Understanding Ovarian Cancer
- Tennis star Chris Evert, who impressively won eighteen grand slam singles tournaments in her career and beat ovarian cancer twice, has admitted that becoming famous at a young age had a negative impact on her relationships and marriages. However, becoming a mom and battling cancer has changed offered her a new perspective on life.
- Ovarian cancer often goes undetected in its early stages due to vague symptoms like bloating, pelvic pain, and changes in bowel habits. Many cases begin in the fallopian tubes, with cancerous cells eventually spreading to the ovaries.
- After initial treatment, doctors may recommend maintenance therapy to delay recurrence and extend remission.
- Ovarian cancer has a high rate of recurrence: nearly 1 in 4 early-stage cases and over 80% of advanced cases, according to the Gland Surgery journal.
The mom of three, who impressively won eighteen grand slam singles tournaments in her career, was previously married to British former professional tennis player John Lloyd, former alpine ski racer Andy Mill, and Australian former professional golfer Greg Norman.
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Evert explained further, “I mean, I don’t think I’ve ever gotten a ticket in my life, because policemen have pulled me over many times and seen that I’m Chris Evert. And they go, ‘I’m such a big fan of yours, I’m gonna let you go.’
“I think when that happens years, and years, and years, and years, I think you become a little entitled and a little enabled … and I’m the first to admit that. I feel like that affected my relationships with people, and with my marriages. You pay a price.”
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Although Evert has remained single over recent years, prior to her admittal about her fame affected her relationships, she told People in 2019 that she’d be willing to date again.
However, she has learned that “all of the good ones are married.”
She added, “My work this year is especially strong and successful, but I would like to date again if that should happen.”
More recently, in an interview with Ralph Lauren, Evert shared what her beloved sport instilled in her.
She said, “Tennis taught me as a child to focus, because you really had to concentrate on every point. It has a lot of life’s lessons.
“I was 16 years old and I wore an all lace dress to the U.S. Open and became a big hit. I wasn’t aware at the time that it was becoming iconic and I wanted to put some femininity into sports.”
“Winning Wimbledon is ever tennis players highest dream. I loved winning Wimbledon because of the history. You would raise that plate over your head and you walk around the whole court,” Evert, who retired from the sport at 34 and shares her three children with her ex husband Andy Mill, continued.
“It’s the best high, I think an athlete can ever feel.”
Although being young took a toll on her relationships, Evert did also confess that being a mom was even more special than winning at Wimbledon. She also shared that her ovarian cancer diagnoses helped her “appreciate things more” and gain a new perspective on life.
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“You realize what’s important, which is family and which is health. Only you know how you feel. Something’s a little off … get it test right away. If you get anything early, you’re going to be successful.”
Chris Evert’s Cancer Journey
Evert first revealed she was diagnosed with stage 1 ovarian cancer in 2022. After undergoing treatment, she reached remission as no evidence of the disease was present during scans at the time. However, when dealing with ovarian cancer, there is a high chance of recurrence despite initial treatment.
Then, in December 2023, in a joint post with ESPN on X, Evert went public with her recurrence diagnosis.
“I wanted to give you all an update. My cancer is back,” she wrote in the post, explaining why she would not be a part of ESPN’s 2024 Australian Open coverage. “While this is a diagnosis I never wanted to hear, I once again feel fortunate that it was caught early.”
A message from @ChrissieEvert
Evert will not be part of ESPN’s 2024 @AustralianOpen coverage pic.twitter.com/LKGmKDBNGU
— ESPN PR (@ESPNPR) December 8, 2023
Most women, approximately 80 percent who are dealt with an ovarian cancer diagnosis, will respond positively to their first round of treatment and go into remission. However, of that 80 percent, a majority will likely experience a recurrence, meaning their cancer will come back.
“With ovarian cancer, the standard of care is a very, very effective chemotherapy,” gynecologic oncologist at Arizona Oncology Dr. Dana Chase told SurvivorNet in an earlier interview.
“Meaning we give you chemotherapy when you first have your diagnosis of ovarian cancer – 80% chance that you go into remission. So, 80%, I consider pretty good for cancer therapy,” Dr. Chase added.
Coping with Recurrence
Some experts say the number is even a little higher, around 85 percent.
“Unfortunately, for about 85 percent of patients, the disease will come back,” Dr. Kimberly Resnick, gynecologic oncologist at MetroHealth in Cleveland, previously told SurvivorNet.
“For the majority of ovarian cancer patients, their course with ovarian cancer is going to look like a wave, meaning there will be times when the disease rises and when it has to be treated. And then there will be times when they’re in the valley when they’re in remission.”
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 the 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.
Thankfully, in February 2025, Evert told We Are Tennis she was “cancer free.”
