December 6, 2023 • 22 mins
Hosted by comedian and 2x ovarian cancer survivor, Karen Mills, and featuring Dr. Gizelka David-West, Gynecologic Oncologist at Northwell Health and lead singer of the band N.E.D.
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Episode Transcript
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Speaker 1 (00:05):
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power, and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:28):
Hi everyone. My name is Karen Mills, and I've been a
nationally touring comedian forover 25 years, and am a
two-time ovarian cancersurvivor for the third and
final installment of ourovarian cancer 1 0 1 series.
I'm here with Dr. Gazelka DavidWest to discuss the very reason
Tina's Wish was founded. Theneed for an early detection
(00:50):
test for ovarian cancer,similar to Tina Brossman story.
My symptoms were unclear andattributed to other conditions.
The Tina's wish team sharedwith me that Tina was not angry
for having ovarian cancer, butrather angry that she didn't
have a fighting chance againstthis disease. For me, I , um,
(01:11):
I, I had one episode where Ihad some pretty intense pain,
but it lasted about 30 minutes.
And, you know, I don't knowanyone who hasn't, I had cramps
at one time or another, and soI just completely blew it off.
And then I had a , um, a , ascheduled , uh, physical coming
up, so that was like six weekslater. And I almost even forgot
(01:34):
to mention it because it waslike, as I said, it only
happened the one time. And ,um, the nurse practitioner was
examining me and when she gotto my abdomen , um, all the
blood Dr . Drained out of herface and she said, you have a
huge mass. And she immediatelysent me for a sonogram and a
ultrasound, which didn't tellus anything except , uh, that
(01:57):
it was huge. And they thoughtit might be attached to my
right ovary, but couldn't besure. And of course, everything
happens on a Friday. So , uh, Icouldn't get a CT scan
until the following week. And ,um, and then I met with the
oncologist to go over theresults. And , um, and I, it
(02:17):
turned out that, you know, Ithought it was one huge mass,
but my right ovary was the sizeof a cantaloupe and my left
ovary the size of a grapefruit,and it was just kind mushed
together, and that's why theythought it was one mass. And
just , um, doctor, just to beclear, mushed together, I think
is the , um, technical term,
Speaker 3 (02:40):
Right on .
Absolutely . I was gonna saythat myself. Nothing more
technical than that . .
Speaker 2 (02:50):
And so when I , uh, the oncologist went over my
radiology report and said thatmy , um, uh, ca 1 25, which
normal range is zero to 35, was11,000. And I , I was actually
very offended because , um, hewent on to tell me that the,
the radiology report said thatmy pancreas was unremarkable.
(03:13):
And I have been very pleasedwith my pancreas .
Speaker 4 (03:17):
So
Speaker 2 (03:17):
I didn't think that was fair..
Speaker 3 (03:21):
I know some of it .
I do laugh a lot with patients.
I'll tell 'em it's good to beboring. It's good to be
Speaker 4 (03:26):
Unremarkable
. Oh , but Karen ,
Speaker 3 (03:33):
You had also mentioned like the bloating
that you had that you kind ofchalked up to, like menopausal
stuff, right? Like that just,you didn't even clue into that
at all.
Speaker 2 (03:41):
Yeah , no, I was, I was tired, I was bloated and I,
it almost, it never felt like Icould completely empty my
bladder. And , uh, you know,and that describes every
menopausal woman I know. So Ithought that's all that is, is
menopause. And so that's why Ididn't go in earlier. And , um,
and that's why you have toreally, you know, be aware that
(04:03):
when something's not right withyour body, just be sure that
the doctor determines that it'smenopause and not you, because
, uh, you , you really need toadvocate for your own health
and be sure.
Speaker 3 (04:16):
Right? Absolutely.
Absolutely. And, and , um, youknow, as we mentioned in one of
our previous talks , um, evenif a doctor dismisses you
right? And oh , I didn't findanything, but you're still
having these symptoms, don'tstop, go to somebody else, get
another opinion, it's okay. Idon't take offense to second
opinions, third opinions, dowhat you need to do to get the
(04:39):
right answers and helpyourself.
Speaker 2 (04:42):
Well, and to be clear, there is no early
detection test for ovariancancer, correct?
Speaker 3 (04:47):
Correct. There is no early detection. Um, you know,
we talk about mammograms forearly detection of breast
cancer colonoscopies for earlydetection for colon cancer, pap
smears, early detection forcervix cancer, but none of them
, um, will test for or screenfor ovarian cancer. There is no
(05:09):
early detection.
Speaker 2 (05:11):
And so just going for an annual checkup is not
enough. Correct? Correct .
Speaker 3 (05:15):
Correct. It's not enough. It's helpful, you know,
course our conversation withsymptoms, but it's not enough
that papsmear that they do onyour annual te on your annual
GYN visit is not screening forovarian cancer.
Speaker 2 (05:28):
And we discussed earlier that , um, you should,
however, continue to get papsmears even after you go
through menopause.
Speaker 3 (05:36):
Correct? Correct.
