Bloating throughout the day, especially requiring a larger waist size on your pants
Pelvic or abdominal pain
Difficulty eating, feeling full quickly or weight loss
Urinary symptoms (urgency or frequency)
Frequent pain with intercourse
If I decide to get tested for ovarian cancer, what’s going to happen?
It’s important to remember that we want to rule out the zebras—or more unusual diagnoses—in the hopes of finding what we call horses, or more common ailments. Here’s what you can expect.
Pelvic exam: Your doctor will feel your cervix, uterus and ovaries. She may do a Pap smear, which evaluates for cervical and uterine cancers or changes in their cells, but not for ovarian cancer.
Pelvic ultrasound: This will take a “picture” of your ovaries and analyze what might account for that full, bloated feeling. It does not involve any radiation, just sound waves. Usually part of the test involves putting an ultrasound probe in the vagina, which may show the ovaries better. If there are growths, the ultrasound can’t always determine if these growths are likely to be cancer.
CT scan: This test uses X-rays to examine part of the body. It allows smaller problems to be detected. It visualizes the ovaries and uterus, as well as the bowel, lymph nodes and the spaces around them. A CT scan for ovarian cancer often includes an examination of the abdomen, as well as the pelvis. In that case, oral contrast is given to you to drink so that the bowel will stand out from the surrounding area. When the abdomen is examined, the liver, kidneys, spleen and pancreas are also seen. Often the radiologist doing the test will want to better visualize the blood vessels. This is done by an injection of dye into your arm. The dye contains iodine. So if you are allergic to iodine-containing substances, be sure and tell the doctor, as you will likely be allergic to the dye. Also, if you have any problems with kidney function, be sure to tell the doctor, as he or she might not want to do this part of the test.
MRI scan: This scan uses a magnetic field instead of X-rays to view the internal organs. It sees soft tissues very well. The best test is done with an enclosed scanner, where you’ll hear a lot of banging. (If you’re claustrophobic, speak up.) An injection of gadolinium (an element used as a contrast agent in MRI scans) is often done to see the blood vessels. Your kidney function should be confirmed as normal before you are given gadolinium, particularly if you have any problems that could affect the kidneys, like high blood pressure, diabetes mellitus, lupus, dehydration or kidney diseases.
Blood tests: A blood count (CBC) looking for anemia and liver function tests are commonly done. In fact, there is a blood test (CA-125) that had been touted to diagnose ovarian cancer. Unfortunately it is not a good screening test and has not been recommended as a routine screen in most people. CA-125 can be falsely high in someone who does not have ovarian cancer and falsely low in someone who does have ovarian cancer. On the other hand, CA-125 is often used to detect early recurrence of cancer in someone who had a high CA-125 with the original cancer and has had her ovarian cancer treated.
Laparoscopy: This is an even more precise test, in which a thin viewing tube (called a laparoscope) is placed through a small cut made in the abdomen. Using the scope as a guide, the surgeon takes a sample of fluid and tissue from the growth. These samples are then tested for cancer.
Every month around my period, I get bloated, I cramp and I have horrible diarrhea. I don’t mean to be a big baby, but how can I deal with it without letting it ruin my life?
Well, first remember that you’re not alone: about 85 percent of women suffer from some form of PMS each month, whether or not they have endometriosis. PMS, as defined by the American Congress of Obstetricians and Gynecologists, is “the cyclic occurrence of symptoms that are sufficiently severe to interfere with some aspects of life, and that appear with consistent and predictable relationship to the menses [menstrual period].” Only about 3 to 8 percent of women have severe symptoms. PMS symptoms may include upset stomach, bloating, constipation or diarrhea, appetite changes, mood disturbances, joint pain, headache and acne.
Changes in bowel habits during menstruation are reported by many women (34 percent in one study), and the symptoms are cyclical in almost 30 percent of women. At the time of menses, gastrointestinal complaints that women report are increased gas (14 percent), increased diarrhea (19 percent), and increased (11 percent) and decreased (16 percent) constipation.
One big tip—get enough calcium! A calcium supplement with vitamin D helps ease some symptoms of PMS. If you’re between the ages of eighteen and fifty, you need at least 1000 mg of calcium per day. If you’re older than fifty, you need 1200 mg. Eat plenty of fruits and vegetables, and get enough whole grains. Avoid alcohol and caffeine. They’ll exacerbate your troubles.
For the bloating, try enteric-coated peppermint capsules before meals, although if they cause heartburn, you should stop. Loperamide (Imodium, one half to two tablets) could help treat or prevent the diarrhea, though too much can cause constipation. Pepto-Bismol is also worth a try—two tablespoons or tablets up to four times per day. Remember your stool and tongue may turn dark or even black after using it, but this is a harmless side effect.
I’m going to have a hysterectomy, and I’m worried that it might affect my bowels. I am already somewhat constipated. Will I get worse?
Probably not. Chronic constipation after a hysterectomy, unless it is an extensive operation for cancer, is not common. One study reported less frequent bowel movements, more laxative use, harder stools and constipation after hysterectomy, but this was not statistically more significant than in women who have not had hysterectomies. In more recent studies, no increase in constipation occurred in women without GI symptoms who underwent a hysterectomy. Furthermore no increase of IBS occurred after a hysterectomy in women without GI symptoms before surgery. Overall, movement of the stool through the colon does not change as a woman gets older, but the signal to let you know the stool is waiting to come out does decrease with age, unfortunately.
Can endometriosis come back?
Unfortunately, the likelihood that endometriosis will return is high. Five years after a patient has stopped medications to treat endometriosis, the recurrence rate is over 20 percent. Endometriosis and the pain associated with it can even recur after a successful ablation (cautery) or hysterectomy. The recurrence rate after surgery is higher when the ovaries (even one) are left or the endometriosis was severe, in which case it recurs in 30 to 47 percent of women. Of over eleven hundred women who had endometriosis diagnosed by surgery and who responded to a 1998 Endometriosis Association survey, 42 percent underwent surgical procedures for endometriosis at least three times.
You always have to be aware that recurrence is a potential problem. A cure of the endometriosis can only be assured if all estrogen, which can stimulate the endometriosis, has been removed. This occurs if a woman has both of her ovaries removed or goes through menopause. However, if one ovary is left behind after endometriosis surgery to prevent a woman from getting hot flashes or other symptoms related to menopause, the endometriosis can continue to be stimulated.
This problem often goes unrecognized. Women are told that they had a hysterectomy and that should “cure” the endometriosis. Not always! They don’t know that a hysterectomy can involve removing only the uterus or removing the uterus with one or both ovaries. If you switch to a new physician, it’s important for him or her to know right away what kind of hysterectomy was performed.
One such blunder happened with Susan, a forty-one-year-old woman who came to me with abdominal pain and