Recognizing the Subtle Symptoms of Ovarian Cancer
- At 67, Carla Peoples discovered the life-saving power of asking more questions. After noticing unusual weight loss in her limbs while her stomach continued to swell, she pushed for answers—only to learn she had two large ovarian masses. The diagnosis: stage 3 ovarian cancer.
- Genetic testing, which is a simple blood test, allows doctors to learn about your cancer risk and details about your tumor at the molecular level. It plays a key role in tailoring maintenance treatments, helping doctors choose the most effective option for each patient.
- Many different genetic changes, or mutations, are associated with ovarian cancer. Among the most common are the BRCA set of genes, BRCA 1 and 2. Homologous recombination deficiency (HRD) is a genetic factor that sometimes affects women with BRCA mutations.
- Carla wishes she had gotten a second opinion when she was misdiagnosed with a prolapsed bladder before learning she had cancer.
- Second opinions provide benefits such as ensuring diagnosis accuracy, revealing more effective treatments, and giving patients peace of mind in healthcare decisions.
- Some health insurance companies will cover the cost of a second opinion. Still, it’s a good idea to find out if yours does before you visit a new doctor, as some insurance companies have stipulations on the extent of coverage they will provide. Keep in mind that you don’t need to stop at a second opinion. Provided that you have the time and financial resources.
After surviving a harrowing battle with stage 3 ovarian cancer, 67-year-old Carla Peoples of Texas is speaking out with hopes her story will empower others to trust their instincts and push for answers when something feels off.
Peoples says her symptoms were subtle but alarming: she was losing weight in parts of her body, yet her stomach kept growing.
Read More- A feeling of bloating or fullness
- Pain in the pelvis or abdomen
- Nausea
- Vomiting
- Changes in bowel habits
Ovarian cancer often begins in the fallopian tubes, where rogue cells migrate to the ovaries and form tumors. This type of cancer has been called the “cancer that whispers” because women often don’t experience symptoms until their cancer has already reached its late stages. The symptoms that do appear at first are hard to identify as cancer.
“Ovarian cancer does not have any specific symptoms,” Dr. Beth Karlan, a gynecologic oncologist at UCLA Medical Center, told SurvivorNet.
Initially misdiagnosed with a prolapsed bladder, also called a cystocele. This occurs when “supportive tissues around the bladder and vaginal wall weaken and stretch, allowing the bladder and vaginal wall to fall into the vaginal canal,” the National Institute of Diabetes and Digestive and Kidney Diseases explains.
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“I [felt] like I’m 10 months pregnant. And I looked at it, too,” she said.
Peoples knew something wasn’t right. The discomfort escalated until she was rushed to the emergency room with severe pain. A CT scan revealed two large masses on her ovaries—one the size of a football, the other comparable to a small watermelon.
Doctors confirmed stage 3 ovarian cancer. Further testing revealed Peoples carries the BRCA gene mutation, which significantly increases the risk of breast and ovarian cancers.
Several genetic changes or mutations exist that are associated with ovarian cancer. The BRCA set of genes, BRCA 1 and 2, is among the most common.
The BRCA1 and BRCA2 gene mutations typically help regulate cell growth, but when mutated, they fail to control unchecked tissue expansion, increasing the risk of breast, ovarian, and other cancers.
WATCH: Understanding the BRCA Mutation
She underwent six rounds of chemotherapy, followed by targeted maintenance therapy to reduce the risk of recurrence. The experience was grueling—but it also galvanized her to speak out.
Peoples says her biggest regret is not asking more questions when she was first misdiagnosed.
“I wish I had pushed harder,” she said. “I hope by sharing my story, others pay closer attention to odd symptoms and don’t be afraid to get a second opinion from a doctor.”
The Value of a Second Opinion
- Getting a Second Opinion at the VA
- Getting a Second Opinion for Multiple Myeloma
- Getting a Second Opinion is a Smart Move After a CLL Diagnosis
- The Importance of Second Opinions for Ovarian Cancer Diagnosis and Treatment
- You Should Get a Second Opinion for Breast Cancer — There’s a Big Chance it Will Change Your Treatment
Why Self-Advocacy in Healthcare Can Be Life-Saving
When patients actively advocate for their health, it can lead to earlier diagnoses, broader treatment options, and ultimately better outcomes—especially when initial symptoms are overlooked or dismissed.
Part of this advocacy means not settling for a single medical opinion. Persistence matters: revisiting your doctor, pushing for answers, and seeking additional perspectives from other healthcare providers can be crucial steps in the journey.