And I will tell you, anotherkind of patient story that I've
seen many times over is the 60something , 70 something year
old woman , um, who comes inand says, you know what? I
haven't seen a gynecologistsince my last kid was born. And
they're in their , you know,they're 30 something years old.
(05:58):
And that's, that is the patientthat, you know, on ovarian
cancer, we find, you know,'cause they just hadn't gone
and symptoms came and went, orthey'd started developing
symptoms but didn't seek outcare with the gynecologist.
Maybe they were going to theirprimary care and the primary
care didn't pick up on, on thecues or the clues and , um,
(06:20):
then advanced ovarian cancer.
But so , um, after you're donewith having your babies still
go to your gynecologist aftermenopause still go to your
gynecologist, it's importantbecause the conversations come
up, family history discussionscome up, symptoms discussion
comes up, and , um, if you'retalking about it, if somebody
(06:41):
is paying attention to you,you'll have a test done earlier
than, than you would neednecessarily, and you may find
something and detect somethingearlier than later ,
Speaker 2 (06:53):
Later . And even though a pap smear does not
detect ovarian, it does, it candetect other , uh, gynecologic
cancers. Correct.
Speaker 3 (07:02):
Specifically cervix cancer. Okay . It's really ,
um, the only it's designed totest and screen for cervix
cancer. What
Speaker 2 (07:09):
Is the difference between cervical and ovarian?
Speaker 3 (07:12):
Sure. So great question. Again, this kind of
brings us back to anatomy. Iwish I had like a little
chalkboard to draw a picturefor people. Um, but um, so the
uterus and cervix are onestructure, right? So they are ,
um, um, they're connected andthen the fallopian tubes in the
ovaries are also connected tothe uterus and kind of they're
all part of this reproductive ,um, organs. And , um, cervix
(07:37):
cancer starts purely at thecervix at that level of the ,
um, the lower level of this ,um, anatomical structure, which
is connected to your vagina,whereas the ovaries are kind of
floating higher up in yourpelvis, deep in your pelvis. It
is , they're , they're awayfrom each other. They're not
immediately connected. And so ,um, they're very, they're
(07:57):
essentially different organs,if you will, just part of this
tract. Right. And so that's whythey're considered separate
entities and they're not linkedreally at all. Right. Your
ovaries are one part of theanatomy and the cervix is
another part.
Speaker 2 (08:13):
Uh , and I , uh, when I was diagnosed, I luckily
was an early stage and theyfirst said stage one, but then
later , um, they said upgraded,I call it downgraded to
stage two because they found aspot in my , um, fallopian
tube.
Speaker 3 (08:30):
Correct? Correct.
Yeah. So it's kind of, it , um,it left the ovary already and
kind of traveled to thesurfaces or the canal of the
fallopian tube. Right.
Speaker 2 (08:42):
And is that what happens with more advanced
stages? Is it, it just hastraveled further?
Speaker 3 (08:48):
Correct. And so what I, I described to my patients
is , um, ovarian cancer, again,can start in the fallopian tube
, um, or on the surface of theovaries. And then what happens
is these cancer cells kind ofspray their cells out into the
abdominal cavity like sand. Solike, I think of, think of like
(09:09):
a salad bowl with like , um,I'm thinking of your
intestines, like sausages andlike
Speaker 2 (09:16):
Speaker 3 (09:17):
Put sausage in their salad, but whatever. Think of a
bowl full of sausages and youthrow sand on them and like the
sand coats every surface ofeverything in that bowl, even
the lining of the bowl. Right.
They have this, are youpicturing this or am I giving
you visual ?
Speaker 2 (09:32):
Yes , I'm , oh yeah, I'm,
Speaker 3 (09:33):
So that's advanced stage ovarian cancer. It's
those little bits of sand thathas traveled all throughout
this abdominal cavity and hascoated surfaces and has creates
masses on those surfaces,creates fluid on those , um, in
that cavity. So a lot of timesmaybe there might not be this
big mass like you had, but thebelly is just full of fluid.
(09:57):
And so another story is apatient comes at , oh, it , my
, I started having to getbigger pants or my belts size
was, you know, getting biggerand bigger, but it was the
holidays, so I thought I wasjust eating too much. But
really it's their belly fillingup with fluid because these
cancer spots are coating thesurfaces of , um, the organs
(10:20):
and the tissue in thisabdominal cavity.
Speaker 2 (10:23):
Ah , well, you know, I, I played senior basketball,
I played college basketball andI was playing in a senior , um,
uh, over 50 tournament , uh,whoa . Yeah, right before I was
diagnosed. And , uh, I took acharge and I, you know, I think
about that sometimes. I mean,if, if tho if my, because my
(10:44):
ovaries have ruptured
Speaker 3 (10:47):
Yeah. You know, rupture of these masses is not
typical presentation, you know,it's really fascinating how the
organ can expand.
Speaker 2 (10:55):
Oh, that's good
Speaker 3 (10:56):
To know . And like just kind of compensate for
that expansion and get biggerand bigger without rupturing.