She explained, “Well, I’m cancer free, so I’m good. I have to get a CAT scan every three months to be proactive with it, because it came back a second time, and they want to be cautious.
“I just had my CAT scan, and everything was clear. So that’s all I can do. I feel like I’m living every three months… and then I get a CAT scan. But I’m doing fine and I’m getting stronger and stronger, so that’s good.”
Regarding how her experience as a professional athlete has shaped her journey, Evert said, “You need to have thick skin. You need a strong backbone, and you have to be able to handle the highs and lows — the tough losses as well as the good ones.
“I think that has helped me tremendously in this fight. I think it’s definitely the competition and being a professional athlete that has helped me [through cancer].
While the steps in treating ovarian cancer are tailored to fit everyone’s unique disease characteristics, most patients will undergo surgery at some point during the course of their treatment. The only difference is at what point during treatment does the surgery take place – before or after chemotherapy. Debulking surgery, which Evert underwent, is a procedure that aims to remove as much of the cancer as possible, with the goal of improving one’s overall outcome.
“Many women with newly diagnosed ovarian cancer will be offered a primary debulking surgery,” says Dr. Adam ElNaggar, gynecologic oncologist at the West Cancer Center in Memphis, Tennessee.
“That is the initial step towards treating the ovarian cancer.” Primary debulking surgery is when the surgery is given as the first treatment after an ovarian cancer diagnosis. The most common alternative is neoadjuvant chemotherapy, in which the first treatment is instead chemotherapy.
Debulking Surgery for Ovarian Cancer: What to Expect
Debulking surgery is performed by an GYN or surgical oncologist, who operates directly within the body to physically remove the cancer. According to Dr. ElNaggar, open surgery, versus a minimally invasive approach, usually involves making a vertical incision down the middle of the belly, “with the goal of removing all the disease that can be seen with the naked eye.”
The cancer is removed from anywhere that it’s visible in the abdomen. “That will of course include the uterus, the cervix, the fallopian tubes, the ovaries,” says Dr. ElNaggar. Other areas might also be affected, including the lymph nodes, the omentum (a “fatty apron” that hangs over the stomach), the spleen, and the gallbladder.
Surgery may also include a bowel resection if the cancer has spread to the small or large intestine. A bowel resection involves removing and then reconnecting part of the intestine, after which the patient may need to have an ostomy bag to collect waste until their bowel heals.
After the surgery is complete, patients are placed into one of three categories, depending on how much of the cancerous tissue was successfully removed.
The three categories are:
- Suboptimal cytoreductive surgery: Patient still has tumors larger than 1 centimeter in the abdomen
- Optimal surgery: Any disease that is left in the abdomen measures less than 1 centimeter
- No gross residual disease: No disease can be seen in the abdomen
Patients with optimal surgery or no residual disease tend to have a better prognosis following surgery than those who have more cancer left behind. However, even if the patient is categorized as “optimal” or “no gross residual disease,” this does not mean that the cancer is completely gone. “It takes about a million cancer cells to be the size of a tip of a pen,” says Dr. ElNaggar.
“So while I can’t see any cancer, we know that it’s there, and therefore the next step to curative therapy is to give chemotherapy after the surgery.”
Ovarian Cancer: What To Know
It’s important to understand that according to the American Cancer Society, it is rare in people younger than 40, as it usually occurs in people after menopause. Half of all ovarian cancers diagnosed are in people older then 63.
With ovarian cancer, chemotherapy is usually the first stage of treatment, but staging the cancer is a little more difficult until your doctor performs a surgery.
Gynecologic oncologists often recommend a staging procedure when they have evidence that the cancer may be early or limited, which has to do with the location of the tumor. Based on where the cancer is found, it will be assigned a stage.
“If it’s remained in the ovary where it was initially found or developed, then the cancer is Stage 1,” says Dr. Amanda Fader, vice chair of gynecologic surgical operations at Johns Hopkins University in Baltimore, told SurvivorNet.
How Do I Know The Stage of My Ovarian Cancer? Staging Surgery Determines Spread
“But if the cancer has started to spread to other organs or through the lymph nodes to other parts of the body, then it would be identified as Stage 2, 3, or 4,” Dr. Fader added.
The Stages of Ovarian Cancer
As Dr. Fader mentioned, the stages of ovarian cancer depend on if the cancer has spread elsewhere into the body, and how far.
