Most women try to take care of our bodies. We make healthy food choices; we exercise. We get our mammograms and our annual female exams. So let’s consider the following scenario—one that occurs far too often.

“Mary” had a normal GYN exam six months ago; her pap test was normal. But lately, she is experiencing some vague, fleeting symptoms that “something isn’t right.” She is more tired than usual, she feels full quickly, she is bloated and her clothes don’t fit around the abdomen. Perhaps she begins to have bladder problems or bowel issues. These complaints begin quietly and intermittently, but gradually over two to four weeks, they occur more often and become more pronounced.

We women are strong, active and busy; we don’t complain; we don’t have time; we put our symptoms off. We say to ourselves, “I am just aging; I haven’t been watching my eating habits; I am under more stress, perhaps I just have a bladder infection.” When we finally make that appointment with our provider, we find out that there is no bladder infection, or we are referred to a gastroenterologist for digestive problems. One does not think of revisiting our gynecologist, as none of these symptoms appear to be “female” problems. Of course, there are many diagnoses to consider related to these symptoms, and one of them may be ovarian cancer.

Ovarian cancer is the most lethal gynecologic cancer, and one of the five leading causes of cancer deaths among women in the U.S. Approximately 22,000 women are diagnosed with ovarian cancer each year, and about 15,000 women die, according to the American Cancer Society.

Because there is no reliable screening for ovarian cancer (a pap test does not detect it), 80 percent of women are diagnosed with an advanced form of the disease. Every woman is at risk at any age, but risk increases with age (median age at diagnosis is 64), no pregnancies and a personal or family history of breast, colon, uterine or ovarian cancer.

About 10 percent of the population carries the BRCA gene mutations, which puts them at a 70 percent risk of breast and ovarian cancer. So for the other 90 percent, there seems to be no direct reason for having ovarian cancer, unlike smoking/lung cancer or sun exposure/skin cancer links. That is why ovarian cancer has been called the “silent” disease. It may masquerade as a gastric or bladder problem; sometimes there are no symptoms at all. Too often we don’t realize that the cancer has spread throughout the abdomen.

Most likely, our various symptoms are not going to be due to ovarian cancer. About 22,000 women are diagnosed with ovarian cancer annually, compared to more than 200,000 breast cancer diagnoses. But for those women with late-stage ovarian cancer, the five-year survival rate is only 30 percent. With such subtle symptoms, the longer we are not diagnosed or misdiagnosed, the less chance we have of achieving a good outcome.

Initial diagnosis begins with a rectal-vaginal exam, a vaginal ultrasound and a CA 125 blood test. Depending on the results, a CT scan will help to confirm the diagnosis. A consult to a GYN oncologist is the next step, and surgery should only be peformed by a GYN oncologist surgeon.

We can help ourselves by listening to our bodies, learning the signs and symptoms of ovarian cancer and knowing our family history. If we have worrisome symptoms, we can ask our health care provider, “Tell me why I don’t have ovarian cancer.”

Margaret Hoeft is a retired family nurse practitioner, an eight-year ovarian cancer survivor and co-chair of the National Ovarian Cancer Coalition, Tucson chapter. For more information, email [email protected].