But yeah, I mean, I think ifyou had enough of a trauma
against the belly with such abig mass, then yeah, it could
kind of like a water filledballoon. Right.
Speaker 2 (11:10):
And, and that would that then spread the sand
further, right ? Yeah ,
Speaker 3 (11:15):
Sure. So the , the fluid in that mass has the
cancer cells and it absolutely.
That can then spread the , um,cells throughout.
Speaker 2 (11:24):
And the point you made with , um, the , like the
lady who hadn't had a pap smearsince she had her kids or
something. I mean, it is soimportant to establish , uh, a
doctor that you go to on aroutine basis and share your
family history and, and knowsyou and can help you through
(11:46):
things that seem strange or ,um, something that makes you
uneasy or that knows yourhistory. All that's very, very
important to maintain. Correct.
Speaker 3 (11:55):
Absolutely.
Absolutely. You know , um,there's some patients who keep
the same primary care doctorfor decades, right. Or the same
gynecologist, and sure. If youhave that luxury to have the
same person, great. Plugyourself in with, with
somebody, make sure you'reseeing somebody on a yearly
basis. And if you have a strongfamily history, it's even more
important, right. Um, todiscuss, you know, what your
(12:17):
options are. What kind ofsurveillance should you have,
if any? What kind of screeningoptions could there be, if any?
Right. I mean, it's , um, um,we're constantly doing more and
more research every day .
There's , um, new informationcoming out. And so you're not
gonna be , um, privy to that ifyou're not going to the
(12:39):
doctors. You're not going tospeak with the medical
professionals.
Speaker 2 (12:44):
And I don't want this to sound like I would put
down any doctor, but , um, butif you're with someone that is,
you know, you may experiencesay, but they are not as up on
, uh, new things in me , themedical field or new research.
I mean, it is important to, youknow, as you say, get second
(13:07):
opinions and that type ofthing. But, you know, I know
friends who have doctors thathave been practicing for 40, 50
years that are like, oh, it'sjust menopause, you know? Yeah
.
Speaker 3 (13:22):
Yep . Absolutely.
You gotta a hundred percent.
And look, there's no offense tobe taken anywhere if you're, if
you're sitting across from adoctor who is just not up to
speed with, you know, the timeswho's kind of stuck in the
certain time interval that justdoesn't seem, you know, up to
snuff, then run .
(13:45):
Another doctor .
Speaker 2 (13:48):
I didn't wanna sound too , uh, joking .
Speaker 3 (13:51):
No, I mean, it's, you know, I , it's , um, just
like in any profession, there'sexcellent, good, mediocre bad.
I mean, it's, it's the realitythat we all have to understand
and
Speaker 2 (14:04):
It's true. Um,
Speaker 3 (14:05):
Going word of mouth, knowing who your friends are
seeing who is highlyrecommended , um, doing your
own research, that's part ofadvocating for yourself, right?
Don't walk in blindly to , um,um, into your appointment. You
know, try to , um, get as muchas you can ahead of time. That
(14:27):
can potentially help , um, withthe, with the conversations
that you're gonna be having.
Speaker 2 (14:33):
Why do you think we don't have an early detection
test yet? Or are we getting anycloser?
Speaker 3 (14:38):
Yeah, so , um, in, you know, the years of my
training and my practice, it'sdefinitely been underway.
There's always research beingdone. It's, it's just a very
hard disease to, to target.
Just like I said, the ovariesare deep in your pelvis.
They're away from what we cansee and feel on those pelvic
(14:59):
exams or during a pap smear,right? And so more intricate
testing and designs have to be, um, developed to help us
really clinch an earlydetection test. And , uh, I
think that's big mission ofTina's wish, right? This is a
huge part of what they'redoing. Uh, they're focusing on
(15:20):
tackling this riddle andfiguring out, you know, how can
we do this? And there's a lotsof collaboration with , uh,
great , uh, cancer institutionsand researchers that are
looking at various , um,strategies and various tests,
right? I think , um, there arelots of funded research already
underway, and a couple of thetrials are , um, in clinical
(15:43):
study phase. What does thatmean? That means that it's
starting to be tested , um,outside of the laboratory. Um ,
patients, certain patientpopulations are being consented
and screened and counseled toundergo these tests, which is a
major , um, um, milestone inresearch when you can get
(16:06):
clinical , um, study phase. Andso there's hope, there's lots
of hope and progress beingmade. I think we're just
unfortunately not there yet
Speaker 2 (16:15):
Because 80% of , uh, of people diagnosed at an
advanced stage is a lotdifferent survival rate than ,
uh, compared to an early stage.
I was very fortunate that mine, uh, was called early, but ,
um mm-hmm . Butit , it's just so important.
Speaker 3 (16:32):
Absolutely.
Absolutely. Um, you know, fiveyear survival, as we mentioned
, um, for advanced stage isreally about 27%, but early
stage it's upwards of 90% andbeyond. So it's a big
difference. And so , um, cancersucks. Nobody wants it, but if
it can be found early,definitely impacts survival for
(16:55):
sure.
