A Full Plate

Jennings is a nurturer by nature. She’s always there for her friends and family and also finds community in helping strangers cope with the same challenges she has faced. She founded an infertility support group, “Women of Hope,” and an adoption support group, “Amazing Families,” many years ago. And, most recently she’s used her personal Facebook page for ovarian cancer education and advocacy.

Jennings lives just 10 minutes down the road from Duke Cancer Center with her husband Spencer, a civil engineer with the N.C. Department of Transportation; their daughter Kaitlin, 22, a Catawba College senior pursuing a double music major in Worship Arts and Vocal Pedagogy; and their son Roman, a 20- year-old story consultant and videographer helping to develop local non-profits and businesses. Jennings’ mother Muriel Coffey, an active and healthy 97-year-old, also lives with them.

A stay-at-home mom, Jennings has her hands full managing a multi-generational household.

Cooking nearly every day from scratch for her family — from a pot of chili to shrimp coconut curry — is one of her favorite ways of expressing love, of assuring her family she’s there for them. She always makes enough for leftovers or to feed last-minute guests. 

When Jennings was suddenly faced with stage 4 epithelial ovarian cancer in June 2017, the family’s caregiver-in-chief was bereft.

Jennings’ ovarian cancer had gone undetected for at least six months before diagnosis. In January 2017, she saw her primary care doctor for mild lower abdominal pain and constipation. A UTI was ruled out as the source. Over the next several weeks, she would see two different doctors and undergo a series of tests, including two physical exams, four ultrasounds and an MRI. Nothing alarming was found. One of the scans was incorrectly read. It wasn’t until she was four months into pelvic physical therapy and had started colonic massage that she discovered, on her own, “a definite lump” to the left of her uterus. A follow-up ultrasound (her fifth) by her doctors plus a CT scan at Duke of her abdomen showed cancer everywhere.

“I was in the best shape ever compared to my teens and twenties. It was a complete shock,” said Jennings, who had a side gig as a Beachbody fitness coach and was eating healthy and working out at the time. “What’s amazing is that when the cancer was discovered, I was already at stage 4.”

Per the American Cancer Society, up to 25% of ovarian cancer diagnoses are due to the patient having a family cancer syndrome, which means they’ve inherited particular mutations in particular genes that drive not only the development of ovarian cancer, but also breast and colorectal cancers. Jennings had no family history of ovarian cancer.

A Silent Killer

Ovarian cancer is often called the silent killer because it spreads fairly quietly before causing painful symptoms. It can be easily missed.

When it does cause symptoms — most commonly bloating; pelvic and/or abdominal pain; feeling full quickly, upset stomach, or trouble eating; having to urinate frequently; extreme tiredness; difficulty having bowel movements; and abdominal swelling — a range of benign conditions may be initially suspected.

Because ovarian cancers frequently cause these non-specific symptoms, oncologists advise that women should seek prompt medical attention if these symptoms last more than a few weeks.

Unfortunately, early discovery represents only 20% of all cases. By the time most women are diagnosed with ovarian cancer, as in Jennings’ case, it’s already advanced through the abdominal cavity.

When Jennings’ CT scan showed clear evidence of cancer, she was immediately referred to gynecologic oncologist Angeles Alvarez Secord, MD, MHS, at Duke Cancer Institute.

When the two first met to discuss her options, in June 2017, Jennings already knew what she was up against. She’d done her homework. She’d read the sobering statistic that even with treatment, only 29% of stage 3 or 4 ovarian cancer patients live longer than five years after diagnosis. She aimed to be in that 29%. (The five-year survival rate for those diagnosed early, meanwhile, is 94%.)

Jennings had learned that a combination of cancer-reducing surgery and chemotherapy was standard-of-care treatment for her cancer type. Limiting treatment to palliative care, aimed solely at improving her comfort level, was also an option.

But Secord, who also serves as associate director, clinical research, for the Gynecologic Cancer group at DCI, surprised her by putting an additional option on the table — a clinical trial.

“Dr. Angel,” as Jennings’ friend Rebecca Gordon (currently under Secord’s care for stage 3c Ovarian Cancer) would later call the oncologist, had thrown her a lifeline.

Screening

Unlike in breast cancer, there are no reliable screening tests or exams to detect ovarian cancer early in women of average risk with no symptoms. (There’s no mammogram equivalent.) Per the United States Preventive Services Taskforce (USPSTF), any benefit to screening these women for ovarian cancer with diagnostic tools are outweighed by the harms, including potential false-positive results as well as unnecessary testing and diagnostic surgery.

In studies where transvaginal ultrasound, a diagnostic tool, was used to screen for ovarian cancer, most of the masses turned out not to be cancer upon further examination. Research measuring the level of CA-125 (a protein) in the blood — albeit a valuable test for helping guide treatment in ovarian cancer patients — hasn’t yet been found to be an effective screening method for asymptomatic women either.

High CA-125 levels in the absence of other symptoms is more often indicative of common conditions such as endometriosis and pelvic inflammatory disease than a sign of the presence of cancer.

Further, there’s been no “adequate evidence” that screening with ultrasounds or CA-125 tests reduce ovarian cancer mortality. [These screening tests may, however, be recommended for women who are at high risk for ovarian cancer, such as those with BRCA gene mutations. Doctors may also discuss preventive surgeries to remove the ovaries and fallopian tubes for these patients.] 

Gynecologic oncologist Angeles Alvarez Secord, MD, MHS, emphasizes that it’s important for women to be aware of the symptoms of ovarian cancer.

Secord advises that while these cancers frequently cause non-specific symptoms that can be hard to identify, women should seek prompt medical attention if any of these common symptoms (bloating; pelvic and/or abdominal pain; feeling full quickly, upset stomach, or trouble eating; having to urinate frequently; extreme tiredness; difficulty having bowels movements; and abdominal swelling) last more than a few weeks.