranoid. 

Low index of. Hi. I mean low threshold, high index of suspicion to look for these things, or we will not find them at stage one and two, and then you won't get to sit here listening and talking five years later. Okay. I'm about to embark on a bear of an office day. Good luck to me. Good luck to you. I hope everyone does well.