Speaker 2 (16:56):
And how is, how is it actually detected?
Speaker 3 (17:00):
Right? So , um, you know, the patient who has these
symptoms, they , um, gets aworkup , um, an imaging scan ,
um, a pelvic ultrasound or a CTscan or a PET CT scan will then
, um, give us the , um, theradiographic evidence that
there is high suspicion forcancer. So when you have
(17:23):
patients with presenting withadvanced stage who have that
fluid in the belly that Imentioned, or those sand like
particles, the radiologists canput needles in that fluid and
suck it out. And pathologistscan then see the cancer cells
floating there to make adiagnosis, or if they can
biopsy some of those particlesor sand implants, or if there's
(17:45):
things , um, that a needle cankind of get into to biopsy,
then the pathologist looks atthat tissue and proves the
diagnosis. Or like in yourcase, you went to surgery,
right? And they took these bigmasses out, and it was only
after your surgery. Did youknow for a fact it was ovarian
cancer, right?
Speaker 2 (18:05):
Uh , yeah . Yes, exactly. And, and they, they
said there's no reason tobiopsy because they're so
large, they've gotta come outregardless, so ,
Speaker 3 (18:13):
Correct, correct.
And , um, even if they would'vebiopsied such a big mass like
that, they may not have gottenthe whole picture. I, you know,
I've had cases where the bigmass was biopsy , but you
biopsy one corner of the mass,but then the other corner is
where the cancer is, you know,so, you know, so if it's the
masses the size of acantaloupe, just imagine a
(18:35):
cantal, a picture, a cantaloupein your head, you stick a
needle on the top of it. You'renot, that needle didn't
determine what's on the bottom.
Right,
Speaker 2 (18:43):
Exactly. And, and they said I had fibroid tumor
mixed in, so, yes ,
Speaker 3 (18:48):
Exactly. So if they had stuck a needle in any of
that, they could have picked upa piece of the fibroid and
said, oh, it's just fibroids.
Okay, you can wait another Xnumber of weeks before your
surgery. Right. And then youwouldn't have had early stage
ovary cancer. So , um, this isanother reason where biopsying
the ovaries for early detectionscreen is just not good enough.
We need something that's kindof at a cellular , um,
(19:11):
particulate level, somethingthat , um, picks up floating
cells or floating DNA , right?
Like something like maybe a paptest for the ovaries, something
that maybe , um, is , um, sospecific to the cell makeup of
ovaries or DNA of ovary cancerthat swabbing inside that
(19:33):
uterus , um, could maybe findsomething that's floating
around in that tract . You knowwhat I mean? It's , um, I'm
getting into the nitty grittyhere and I don't wanna lose
people, but , um, it's, this iskind of what the research is
exploring right now.
Speaker 2 (19:49):
And are you hopeful that we will have that? And
Speaker 3 (19:53):
I am, I am hopeful.
I mean, Tina's wishes reallybeen doing amazing things with
their partners that they'reworking with. Um, the research
studies that are ongoing rightnow, I'm absolutely hopeful
that we're, we can only getcloser. We can't get any
farther away from it. I mean,there's so much that's being
done and , um, so manyresources are going into it
now. Um, I think we definitelyare, are gonna get there.
Speaker 2 (20:18):
Well, that's certainly what we all pray for
and , um, continue to work for.
And we're so grateful to Tina'swish for all they're doing ,
uh, to make these hugecontributions to , um, to
gynecologic health. So , um,absolutely. Any other , uh,
closing comments? Um,
Speaker 3 (20:38):
Uh, let's see. I think we nailed it, Karen.
Speaker 2 (20:43):
I think we did too.
You know, the only , the , theone thing that has shocked me ,
um, was that, you know, I'm anationally touring comedian. I
travel all the time. So youwould think that at some point,
you know, I'm always goingthrough those X-ray machines.
Yeah . PSA agent , you pulledme aside.
Speaker 3 (21:05):
Basketball in your belly doing
Speaker 2 (21:06):
. Yeah. I
don't see a gun, but you're
packing a fruit stand lady, ,
Speaker 3 (21:12):
You're absolutely right that they need to be
educated too. Maybe they'll belistening to the podcast.
They'll, they'll, now they'llhave a more awareness, right.
And the next lady that walksthrough with that little , like
, cantaloupe in her belly,they'll say, Hey , you gotta go
to your gynecologist .
Speaker 2 (21:23):
Yeah, exactly. I think it should be like a , you
know, get a, get a double , uh,uh, screening. A as you go
through , uh, security. Itmakes sense to me . Exactly.
Speaker 3 (21:35):
Exactly. We need to put up a sign. We gotta , like
.
Speaker 2 (21:39):
Well , Dr. David West , uh, thank you so much
for being our subject matterexpert and an expert. You are.
Uh, we, I appreciate all youroverview on ovarian cancer and
, uh, and your time and allthat you do to improve women's
health. And a huge thank you toeveryone listening. We hope you
will continue to share theinformation you take from this
(22:01):
podcast with those around you.
