Individualizing Treatment in Ovarian Cancer - Episode 1
Angeles Alvarez Secord, MD: Michelle, I’m so happy to be here with you today. As an ovarian cancer survivor, I think you have so much to share on your experience. This can help other women. Discuss how you presented with ovarian cancer. What were some of the symptoms or signs that you had? If you could share that with people, I think that could be really important so that they can learn how to identify these important symptoms.
Michelle Berke: Absolutely. Thanks for having me here today. I’m glad to be here. I was first diagnosed on October 13, 2014. At the time, I was working for a catering company. I was doing a big event one morning. I don’t know if you’ve ever seen the coffee urns, but they can weigh up to 25 pounds. I was lifting a coffee urn and I injured myself. I ended up going to the emergency room. Twelve hours later, I found out I had a ventral hernia and ovarian cancer. I was completely shocked. I did have signs and symptoms of ovarian cancer. I thought I had IBS [irritable bowel syndrome]. I was told I had IBS. For the better part of 2014, I spent it not feeling quite up to par.
The symptoms that I had matched the symptoms of IBS. I had bloating, diarrhea, feelings of fullness. I just wasn’t really feeling well for a better part of the year.
Angeles Alvarez Secord, MD: So, we’re talking about 10 months where you had these gastrointestinal symptoms?
Michelle Berke: At least. It probably was even more than 10 months. It was probably a year and a half, at least.
Angeles Alvarez Secord, MD: I remember you telling me that as well when I first met you. Actually, I don’t think it was the first meeting where you relayed that information. It was maybe the second meeting when you said, “You know, I’ve been feeling badly for a while.” And you did seek care, but you also didn’t push things further because you had so much else going on in your life, family, and work, and trying to put all that first.
Michelle Berke: I did. You’re so busy working and living your life. I was working 60 hours a week and was taking care of my mom. She was sick.
Angeles Alvarez Secord, MD: Your story is so common. A lot of women have those same types of symptoms as you did. I would urge anybody out there that has 2 to 3 weeks of persistent daily issues of abdominal bloating, swelling, nausea, vomiting, or a change in their stool habits that just doesn’t seem right.
Michelle Berke: That was all me.
Angeles Alvarez Secord, MD: And also, feeling that they have to go to the bathroom all the time. So, increased urinary frequency, pelvic pressure, or pelvic pain. If you have those symptoms occurring daily, for 2 to 3 weeks, make that appointment with your doctor. Something else that you said that really resonates with me is that you’re putting everything else first.
Michelle Berke: And not myself.
Angeles Alvarez Secord, MD: Women do that all the time. You really have to be a strong advocate for yourself and see the right doctor. You went to the emergency department. They referred you to us. I think I saw you pretty quickly?
Michelle Berke: It was 2 days later. I was diagnosed on October 13. I saw you on October 17. Then, on the following Tuesday, on the 21, I was having my first of 3 surgeries with you.
Angeles Alvarez Secord, MD: Right. I think sometimes people don’t get into the doctor soon enough. Or, they might go to somebody who doesn’t even know what a gynecologic oncologist is.
Michelle Berke: I didn’t.
Angeles Alvarez Secord, MD: Right.
Michelle Berke: Until I met you, I had no idea. In fact, I went to my family doctor. I had an ultrasound done because I did have these symptoms. So, I went to see him. As I was walking out the door, he said, “You know what? Let’s just double check on this. Let’s get an ultrasound.” So, when I was diagnosed by the emergency room doctor, I literally had my family doctor calling me back just 2 days later saying, “I think you have ovarian cancer.” It all just came on so quickly.
Angeles Alvarez Secord, MD: I think that’s also a really important point to make: how you got the diagnosis. An ultrasound can sometimes lead to the diagnosis, but if you’re having all of these symptoms and your ultrasound is negative, you may have to push for something further, like a CT scan.
I had a patient in whom an ultrasound didn’t show anything. Sometimes, the ovaries can still be very small. People can have something called peritoneal cancer, which acts the same way. The ovaries will be small but they’ll have this small volume cancer all over the peritoneal cavity. The peritoneum is that lining of the abdomen, inside.
So, the other thing is, go see a doctor and make sure you’re getting the right tests. The CA-125 blood test can be helpful. If that’s elevated, and you have something on ultrasound, and you’re of certain age, then the likelihood of you having ovarian cancer is increased. And we’re talking a lot about ovarian cancer but, you know, there’s not just ovarian cancer. There’s tubal cancer that occurs in the fallopian tubes.
Michelle Berke: The CA-125 test can actually do that also?
Angeles Alvarez Secord, MD: CA-125 is a good marker for both. It’s a very nonspecific marker. If you have an elevated level of CA-125, it doesn’t necessarily mean ovarian cancer. It could be other things. If you have pneumonia, or any inflammation, or any ‘-itis’—pneumonitis, hepatitis—those types of things can also cause an elevated level of CA-125. Fibroids can cause an elevated level of CA-125. Congestive heart failure…
Michelle Berke: There’s a lot.
Angeles Alvarez Secord, MD: You have to be careful about how you evaluate it. But your story and how you presented with it, and those signs and symptoms, combined with the abnormal ultrasound, definitely would have triggered the next step in evaluation.
Transcript Edited for Clarity