Kristen Foreman first noticed something was wrong in July 2019, when she began struggling to get up the stairs. "I could walk up maybe 10 steps and just feel so winded," Foreman tells SheKnows. "That wasn't the case usually, and so that was alarming." Along with the extreme fatigue, she noticed spotting in between periods. Then came frequent urination. When her symptoms persisted, Foreman started talking to her doctors.
What doctors originally thought might be ovarian cysts, fibroids, or iron deficiency turned out to be ovarian cancer. It was a shocking diagnosis for Foreman, then 33, given that about half of women diagnosed with ovarian cancer are 63 or older, according to the American Cancer Society. As she began treatment for the disease, she dealt with losing her fertility, navigating a pandemic, and feelings of isolation as she experienced something that none of her loved ones could fully understand. But Foreman emerged from it with a purpose: to connect with other patients in her situation and encourage them, above all, to advocate for themselves.
It's not too surprising that Foreman's early symptoms weren't recognized as ovarian cancer. According to Matthew Powell, MD, professor and chief of the gynecologic oncology division at Washington University, common signs of ovarian cancer include bloating, pelvic pain, difficulty eating or feeling full quickly, and urgent or frequent urination. Other symptoms might include fatigue, heartburn, upset stomach, back pain, constipation, pain during sex and changes in menstruation.
As you probably noticed, "these symptoms closely resemble those of other, less severe conditions," Dr. Powell tells SheKnows. That leads often leads to misdiagnoses, he explains.
When Foreman got a sonogram at her doctors' recommendation, it revealed a cyst near her left ovary - again, not necessarily a cause for concern or a sure sign of cancer. Ovarian cysts are fluid-filled sacs that form on or inside an ovary, according to Mayo Clinic, and they're common, often going away on their own without treatment.
However, Foreman instinctively knew something was wrong. "I felt that it was something different," she says. "There was more going on." Within a month, Foreman noticed that her lower abdomen was starting to get distended, something she initially put down to overeating. It turned out to be the cyst, which was growing in size.
By October 2019, Foreman had been diagnosed with ovarian cancer. Doctors surgically removed her left ovary (called an ovariectomy), attempting to preserve her fertility in the process, but when they found cancer, they recommended she move forward with a full hysterectomy (removing the uterus). Just weeks prior to that surgery, another blow: doctors had found endometrial carcinoma. "The cancer had spread," Foreman says.
As a result, Foreman had to come to terms with both the diagnosis of cancer and losing her fertility. She had to process them one by one - first infertility, then cancer - because accepting both at the same time would've made her "completely despondent," she said. "It was numbing," she went on. "It's hard to put into words."
Both ovarian and endometrial cancers can impact fertility. That's because of the need for surgical intervention - as Foreman experienced - as well as treatments like chemotherapy, "which can affect reproductive organs and their functions," Dr. Powell says. Many endometrial and ovarian cancers are diagnosed post-menopause, he adds, but for younger patients like Foreman, doctors will often try to preserve the patient's fertility, depending on as the stage of the disease and the patient's overall health. "Options such as egg or embryo freezing might be available prior to treatment," Dr. Powell notes, but in some cases, it's just not possible.
Foreman underwent six cycles of chemotherapy followed by a month of radiation. It all happened in 2020, and her cancer treatment coinciding with the pandemic was a profoundly isolating experience. Foreman remembers navigating feelings of hopelessness and disconnection from her loved ones.
"It was just a different type of loneliness that you feel when you have that diagnosis," she says. "Because although those around you try to comfort you and support you as best as they can, they will never know what it is to go through all that cancer entails."
Foreman's treatment was ultimately successful. Three years later, she remains under surveillance, which means meeting with her oncologist a couple times a year. Mentally, therapy and acupuncture have helped her cope with the stress and overwhelming nature of her journey.
What Foreman says has helped the most, though, is being able to help others. "About a month after my hysterectomy, I just I came to grips with the fact that I wanted to use this not as a excuse to feel sorry for myself or for others to feel sorry for me," she says. She turned her energy towards other patients experiencing this life-changing diagnosis, with the goal of lessening the feelings of isolation she herself experienced. That meant mentoring other patients, providing resources, letting them know it's OK to grieve, and offering support and the kind of empathy only a fellow cancer survivor could give. "If I could help lighten the load of other women going through this, I definitely wanted to do that," Foreman says.
It's a natural role for Foreman, who also works as a patient advocate and is passionate about helping people advocate for themselves and their health. "I think white coat syndrome definitely serves as a barrier within treatment," she says. Doctors have all the credentials, but only you know exactly what your body is feeling. "We shouldn't discredit ourselves when we notice something, even though physicians may minimize it," Foreman says.
Even doctors themselves agree. "Listen to your body, taking notes of any persistent irregularities that don't resolve over time," Dr. Powell says. "Proactive and informed conversations with your doctor can pave the way for earlier diagnosis and more impactful treatment options."
That includes asking your doctor about new kinds of treatment. One example? A new drug, Jemperli, which was approved by the FDA this summer to treat cases of advanced or recurrent endometrial cancer that exhibit certain indicators of cell repair malfunction. Using Jemperli along with chemotherapy "offers a new, potentially practice-changing treatment option for those facing this challenging disease," says Dr. Powell, who was a clinical investigator in a trial that led to the drug's approval. It's just one instance of an advancement in gynecologic cancer treatment, and something that patients can talk to physicians about as they consider different options.
So how do you advocate for yourself in the doctor's office? Foreman's advice: be persistent in expressing your level of concern to doctors and don't hesitate to get a second opinion if you feel it's necessary. "It's OK to move outside of certain physicians and find different options," she says. It's also helpful to know your family history and consider getting genetic testing if you have a family history of a genetic condition, such as breast cancer.
And as much as you can advocate for yourself, it's also helpful to build a care team around you to help. Nurse navigators or social workers (Foreman used both) can help to shoulder your burden, which Foreman says can feel "so overwhelming."
Foreman's care team was "phenomenal," she remembers. "They definitely played a key role and they helped to lighten my load in terms of anxiety, with everything being so new," she says. "I never felt like members of my treatment team were not within reach. I definitely think that it was a key part in helping me to get through a lot of this."
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