Nicole’s early college career was similar to that of most students. She enjoyed her independence and the wide variety of courses her majors in biology and psychology required her to take. She worried about her grades and finding ways to balance her course work with her social life. She also tried to find time to lift weights in the school’s athletic center and to snowboard at a local ski hill. Some weekends, to take a break from school, she would ride the bus home to see her family. Managing to get schoolwork done, see friends and family, and still have time left to work out had been difficult, but possible, for Nicole during her first two years at school. That changed drastically in her third school year.
One morning in October of her junior year, Nicole began having episodes of severe abdominal cramping. The first time this happened, she was just beginning an experiment in her cell-biology laboratory course. Hunched over and sweating, she barely managed to make it through the two-hour respiration experiment she and her lab partner were performing. Over the next few days, the cramps intensified so much that she was unable to walk from her apartment to her classes without stopping several times to rest. Later that week, as she was preparing to leave for class, she had a cramp that was so severe that she had to lie down in the hallway of her apartment. When her roommate got home a few minutes later, she took Nicole to Student Health Services for an emergency visit.
The physician at Health Services first determined that Nicole’s appendix had not burst, and then made an appointment for Nicole to see a local gynecologist the next day. After hearing Nicole’s symptoms, Nicole’s gynecologist pressed on her abdomen and felt what he thought was a mass on her right ovary. He used a non-invasive procedure called ultrasound to try to get an image of her ovary. This procedure requires the use of high-frequency sound waves. These waves, which cannot be heard by humans, were aimed at the ovaries. The pattern of echoes they produced created a picture called a sonogram. Healthy tissues, fluid-filled cysts, and tumors all look different on a sonogram.
Nicole’s sonogram convinced her gynecologist that she had a large growth on her ovary. He told her that he suspected that this growth was a cyst, or fluid-filled sac. Her gynecologist told her that cysts often go away without treatment, but this one seemed to be quite large so it would need to be removed. After her appointment, Nicole went home and called her professors to let them know she would be missing classes for the next week because she would be having surgery.
Even though the idea of having an operation was scary for Nicole, she was relieved to know that the pain would stop; her gynecologist had also assured her that she had nothing to worry about, because cysts are not cancerous. A week after the abdominal cramps began; the cyst and her completely engulfed right ovary were surgically removed through an incision just below her navel. The cystic ovary was then sent to a scientist who specializes in determining whether tissues are cancerous or not. The scientist, called a pathologist, determined that Nicole’s doctor had been right—she found no sign of cancer.
After the operation, Nicole’s gynecologist assured her that the remaining ovary would compensate for the missing ovary by ovulating (producing an egg cell) every month. Her doctor also informed her that he would have to carefully monitor her remaining ovary to make sure that it did not become cystic, or even worse, cancerous. She could not afford to lose another ovary if she wanted to remain fertile and have children some day.
Monitoring her remaining ovary involved monthly visits to her gynecologist’s office where Nicole would have her blood drawn and analyzed. The blood would be tested for the level of a protein called CA125, which is produced by ovarian cells. Higher-than-normal CA125 levels usually indicate that the ovarian cells have increased in size or number, and are thus associated with the presence of an ovarian tumor.
Nicole went to her scheduled check-ups for five months after surgery. The day after her March check-up, Nicole received a message from her doctor asking that she come to see him the next day. Because she needed to study for an upcoming exam, Nicole tried to push aside her concerns about the appointment, and by the time she arrived at her gynecologist’s office she had convinced herself that nothing serious could be wrong. She thought a mistake had probably been made and that he wanted to perform another blood test.When her gynecologist entered the exam room, Nicole could tell by his demeanor that something was wrong. He started speaking to her and she began to feel very anxious—he told her that he thought she had a tumor on her remaining ovary, but she could not believe that she had heard him correctly.When her gynecologist said the word Cancer, she felt as though she was being pulled under water. She could see that he was still talking, but she could not hear or understand him. She was too nauseous to think, so she excused herself from the exam room, took the bus home, and immediately called her mom. After speaking with her mom, Nicole realized that there were many questions she needed to ask her doctor.
She did not understand how it was possible for such a young woman to have lost one ovary to a cyst, and then have a tumor on the other ovary. She wondered how this would be treated, and what her prognosis would be. Despite her background in biology, she did not even really understand what cancer was. Nicole decided to do some research for answers to her questions.