WATCH: The value of getting a second opinion
Dr. Steven Rosenberg, Chief of Surgery at the National Cancer Institute, underscored this point in a conversation with SurvivorNet:
“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care. Because finding a doctor who is up to date with the latest information is important,” Dr. Rosenberg said.
His words are a powerful reminder that having the right medical team can make all the difference—and that begins with being your own strongest advocate.
Getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon who is recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.
Other reasons to get a second opinion include:
- To see a doctor who has more experience treating your type of cancer
- You have a rare type of cancer
- There are several ways to treat your cancer
- You feel like your doctor isn’t listening to you, or isn’t giving you sound advice
- You have trouble understanding your doctor
- You don’t like the treatment your doctor is recommending, or you’re worried about its possible side effects
- Your insurance company wants you to get another medical opinion
- Your cancer isn’t improving on your current treatment
WATCH: The Importance Of Getting A Second Opinion: Tara Lessard Shares Her Cancer Story.
Genetic Testing and Ovarian Cancer
Genetic testing—analyzing a patient’s DNA or biopsy tissue—can reveal critical insights about cancer: how it forms, how it behaves, and how best to treat it.
“There are certain cancer-causing genes that can be passed down from generation to generation,” explains Dr. Derrick Haslem, the director of medical oncology at Intermountain Healthcare in Salt Lake City.
As researchers uncover more about these inherited mutations, they’re not only pinpointing who might be most at risk—they’re also refining how cancers are detected and treated.
When it comes to ovarian cancer, this information is especially vital.
WATCH: What genetic testing reveals about your cancer?
“There are a lot of mutations that put people at a higher risk for ovarian cancer,” says Dr. Haslem. That’s why your medical team asks about your family history—because genetic red flags can run in families. “If you have a family history of ovarian cancer or breast cancer, that’s a really important thing to bring up with your healthcare provider.”
Mutations in the BRCA1 and BRCA2 genes are among the most common genetic links to ovarian cancer. Another factor, homologous recombination deficiency (HRD), can occur in women with BRCA mutations and further disrupts the cells’ ability to repair their DNA.
If you do have a strong family history, your doctor may recommend testing for BRCA mutations or other inherited syndromes like Lynch syndrome, which can also increase risk for ovarian, colorectal, and breast cancers.
Sometimes, testing positive for a high-risk mutation may lead to conversations about preventive steps. “If you were tested and you had that gene, then somebody might talk to you about prophylactic surgery to remove the ovaries and fallopian tubes,” says Dr. Haslem. This kind of preventive surgery can significantly reduce future cancer risk in those genetically predisposed.
Beyond risk assessment, genetic findings also guide treatment. “Certain chemotherapies and targeted therapies are much more effective in those types of cases,” Dr. Haslem adds. For example, PARP inhibitors—designed to block DNA repair in cancer cells—have shown strong results in patients with BRCA mutations and HRD.
Ultimately, genetic testing isn’t just about knowing your risk—it’s a tool that helps tailor treatment and potentially saves lives.
Ovarian Cancer Recurrence and Treatments to Help
Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal. With recurrence a strong possibility for this disease, especially in the later stages of ovarian cancer, certain drug treatments to deal with it are giving many women hope.
Ovarian cancer is sub-categorized into two groups.
- Platinum-Sensitive Ovarian Cancer: Your cancer does not return for more than six months after treatment with platinum-based chemotherapies, like carboplatin and cisplatin.
- Platinum-Resistant Ovarian Cancer: Your cancer returns within six months of treatment with platinum-based chemotherapies, like carboplatin and cisplatin.
“The mechanism that causes platinum resistance will cause someone to be resistant to other chemotherapies, as well. That’s why we’re looking for what we call targeted therapies – precision medicine,” Dr. Noelle Cloven from Texas Oncology-Fort Worth Cancer Center explained.
RELATED: Recurrent Ovarian Cancer Treatment: Is Your Disease “Platinum-Sensitive”?
Targeted therapies or precision medicine specifically target the proteins controlling cancer cells’ growth, division, and spread.
Maintenance Therapy for Ovarian Cancer
Maintenance therapy plays a critical role in helping ovarian cancer patients stay in remission after completing their initial treatment, which often includes surgery and chemotherapy.
“Maintenance therapy is continued treatment after the patient finishes their initial treatment,” explains Dr. Alpa Nick, a gynecologic oncologist with Tennessee Oncology in Nashville.
WATCH: PARP inhibitors are now options as part of ovarian cancer treatment for a growing number of women.