And, you know, everyonedeserves to know early and know
hope, and this is our missionat Tina's Wish. Stay tuned for
more information on upcomingepisodes.
Speaker 1 (22:19):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power, and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:28):
Hi everyone. My name is Karen Mills, and I've been a
nationally touring comedian forover 25 years, and am a
two-time ovarian cancersurvivor for the third and
final installment of ourovarian cancer 1 0 1 series.
I'm here with Dr. Gazelka DavidWest to discuss the very reason
Tina's Wish was founded. Theneed for an early detection
(00:50):
test for ovarian cancer,similar to Tina Brossman story.
My symptoms were unclear andattributed to other conditions.
The Tina's wish team sharedwith me that Tina was not angry
for having ovarian cancer, butrather angry that she didn't
have a fighting chance againstthis disease. For me, I , um,
(01:11):
I, I had one episode where Ihad some pretty intense pain,
but it lasted about 30 minutes.
And, you know, I don't knowanyone who hasn't, I had cramps
at one time or another, and soI just completely blew it off.
And then I had a , um, a , ascheduled , uh, physical coming
up, so that was like six weekslater. And I almost even forgot
(01:34):
to mention it because it waslike, as I said, it only
happened the one time. And ,um, the nurse practitioner was
examining me and when she gotto my abdomen , um, all the
blood Dr . Drained out of herface and she said, you have a
huge mass. And she immediatelysent me for a sonogram and a
ultrasound, which didn't tellus anything except , uh, that
(01:57):
it was huge. And they thoughtit might be attached to my
right ovary, but couldn't besure. And of course, everything
happens on a Friday. So , uh, Icouldn't get
until the following week. And ,um, and then I met with the
oncologist to go over theresults. And , um, and I, it
(02:17):
turned out that, you know, Ithought it was one huge mass,
but my right ovary was the sizeof a cantaloupe and my left
ovary the size of a grapefruit,and it was just kind mushed
together, and that's why theythought it was one mass. And
just , um, doctor, just to beclear, mushed together, I think
is the , um, technical term,
Speaker 3 (02:40):
Right on .
Absolutely . I was gonna saythat myself. Nothing more
technical than that .
Speaker 2 (02:50):
And so when I , uh, the oncologist went over my
radiology report and said thatmy , um, uh, ca 1 25, which
normal range is zero to 35, was11,000. And I , I was actually
very offended because , um, hewent on to tell me that the,
the radiology report said thatmy pancreas was unremarkable.
(03:13):
And I have been very pleasedwith my pancreas
Speaker 4 (03:17):
So
Speaker 2 (03:17):
I didn't think that was fair.
Speaker 3 (03:21):
I know some of it .
I do laugh a lot with patients.
I'll tell 'em it's good to beboring. It's good to be
Speaker 4 (03:26):
Unremarkable
Speaker 3 (03:33):
You had also mentioned like the bloating
that you had that you kind ofchalked up to, like menopausal
stuff, right? Like that just,you didn't even clue into that
at all.
Speaker 2 (03:41):
Yeah , no, I was, I was tired, I was bloated and I,
it almost, it never felt like Icould completely empty my
bladder. And , uh, you know,and that describes every
menopausal woman I know. So Ithought that's all that is, is
menopause. And so that's why Ididn't go in earlier. And , um,
and that's why you have toreally, you know, be aware that
(04:03):
when something's not right withyour body, just be sure that
the doctor determines that it'smenopause and not you, because
, uh, you , you really need toadvocate for your own health
and be sure.
Speaker 3 (04:16):
Right? Absolutely.
Absolutely. And, and , um, youknow, as we mentioned in one of
our previous talks , um, evenif a doctor dismisses you
right? And oh , I didn't findanything, but you're still
having these symptoms, don'tstop, go to somebody else, get
another opinion, it's okay. Idon't take offense to second
opinions, third opinions, dowhat you need to do to get the
(04:39):
right answers and helpyourself.
Speaker 2 (04:42):
Well, and to be clear, there is no early
detection test for ovariancancer, correct?
Speaker 3 (04:47):
Correct. There is no early detection. Um, you know,
we talk about mammograms forearly detection of breast
cancer colonoscopies for earlydetection for colon cancer, pap
smears, early detection forcervix cancer, but none of them
, um, will test for or screenfor ovarian cancer. There is no
(05:09):
early detection.
Speaker 2 (05:11):
And so just going for an annual checkup is not
enough. Correct? Correct .
Speaker 3 (05:15):
Correct. It's not enough. It's helpful, you know,
course our conversation withsymptoms, but it's not enough
that papsmear that they do onyour annual te on your annual
GYN visit is not screening forovarian cancer.
Speaker 2 (05:28):
And we discussed earlier that , um, you should,
however, continue to get papsmears even after you go
through menopause.
Speaker 3 (05:36):
Correct? Correct.
And I will tell you, anotherkind of patient story that I've
seen many times over is the 60something , 70 something year
old woman , um, who comes inand says, you know what? I
haven't seen a gynecologistsince my last kid was born. And
they're in their , you know,they're 30 something years old.
