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Unmasking a Silent Killer: Ovarian Cancer

By Lawrence Friedman

After spending 35 years as a community college counselor, Jo-Anne retired and was looking forward to traveling with her husband. Her plans were derailed when abdominal pains had her doubled over in agony.

For seven months, she saw multiple physicians in an attempt to treat pain, constipation, and bloating. They were treating her for suspected gastrointestinal problems with laxatives and dietary changes. The medications and prunes helped only mildly, but not long-term.

When symptoms did not improve, Jo-Anne requested an ultrasound to rule out an abdominal aortic aneurysm (when an area of the aorta bulges and risks rupturing), which runs in her family. The ultrasound found no aneurysm, but it did reveal findings suggestive of advanced-stage ovarian cancer. One of her ovaries was the size of a grapefruit, prompting additional imaging, which showed evidence that the cancer had metastasized to nearby lymph nodes and her liver.

Ovarian cancer has been termed “the silent killer” because its presenting symptoms are often mistaken for other benign conditions, particularly the ones that affect the gastrointestinal system, or simply changes in a woman’s body as she ages. Ovarian cancer does present symptoms, even in early stages. Persistent urinary urgency, pelvic pressure, pelvic pain, and early feelings of fullness when eating could all be indications of this cancer.

Jo-Anne’s symptoms are commonly seen in patients with ovarian cancer, but these are unfortunately considered nonspecific, so they are frequently ignored or attributed to other age-related problems like constipation, irritable bowel, or indigestion, resulting in delayed diagnosis.

Unfortunately, due to the lack of an effective screening strategy, ovarian cancer is often diagnosed at an advanced stage. Only 20 percent of ovarian cancers are found at an early stage. However, if found early, a woman has a 92 percent chance of a five-year survival.

Jo-Anne’s cancer was diagnosed at stage IV, which meant it had already advanced. She will undergo a minimum of three months of chemotherapy, at which time she will be re-evaluated for next steps, including surgery and additional chemotherapy.

Perhaps the most valuable thing a woman can do is be aware of changes to her body and talk to her physician about her personal risk for ovarian cancer.

Make sure you have annual examinations with your gynecologist. In addition, understand your family cancer history from both your maternal and paternal sides. Your physician may advise a more personalized screening plan, including genetic testing, if there is a strong family history of cancer.

Risk factors include:

  • Age (peaks in the eighth decade)
  • Women who have never had children
  • Women who have had breast cancer or have a family history of breast or ovarian cancer
  • Inherited genetic mutations in the BRCA1 or BRCA2 genes
  • Hereditary non-polyposis colon cancer (HNPCC) or Lynch Syndrome
  • Obesity: Excess body fat as measured by BMI (body mass index), including during the teen years
  • Hormone replacement therapy, also called hormone therapy (risk may be different for estrogen-only therapy and estrogen-progestin replacement therapy)


Lawrence Friedman, MD Associate Dean for Clinical Affairs, UC San Diego Health. For questions, comments or topic suggestions please contact: +1 619 471 0234 or


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