One common form of maintenance therapy is a daily oral medication known as a PARP inhibitor, which works by preventing cancer cells from repairing their DNA.
“The biggest question is: How do you choose between bevacizumab (brand name, Avastin) or a PARP inhibitor for maintenance therapy?” Dr. Nick says.
Both are effective options, but they take very different approaches. While PARP inhibitors target cancer cells’ internal repair systems, Avastin works externally by blocking new blood vessel growth, essentially starving tumors of the needed nourishment.
Genetic testing is key to determining which treatment is most effective. “When patients have their surgery, we can test their tumor to decide if their tumor has a homologous recombination deficiency (HRD),” says Dr. Nick. If HRD is present, patients are more likely to benefit from PARP inhibitors.
Some women may be candidates for a combination approach. The Food and Drug Administration (FDA) has approved Avastin in combination with olaparib (brand name Lynparza) for women with HRD-positive tumors who respond to platinum-based chemotherapy.
This pairing increased progression-free survival in clinical trials from 17 to 37 months. “A patient really has to make a decision upfront, or near the beginning of their treatment, that they want bevacizumab maintenance treatment because they’ll have it with their primary chemotherapy,” adds Dr. Nick.
American Society of Clinical Oncology (ASCO) guidelines now recommend that PARP inhibitors be offered to women newly diagnosed with stage III or IV ovarian cancer, regardless of their genetic status, if they’ve responded well to chemotherapy.
Meanwhile, another breakthrough therapy is offering new hope for patients with platinum-resistant ovarian cancer: Elahere (mirvetuximab). This targeted treatment is designed for women who test positive for high levels of folate receptor-alpha (FRα), a molecular marker found on some ovarian cancer cells.
“What that means is that the antibody part of the drug conjugate binds to the folate receptor on the tumor cells, and then that gets taken up into the tumor cell,” says Dr. Lyons.
“And then the drug that is conjugated with is the part that actually kills the tumor cells, by affecting the tumor cells’ ability to divide.” Often described as “biological missiles,” these antibody-drug conjugates are ushering in a new age of precision therapy.
Ovarian Cancer Recurrence
When cancer returns, it is referred to as recurrence. It often occurs because some cancer cells are left behind after treatment. Those cells grow over time and are eventually detected in follow-up scans received by patients in remission.
Ovarian cancer patients faced with a recurrence will likely need to restart chemotherapy or consider another surgical procedure.
WATCH: Ovarian cancer recurrence.
The type of treatment recommended for recurrence can depend on several factors:
- The period within which the cancer recurred
- The kind of chemotherapy the woman underwent in the past
- Side effects that came as a result of past treatments
- The length of time between the last treatment the woman underwent and the recurrence
- The specific mutations and molecular features of your cancer
If a woman’s time between remission and recurrence is more than six months, then the ovarian cancer is categorized as “platinum-sensitive” (that is, responsive to a platinum-based chemotherapy treatment), and that patient will be treated with chemotherapy and another platinum-based drug.
If the recurrence time happens less than six months into remission, the ovarian cancer is classified as “platinum-resistant.” At that point, women are usually treated with another type of chemotherapy and encouraged to enter into a clinical trial. Alternatively, women might be platinum-refractory, which refers to a disease that grows while the patient is on chemotherapy and has a particularly poor prognosis.
Determining the probability that a woman’s cancer will recur depends on the stage at which they were initially diagnosed. According to most data:
- Women with stage 1 ovarian cancer have a 10 percent chance of recurrence.
- Women in stage 2 have a 30 percent chance of recurrence.
- Women in stage 3 have a 70 to 90 percent chance of recurrence.
- Women in stage 4 have a 90 to 95 percent chance of recurrence.
WATCH: Clinical trials can be life-saving.
Clinical trials are an option for women facing ovarian cancer with a high probability of recurrence. If you fall into this category, ask your doctor about possible clinical trial eligibility. Clinical trials help doctors better understand cancer and discover more effective treatment methods. They also allow patients to try a treatment before it’s approved by the U.S. Food and Drug Administration (FDA), which can potentially be life-changing.
Questions for Your Doctor
If you have been diagnosed with ovarian cancer and need guidance to further educate yourself on the disease and treatment, consider these questions for your doctor.
- What type of ovarian cancer do I have?
- What stage is my cancer in?
- Do you recommend I get genetic testing for any gene mutations, such as the BRCA gene mutation?
- What initial treatment options do you recommend?
- What are the possible side effects of the recommended treatment, and how can they be coped with?
- Will insurance help cover my recommended treatment?
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