(05:58):
And that's, that is the patientthat, you know, on ovarian
cancer, we find, you know,'cause they just hadn't gone
and symptoms came and went, orthey'd started developing
symptoms but didn't seek outcare with the gynecologist.
Maybe they were going to theirprimary care and the primary
care didn't pick up on, on thecues or the clues and , um,
(06:20):
then advanced ovarian cancer.
But so , um, after you're donewith having your babies still
go to your gynecologist aftermenopause still go to your
gynecologist, it's importantbecause the conversations come
up, family history discussionscome up, symptoms discussion
comes up, and , um, if you'retalking about it, if somebody
(06:41):
is paying attention to you,you'll have a test done earlier
than, than you would neednecessarily, and you may find
something and detect somethingearlier than later ,
Speaker 2 (06:53):
Later . And even though a pap smear does not
detect ovarian, it does, it candetect other , uh, gynecologic
cancers. Correct.
Speaker 3 (07:02):
Specifically cervix cancer. Okay . It's really ,
um, the only it's designed totest and screen for cervix
cancer. What
Speaker 2 (07:09):
Is the difference between cervical and ovarian?
Speaker 3 (07:12):
Sure. So great question. Again, this kind of
brings us back to anatomy. Iwish I had like a little
chalkboard to draw a picturefor people. Um, but um, so the
uterus and cervix are onestructure, right? So they are ,
um, um, they're connected andthen the fallopian tubes in the
ovaries are also connected tothe uterus and kind of they're
all part of this reproductive ,um, organs. And , um, cervix
(07:37):
cancer starts purely at thecervix at that level of the ,
um, the lower level of this ,um, anatomical structure, which
is connected to your vagina,whereas the ovaries are kind of
floating higher up in yourpelvis, deep in your pelvis. It
is , they're , they're awayfrom each other. They're not
immediately connected. And so ,um, they're very, they're
(07:57):
essentially different organs,if you will, just part of this
tract. Right. And so that's whythey're considered separate
entities and they're not linkedreally at all. Right. Your
ovaries are one part of theanatomy and the cervix is
another part.
Speaker 2 (08:13):
Uh , and I , uh, when I was diagnosed, I luckily
was an early stage and theyfirst said stage one, but then
later , um, they said upgraded,I call it downgraded
stage two because they found aspot in my , um, fallopian
tube.
Speaker 3 (08:30):
Correct? Correct.
Yeah. So it's kind of, it , um,it left the ovary already and
kind of traveled to thesurfaces or the canal of the
fallopian tube. Right.
Speaker 2 (08:42):
And is that what happens with more advanced
stages? Is it, it just hastraveled further?
Speaker 3 (08:48):
Correct. And so what I, I described to my patients
is , um, ovarian cancer, again,can start in the fallopian tube
, um, or on the surface of theovaries. And then what happens
is these cancer cells kind ofspray their cells out into the
abdominal cavity like sand. Solike, I think of, think of like
(09:09):
a salad bowl with like , um,I'm thinking of your
intestines, like sausages andlike
Speaker 2 (09:16):
Speaker 3 (09:17):
Put sausage in their salad, but whatever. Think of a
bowl full of sausages and youthrow sand on them and like the
sand coats every surface ofeverything in that bowl, even
the lining of the bowl. Right.
They have this, are youpicturing this or am I giving
you visual ?
Speaker 2 (09:32):
Yes , I'm , oh yeah, I'm,
Speaker 3 (09:33):
So that's advanced stage ovarian cancer. It's
those little bits of sand thathas traveled all throughout
this abdominal cavity and hascoated surfaces and has creates
masses on those surfaces,creates fluid on those , um, in
that cavity. So a lot of timesmaybe there might not be this
big mass like you had, but thebelly is just full of fluid.
(09:57):
And so another story is apatient comes at , oh, it , my
, I started having to getbigger pants or my belts size
was, you know, getting biggerand bigger, but it was the
holidays, so I thought I wasjust eating too much. But
really it's their belly fillingup with fluid because these
cancer spots are coating thesurfaces of , um, the organs
(10:20):
and the tissue in thisabdominal cavity.
Speaker 2 (10:23):
Ah , well, you know, I, I played senior basketball,
I played college basketball andI was playing in a senior , um,
uh, over 50 tournament , uh,whoa . Yeah, right before I was
diagnosed. And , uh, I took acharge and I, you know, I think
about that sometimes. I mean,if, if tho if my, because my
(10:44):
ovaries have ruptured
Speaker 3 (10:47):
Yeah. You know, rupture of these masses is not
typical presentation, you know,it's really fascinating how the
organ can expand.
Speaker 2 (10:55):
Oh, that's good
Speaker 3 (10:56):
To know . And like just kind of compensate for
that expansion and get biggerand bigger without rupturing.
But yeah, I mean, I think ifyou had enough of a trauma
against the belly with such abig mass, then yeah, it could
kind of like a water filledballoon. Right.
