Scrolling through my twitter feed last year, I was captivated by a video of a woman dancing beautifully, her smile radiant, while propped up on a hospital bed. The video had gone viral in September 2021. Nadia Chaudhari, neuroscientist, researching alcohol addiction at Concordia University had recorded this video for a walkathon that raises funds for supporting students at the University. As I scrolled through her tweets, my heart ached a little as I read,
“Today is the day I tell my son that I’m dying from cancer. It’s reached a point where he has to hear it from me. Let all my tears flow now so that I can be brave this afternoon. Let me howl with grief now so that I can comfort him”.
Nadia was diagnosed with ovarian cancer in May 2020 after being misdiagnosed for five months. Her initial symptoms were bloating, lower back pain, fatigue, and an increased need to urinate, none of which are suggestive of cancer. She died in October 2021 after undergoing a 1.5 years long treatment because her diagnosis happened too late.
Most ovarian cancer cases are diagnosed in the advanced stage when the cancer has already spread across the abdomen and pelvic area. Unfortunately, it is not possible to treat the cancer at this stage. Cancer can be treated by killing the rapidly dividing cells by radiation therapy or chemotherapy followed by removal of the organ or tissue that contains the tumour. This approach is successful if all the cells are killed and removed, and that is dependent on how early the diagnosis of cancer happens.
The absence of symptoms in the early stage of ovarian cancer makes it difficult for the diagnosis to happen in a timely manner and in most cases, women suffer like Nadia did. Only 15% of the cases get diagnosed in the early stage. Nadia was asked to get a transvaginal ultrasound done when she experienced her early symptoms. The test results for which were inconclusive. It was not until blood tests for CA125, CA19-9, and CEA were done along with a laparotomy that the diagnosis was made.
It is not negligence or lack of awareness on the part of doctors, but rather it is the absence of a true screening test for ovarian cancer which is the real cause of misdiagnosis. It so happens that blood tests like CA-125, CA19-9, and CEA are not conclusive and can be elevated in other unrelated conditions. Laparoscopic biopsy is then the only way to diagnose ovarian cancer.
In India, ovarian cancer is the third most common cancer amongst women after breast and cervical cancer, but it has the second highest incidence of ovarian cancer in the world. Ovarian cancer has the highest mortality rate amongst all the cancers that affect women, this makes it imperative for women to be aware of screening and risk factors for ovarian cancer.
At present, transvaginal ultrasound and CA-125 screening are the only available screening tests, which are advised to women who are at high risk of getting ovarian cancer. Some of the risk factors include family history of cancer, not having a full-term pregnancy, hormone therapy post menopause, IVF, smoking and obesity. Until we have a true screening test for ovarian cancer, women must be more vigilant towards any bodily changes and get regular pelvic exams. The pelvic exam helps the gynaecologist to identify any change in the size of ovaries. It is important not to overlook any persistent (if any of these occur more than 12 times in a month) signs and symptoms like feeling full after eating little, abdominal swelling with weight loss, abdominal or back pain, increased urge to urinate, or frequently urinating, pain during sex, and/or changes in menstrual flow. These symptoms do not say with certainty that it is cancer and could be due to other health conditions that can be treated. But if it is cancer, when detected early, ovarian cancer can be treated in 94% of the cases.
The teal ribbon symbolises ovarian cancer awareness to which Nadia devoted her heart and soul during the last months of her life. Soon after her diagnosis, she began an online campaign from the hospital, slowly building up some 100K followers on Twitter and then sharing her story with the world. Awareness is the first step towards accepting that a change is required, the change in the treatment and screening of ovarian cancer in this case. Many researchers around the globe are working towards making that change possible so that someday we will reach where Nadia wanted when she posted,
"I want no one to say that I lost my battle with cancer”.
The video that Nadia Chaudhary had posted for Concordia shuffle, a walkathon that raised funds for supporting the education of University students, can be seen on Twitter.