- Stage 1: The cancer is confined to the ovaries or fallopian tubes
- Stage 2: The tumor involves one or both ovaries with extension to other pelvic tissues (or is a primary peritoneal cancer)
- Stage 3: The cancer has spread outside of the pelvic peritoneum including to the outside of the bowel, liver and spleen and/or it involves the lymph nodes
- Stage 4: There are distant metastases (outside of the pelvis and abdomen) or metastases to the inside of the spleen or liver
When doctors have evidence before the surgery, such as from imaging tests, that the tumor may be limited to the ovary, they will usually recommend a staging procedure. During that operation, doctors remove all or part of the ovary with the tumor and send it, while the patient is still asleep on the operating table, to a pathologist who will examine the tissue and identify the type of tumor so doctors can decide how best to treat it.
If the tumor is determined to be benign, the surgery can end. Otherwise, more extensive surgery is usually performed.
Prior to the surgery the patient and her doctor would have discussed the various possible findings, so that depending on the result of the ovarian biopsy, the surgeon knows what the patient’s wishes are and how to proceed. “We would have made these decisions ahead of time through our preoperative counseling,” explained Dr. Fader.
Understanding Symptoms of Ovarian Cancer
There is no screening test for ovarian cancer, but doctors say it is important for women to be aware of symptoms which can indicate something is wrong.
The signs of ovarian cancer can include:
- Feeling bloated or full
- Pain in the pelvis or abdomen
- Nausea
- Vomiting
- Changes in bowel habits
As we all know, many of these can be similar to symptoms many women experience monthly with their menstrual cycle.
“We don’t have a good screening method, but if you have symptoms, it’s very important that you go to your physician because there might be an opportunity that we can detect it when it’s still early stage,” Dr. Jose Alejandro Rauh-Hain, a gynecologic oncologist at MD Anderson Cancer Center, told SurvivorNet.
“It’s very important that patients are not afraid to ask questions to their physicians. Because the sooner we can diagnose the cancer, the better that prognosis.”
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Battling Cancer as a Parent
Opening up about cancer diagnosis with children can be really difficult task. You want to be honest with them and you want them to be prepared for what might happen, but at the same time you want to protect them, and be as gentle as possible.
John Duberstein, who lost his wife Nina to cancer, explains that he and his wife tried to take a progressive approach and be as open with their kids as possible. But as honest as they were, they ran into some issues with their kids understanding the disease. When Nina started to look healthier, for example, the kids assumed she was getting better, but that wasn’t the case.
Talking to Kids About Cancer: Be Open as Much as You Can
“It was a real eye-opening moment for two people who felt like they were dealing really head-on with this stuff, talking to the kids,” Duberstein told SurvivorNet in an earlier interview.
“So I think it’s important to be open with the kids as much as you can, as much as you feel like they can handle. But it’s also important to revisit it and not make assumptions. At the end of the night, what Nina had to tell them was, ‘I’m not ever going to get better. My cancer is not ever going to go away,’ it was hard for them to hear even though they’d already been prepared.”
Meanwhile, breast cancer survivor Gina de Givenchy previously spoke with SurvivorNet about going through cancer treatment as the mother of a 12-year-old girl.
“I felt it was important to mask it because I really wanted her to know that I was going to be OK. I didn’t want her to see me weak and sickly,” she said. “When it comes to your kids, I think you always want to sort of protect them.”
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The pressures of parenthood can be daunting during a cancer journey, but having little ones that depend on you can also provide another source of motivation to fight for your life.
Jovannie Lorenzo also knows this to be true. When she was diagnosed with colon cancer at 32, she felt an immense amount of fear because she was a single parent of her three kids. Going into her cancer battle, Lorenzo knew she would do everything in her power to be around to raise them.
“I knew that I had to do everything possible to be here for my children,” Lorenzo told SurvivorNet. “They are my saving grace. They are the reason I wake up every morning. They are the reason why I fight every single day and I make a choice to be positive, to be happy, and to move forward.”
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Obviously, not every parent feels comfortable sharing so much about their diagnosis with their children. Some survivors have even told us that they were afraid to tell their family members, but as for Duberstein, de Givenchy, and Lorenzo, honesty was the best policy.
Licensed clinical psychologist Dr. Marianna Strongin encourages people with sick parents “to talk about your feelings with your immediate family as well as your parents.” She’s previously talked about the importance of expressing your feelings in her advice column for SurvivorNet.
“Talking about difficult things does not cause more anxiety,” Dr. Strongin said. “It is NOT talking about the very thing that we are all afraid or worried about that causes our body to feel dysregulated (unable to manage emotional responses or keep them within an acceptable range of typical emotional reactions) and anxious.”
Specifically, with patients who may be scared to talk to their children about a diagnosis, Strongin said children can pick up on their emotions, so it may help to check in with yourself beforehand.
“Having these conversations may bring up deep emotions you may have stowed away. There is nothing wrong with showing our emotions to children as long as we can remain calm and give them a sense of safety,” Dr. Strongin said.
Contributing: SurvivorNet Staff
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