Speaker 2 (11:10):
And, and that would that then spread the sand
further, right ? Yeah ,
Speaker 3 (11:15):
Sure. So the , the fluid in that mass has the
cancer cells and it absolutely.
That can then spread the , um,cells throughout.
Speaker 2 (11:24):
And the point you made with , um, the , like the
lady who hadn't had a pap smearsince she had her kids or
something. I mean, it is soimportant to establish , uh, a
doctor that you go to on aroutine basis and share your
family history and, and knowsyou and can help you through
(11:46):
things that seem strange or ,um, something that makes you
uneasy or that knows yourhistory. All that's very, very
important to maintain. Correct.
Speaker 3 (11:55):
Absolutely.
Absolutely. You know , um,there's some patients who keep
the same primary care doctorfor decades, right. Or the same
gynecologist, and sure. If youhave that luxury to have the
same person, great. Plugyourself in with, with
somebody, make sure you'reseeing somebody on a yearly
basis. And if you have a strongfamily history, it's even more
important, right. Um, todiscuss, you know, what your
(12:17):
options are. What kind ofsurveillance should you have,
if any? What kind of screeningoptions could there be, if any?
Right. I mean, it's , um, um,we're constantly doing more and
more research every day .
There's , um, new informationcoming out. And so you're not
gonna be , um, privy to that ifyou're not going to the
(12:39):
doctors. You're not going tospeak with the medical
professionals.
Speaker 2 (12:44):
And I don't want this to sound like I would put
down any doctor, but , um, butif you're with someone that is,
you know, you may experiencesay, but they are not as up on
, uh, new things in me , themedical field or new research.
I mean, it is important to, youknow, as you say, get second
(13:07):
opinions and that type ofthing. But, you know, I know
friends who have doctors thathave been practicing for 40, 50
years that are like, oh, it'sjust menopause, you know? Yeah
.
Speaker 3 (13:22):
Yep . Absolutely.
You gotta a hundred percent.
And look, there's no offense tobe taken anywhere if you're, if
you're sitting across from adoctor who is just not up to
speed with, you know, the timeswho's kind of stuck in the
certain time interval that justdoesn't seem, you know, up to
snuff, then run
(13:45):
Another doctor .
Speaker 2 (13:48):
I didn't wanna sound too , uh, joking .
Speaker 3 (13:51):
No, I mean, it's, you know, I , it's , um, just
like in any profession, there'sexcellent, good, mediocre bad.
I mean, it's, it's the realitythat we all have to understand
and
Speaker 2 (14:04):
It's true. Um,
Speaker 3 (14:05):
Going word of mouth, knowing who your friends are
seeing who is highlyrecommended , um, doing your
own research, that's part ofadvocating for yourself, right?
Don't walk in blindly to , um,um, into your appointment. You
know, try to , um, get as muchas you can ahead of time. That
(14:27):
can potentially help , um, withthe, with the conversations
that you're gonna be having.
Speaker 2 (14:33):
Why do you think we don't have an early detection
test yet? Or are we getting anycloser?
Speaker 3 (14:38):
Yeah, so , um, in, you know, the years of my
training and my practice, it'sdefinitely been underway.
There's always research beingdone. It's, it's just a very
hard disease to, to target.
Just like I said, the ovariesare deep in your pelvis.
They're away from what we cansee and feel on those pelvic
(14:59):
exams or during a pap smear,right? And so more intricate
testing and designs have to be, um, developed to help us
really clinch an earlydetection test. And , uh, I
think that's big mission ofTina's wish, right? This is a
huge part of what they'redoing. Uh, they're focusing on
(15:20):
tackling this riddle andfiguring out, you know, how can
we do this? And there's a lotsof collaboration with , uh,
great , uh, cancer institutionsand researchers that are
looking at various , um,strategies and various tests,
right? I think , um, there arelots of funded research already
underway, and a couple of thetrials are , um, in clinical
(15:43):
study phase. What does thatmean? That means that it's
starting to be tested , um,outside of the laboratory. Um ,
patients, certain patientpopulations are being consented
and screened and counseled toundergo these tests, which is a
major , um, um, milestone inresearch when you can get
(16:06):
clinical , um, study phase. Andso there's hope, there's lots
of hope and progress beingmade. I think we're just
unfortunately not there yet
Speaker 2 (16:15):
Because 80% of , uh, of people diagnosed at an
advanced stage is a lotdifferent survival rate than ,
uh, compared to an early stage.
I was very fortunate that mine, uh, was called early, but ,
um mm-hmm
Speaker 3 (16:32):
Absolutely.
Absolutely. Um, you know, fiveyear survival, as we mentioned
, um, for advanced stage isreally about 27%, but early
stage it's upwards of 90% andbeyond. So it's a big
difference. And so , um, cancersucks. Nobody wants it, but if
it can be found early,definitely impacts survival for
(16:55):
sure.
Speaker 2 (16:56):
And how is, how is it actually detected?
