At 18, Maya Ortiz developed sharp stomach pain that flared after meals. She chalked it up to her usual “sensitive stomach.” But over the following months, the ache grew to agony. “I’d drink milk and curl my body in search of relief,” Ortiz said. “It just kept getting worse.”
Her primary care doctor advised a bland diet. When that failed, she returned twice more. The doctor reassured, “Remember, you’re young. You look healthy.”
Finally, after pleading, Ortiz was referred to a gastroenterologist, but she never made it to that appointment. Instead, Ortiz’s pain spiked. Her mother rushed her to the ER where the physician hesitated to order a CT scan due to radiation exposure.
It’s reasonable and increasingly common for clinicians to weigh the potential harms of radiation, particularly in pediatric patients, where cumulative early exposure may itself elevate future cancer risk. A 2025 study found, in their cohort, 10% of hematologic cancers may be linked to radiation from medical imaging.
However, in this case Ortiz described significantly progressive abdominal pain. Her mother pushed for the imaging study to be done. After the CT scan, Ortiz checked her patient portal. “I saw the word ‘masses’ everywhere in the report,” she said.
Ortiz was diagnosed with stage III ovarian cancer. She was a senior in high school.
Symptoms of Ovarian Cancer
“Early-stage ovarian cancer is often silent,” says Dr. Kemi Doll, a board-certified gynecologic oncologist at University of Washington. In its initial stages, most patients have no indication that cancer is developing. Doll shares that, in some cases, certain ovarian cancers release hormones that can cause excess body hair, thyroid-related symptoms, or irregular vaginal bleeding. These hormonal signals may alert patients and may “lead to earlier detection,” she adds.
In contrast, late-stage ovarian cancer can cause “bloating, decreased appetite, feeling full after a few bites, irregular periods, nausea and constipation,” says Doll. She adds that some patients experience weight loss alongside a distended, firm abdomen and that “pelvic pain is less common.”
Ortiz often reflects on the smoke signals her body was sending. “If I had known what to look for—if someone had told me—maybe I wouldn’t have waited so long.”
Ortiz is not alone. A 2014 study found that for women over age 50, symptoms of ovarian cancer were not well recognized. Eating challenges or changes in bowel and bladder habits were recognized by less than half the study cohort.
Risk Factors of Ovarian Cancer
Recognizing symptoms is important for diagnosis, but understanding risk factors is vital for prevention. “The most understood risk factor for ovarian cancer is genetic mutation, such as in BRCA1 or BRCA2,” says Dr. Bobbie Rimel, division chief of gynecologic oncology at UW/Fred Hutch Cancer Center. Another risk factor is nulliparity, when someone has never given birth, for any number of personal or medical reasons.
Encouragingly, ovarian cancer rates are declining. Two major factors may explain this trend. Oral contraceptive use has been shown to “decrease ovarian cancer risk significantly,” says Rimel, “increased use of oral contraceptives may account for this decline.” In addition, more women are choosing bilateral salpingectomy, removal of the fallopian tubes for sterilization or during other gynecologic surgery, which “reduces risk by more than 50 percent,” Rimel adds.
Diagnosis of Ovarian Cancer
“Most ovarian cancer actually starts in the fallopian tubes,” explains Dr. Rachel Grisham, section head of ovarian cancer at Memorial Sloan Kettering Cancer Center. “That makes it harder to detect on imaging like ultrasounds or CT scans,” she adds. In many cases, cancerous cells can spread from fallopian tubes to the ovaries and other sites, like the abdominal wall. This stealth process explains why most cases are found late and why earlier detection remains critical.
“The best way to decrease incidence is to identify patients with BRCA mutations early,” says Grisham. Roughly one in four ovarian cancers involves a BRCA gene mutation, making genetic testing an essential tool for prevention. Still, testing is not straightforward: it requires access, education, counseling, and emotional readiness for the results.
Doll says tumor marker labs, such as CA-125 and HE-4, can help indicate whether cancer is likely, though their clinical usefulness varies between younger and older patients. After tumor markers labs result, doctors may need to follow up with an ultrasound of CT scan to explore potential cancer burden.
Types of Ovarian Cancer and Treatments
Treatment varies based on the type of ovarian cancer. The most common type is epithelial ovarian carcinoma, which has several subtypes. The most common subtype is high-grade serous ovarian cancer, which typically affects older women. This high-grade subtype is often linked to BRCA mutations, which may be inherited or develop later in life. Fortunately, patients with high-grade ovarian cancer tend to respond better to traditional chemotherapy.
Ortiz’s diagnosis, however, was different. She has a rare subtype known as low-grade serous carcinoma, which is more common in young adults. She described the brutal nature of her initial treatments with surgery and chemotherapy, which did not stave off disease progression. She also shared, with stark contrast, the tender care from her mother, a nurse practitioner.
“My mom believes she became a nurse years ago, so that she would know how to care of me today,” adds Ortiz. That care, from her mom, helped her endure the rigorous treatment plan.
“Historically, we didn’t realize that these are completely different diseases,” explains Grisham. Unlike high-grade cancers, low-grade types aren’t associated with BRCA mutations and usually arise spontaneously. In the past, low-grade cancers were treated the same way as high-grade ones, but with limited success. When patients are unresponsive to chemotherapy, like Ortiz, they often enter a clinical trial.
Low-grade serous ovarian cancers are driven by specific genetic changes, explains Dr. Grisham. “We’re now trying to identify drugs that target those specific mutations,” she adds. For patients, like Ortiz, “the goal is to move targeted treatments earlier in care, rather than waiting to see if chemotherapy works.”
The Future of Maya Ortiz
What is most moving about Ortiz is her unwavering resilience. “Cancer has taken everything from me,” she told me quietly. Despite the surgeries, complications, symptoms from treatment, Ortiz has focused her energy on educating others about the signs and symptoms of ovarian cancer. She dreams of becoming a physician.
The very journey that has challenged her so deeply has also revealed that she possesses the qualities that define a physician. Through lived experience, she has learned that empathy and patience are not lessons from textbooks but from life itself. In spirit and in practice, she already embodies what it would mean to be Dr. Maya Ortiz, a physician whose compassion was forged in the hardest of circumstances.
