In the summer of 1972, my mother thought she had the flu. That September, she died of ovarian cancer.

By Marlene Nakamoto

We don’t know how long the cancer had been growing inside her. But once the doctors found it, it took her quickly and mercifully. She was 51 years old.

Why couldn’t they save her? Why did this happen to her? Why was the cancer found so late? My adolescent heart agonized over her fate, asking “Why? Why? Why?” like a 2-year-old child who wonders why the sky is blue.

I’ve had so many questions in the back of my mind for so many years. Will I get it? Can I prevent it? If not, can I detect it early enough to have it treated successfully? And the one that causes the most anxiety, “Will my daughter get it?”

Until quite recently – around 2004 – it was believed that ovarian cancer was asymptomatic until its later, most-deadly stages when it has spread beyond the ovary. Currently, however, studies have identified specific symptoms of the disease in its early stages, including:

• Pelvic or abdominal swelling, pressure, or pain.
• Feeling bloated or “full.”
• Gastrointestinal symptoms such as gas, indigestion, nausea, or changes in bowel movements.
• Fatigue or fever.
• Urinary urgency or frequency.

Granted, those symptoms could point to many other conditions or noncancerous diseases, but if the symptoms are unusual for you and they persist for more than a few weeks, the American Cancer Society (ACS) recommends that you contact your ob-gyn.

She’d gone to the doctor for her “flu.” I can still see her face as she told my father she had to have surgery to remove an “ovarian cyst.”

My ob-gyn, Thomas Kosasa, M.D., knows my family history. In his 35-year practice, Kosasa says he’s had only one ovarian cancer case. Some studies have shown an increased risk for ovarian cancer in women who have taken fertility drugs and had never become pregnant. Since Kosasa is an infertility specialist, his meager statistic is rather comforting.

She had a mild stroke the evening before going into the hospital. That morning, she tried to put on her slippers, but her right leg was unresponsive. My father picked her up and carried her to the car.

Pelvic exams are an important part of routine gynecological checkups -- a bimanual pelvic exam, in which the doctor inserts a finger into the vagina and another into the rectum, enables them to better feel the ovaries. But Kosasa says, “a transvaginal ultrasound can catch the cancer earlier.” An ultrasound can look within the pelvis the same way mammography can detect the tiniest speck of breast cancer. (A Pap test will detect cervical cancer only, and not ovarian.)

My mother didn’t have an ob-gyn.

We were in her room when nurses came to prep her for surgery, with huge syringes on a towel-lined tray. I started to cry, and my mom scolded me.

Other tests to help detect the cancer are available, but results can be inaccurate or inconclusive.

A test for CA-125, a blood protein, will show elevated levels in many women with ovarian cancer. Gynecologic oncologist Keith Terada, M.D., says the test isn’t a good screen because it also detects noncancerous diseases of the ovaries, resulting in “false positive” test results. “The test is more useful in monitoring effects of cancer treatment,” says Terada.

Expensive genetic testing may indicate a predisposition for the disease, but that doesn’t mean you’ll actually develop the disease.

Back in her room, after surgery, I was dismayed and confused to see that her swollen belly was the same size. Why hadn’t they removed the cysts?

With one first-degree relative with ovarian cancer, Terada puts me at 5 percent risk. “Higher than the general population,” he says, “but not extraordinarily high.”  For me, Terada recommends a combination of procedures annually: pelvic exam, transvaginal ultrasound, and CA-125 blood test.

My father told me she had cancer. Untouched by the surgery, the cancer seemingly became stronger and bolder. She couldn’t walk, couldn’t swallow, couldn’t eat. She was in intense pain. And the stroke, combined with painkillers, took her even farther away from us.

According to the ACS, ovarian cancer accounts for about 3 percent of all cancers in women. If ovarian cancer is found and treated before it spreads outside the ovary, 93 percent of the women survive at least five years. Less than 20 percent, however, are detected at an early stage. 

Then, all too quickly — at long last — she was gone.

Where I Stand

It appears that I’m in the middle of the road. My factors for increased and decreased risk of developing ovarian cancer are on par with each other; only time will tell if I get the luck of the draw. Even if I don’t, I’m confident that I’ll put up a good fight, because I’m armed with more information than my mother ever had. 

But for my daughter’s sake, I hope the family history ends right here with me.

Note: As with all screening and medical services, work with your doctor and check your health plan benefits.