Speaker 3 (17:00):
Right? So , um, you know, the patient who has these
symptoms, they , um, gets aworkup , um, an imaging scan ,
um, a pelvic ultrasound or a CTscan or a PET CT scan will then
, um, give us the , um, theradiographic evidence that
there is high suspicion forcancer. So when you have
(17:23):
patients with presenting withadvanced stage who have that
fluid in the belly that Imentioned, or those sand like
particles, the radiologists canput needles in that fluid and
suck it out. And pathologistscan then see the cancer cells
floating there to make adiagnosis, or if they can
biopsy some of those particlesor sand implants, or if there's
(17:45):
things , um, that a needle cankind of get into to biopsy,
then the pathologist looks atthat tissue and proves the
diagnosis. Or like in yourcase, you went to surgery,
right? And they took these bigmasses out, and it was only
after your surgery. Did youknow for a fact it was ovarian
cancer, right?
Speaker 2 (18:05):
Uh , yeah . Yes, exactly. And, and they, they
said there's no reason tobiopsy because they're so
large, they've gotta come outregardless, so ,
Speaker 3 (18:13):
Correct, correct.
And , um, even if they would'vebiopsied such a big mass like
that, they may not have gottenthe whole picture. I, you know,
I've had cases where the bigmass was biopsy , but you
biopsy one corner of the mass,but then the other corner is
where the cancer is, you know,so, you know, so if it's the
masses the size of acantaloupe, just imagine a
(18:35):
cantal, a picture, a cantaloupein your head, you stick a
needle on the top of it. You'renot, that needle didn't
determine what's on the bottom.
Right,
Speaker 2 (18:43):
Exactly. And, and they said I had fibroid tumor
mixed in, so, yes ,
Speaker 3 (18:48):
Exactly. So if they had stuck a needle in any of
that, they could have picked upa piece of the fibroid and
said, oh, it's just fibroids.
Okay, you can wait another Xnumber of weeks before your
surgery. Right. And then youwouldn't have had early stage
ovary cancer. So , um, this isanother reason where biopsying
the ovaries for early detectionscreen is just not good enough.
We need something that's kindof at a cellular , um,
(19:11):
particulate level, somethingthat , um, picks up floating
cells or floating DNA , right?
Like something like maybe a paptest for the ovaries, something
that maybe , um, is , um, sospecific to the cell makeup of
ovaries or DNA of ovary cancerthat swabbing inside that
(19:33):
uterus , um, could maybe findsomething that's floating
around in that tract . You knowwhat I mean? It's , um, I'm
getting into the nitty grittyhere and I don't wanna lose
people, but , um, it's, this iskind of what the research is
exploring right now.
Speaker 2 (19:49):
And are you hopeful that we will have that? And
Speaker 3 (19:53):
I am, I am hopeful.
I mean, Tina's wishes reallybeen doing amazing things with
their partners that they'reworking with. Um, the research
studies that are ongoing rightnow, I'm absolutely hopeful
that we're, we can only getcloser. We can't get any
farther away from it. I mean,there's so much that's being
done and , um, so manyresources are going into it
now. Um, I think we definitelyare, are gonna get there.
Speaker 2 (20:18):
Well, that's certainly what we all pray for
and , um, continue to work for.
And we're so grateful to Tina'swish for all they're doing ,
uh, to make these hugecontributions to , um, to
gynecologic health. So , um,absolutely. Any other , uh,
closing comments? Um,
Speaker 3 (20:38):
Uh, let's see. I think we nailed it, Karen.
Speaker 2 (20:43):
I think we did too.
You know, the only , the , theone thing that has shocked me ,
um, was that, you know, I'm anationally touring comedian. I
travel all the time. So youwould think that at some point,
you know, I'm always goingthrough those X-ray machines.
Yeah . PSA agent , you pulledme aside.
Speaker 3 (21:05):
Basketball in your belly doing
Speaker 2 (21:06):
packing a fruit stand lady,
Speaker 3 (21:12):
You're absolutely right that they need to be
educated too. Maybe they'll belistening to the podcast.
They'll, they'll, now they'llhave a more awareness, right.
And the next lady that walksthrough with that little , like
, cantaloupe in her belly,they'll say, Hey , you gotta go
to your gynecologist
Speaker 2 (21:23):
Yeah, exactly. I think it should be like a , you
know, get a, get a double , uh,uh, screening. A as you go
through , uh, security. Itmakes sense to me . Exactly.
Speaker 3 (21:35):
Exactly. We need to put up a sign. We gotta , like
Speaker 2 (21:39):
Well , Dr. David West , uh, thank you so much
for being our subject matterexpert and an expert. You are.
Uh, we, I appreciate all youroverview on ovarian cancer and
, uh, and your time and allthat you do to improve women's
health. And a huge thank you toeveryone listening. We hope you
will continue to share theinformation you take from this
(22:01):
podcast with those around you.
And, you know, everyonedeserves to know early and know
hope, and this is our missionat Tina's Wish. Stay tuned for
more information on upcomingepisodes.
Speaker 1 (22:19):
For more information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
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