It's Always Something: Ten Months of Wrong Answers Before an Ovarian Cancer Diagnosis

Gilda Radner was one of the original cast of Saturday Night Live. She wrote this book in 1988 and 1989, in the gaps between treatments for ovarian cancer, and took its title from a catchphrase of one of her characters.

Spoilers, stated plainly. Radner died on 20 May 1989, before the book reached most readers. She knew when she wrote it that she might not see it published, and the last chapters are written in that knowledge. Nothing here treats her death as a revelation.

The book is roughly two thirds childhood and comedy, one third illness, and the two halves are not separate. Then there is the rest of the book. Growing up in Detroit. An eating disorder that ran through her twenties. Her father's brain tumour when she was fourteen. Her marriage to Gene Wilder. None of it is padding placed before the cancer. It is the reason the cancer chapters land as they do.

It is worth knowing that this is a celebrity memoir written at speed, by someone very ill, in 1989. It reads like that: warm, digressive, funny in places that are not funny, occasionally repetitive. That is not a criticism so much as a description.

The structure is chronological and loose. Early chapters cover her childhood, her weight and her father's illness and death. A long middle section covers Saturday Night Live, the characters, the exhaustion, and then her marriage.

The illness section begins with symptoms rather than a diagnosis, which is what makes it valuable. It began in 1985, while she was filming in England: severe fatigue, and pain in her upper legs. Then came roughly ten months of consultations. Each one produced an explanation. Each explanation turned out to be wrong. She was diagnosed with stage IV ovarian cancer in October 1986, had surgery including a hysterectomy, and a large abdominal tumour removed days later.

The remaining chapters cover chemotherapy, radiation and a period of remission. There is the wig. There is the support group she joined at the Wellness Community in Santa Monica. There is maintenance chemotherapy, begun in 1988, and the recurrence in December of that year. She writes about hope and about the exhausting obligation to perform it.

There is no medical appendix, no source list, and no glossary. Readers who want the language explained will need to bring it with them or look it up. The widely circulated paperback edition runs a little under 300 pages.

One structural note. Because she wrote it while ill, the book's sense of time is uneven. Years of her life pass in a paragraph; a single week of waiting for a scan result takes a chapter. That distortion is accurate to the experience and disorienting to read.

Nothing else in this genre is as good on the period before diagnosis. Ten months of being told it was something else is described from the inside, including the part most accounts leave out: the way repeated reassurance makes a person doubt their own body and stop pressing.

It is very good on the social work of being ill. Being the funny one when you feel terrible. Managing other people's fear. Being recognised in a hospital corridor.

It is good on the specific loneliness of a cancer that most people around you cannot picture. Ovarian cancer has no visible site, no ribbon-familiar self-exam, and no public script, and she notices that people did not know what to say to her in a way they might have if she had named a more familiar diagnosis.

It is honest about the support group without being pious about it, and honest about her marriage without turning her husband into a saint.

The clinical content is nearly forty years old. Ovarian cancer treatment in 1987 is not ovarian cancer treatment now, and the drugs, the surgical staging practices and the use of second-look procedures have all changed. Do not read the treatment chapters as a description of what happens today.

The genetics are absent, and necessarily so. BRCA1 was not identified until after her death. Any reader who assumes her family history means their own risk is fixed should take that question to a clinician rather than to this book.

The tone occasionally reaches for meaning in a way some readers will find grating: illness as a lesson, cancer as a teacher. She is entitled to that, having lived it. It is not a claim about biology, and there is no federal evidence that attitude changes ovarian cancer outcomes.

There is also a reasonable question about how her care was reported. The book is her account, written from memory and from notes, and it is the only account. This page does not treat it as a medical record, and neither should a reader. What can be said is that a long interval between first symptom and diagnosis is common in ovarian cancer, for the reasons NCI gives below, and that her experience was not unusual.

The book's central medical fact is that her symptoms were real and were not recognised. NCI's patient summary is direct about why that happens. Ovarian epithelial, fallopian tube and peritoneal cancer may not cause early signs or symptoms, and when signs or symptoms do appear, the cancer is often advanced.

The symptoms NCI lists are pain, swelling or a feeling of pressure in the abdomen or pelvis, together with digestive changes such as bloating and constipation. Those are also the symptoms of a great many harmless things, which is exactly the trap Radner describes.

NCI's general instruction sets the threshold: symptoms that do not get better after a few weeks should be seen by a doctor, and because cancer often causes no pain, pain is not the signal to wait for. What that changes in practice is persistence, not panic. A symptom that has not resolved is a reason to go back, and going back a second time with a note of dates is a normal thing to do, not a nuisance.

For the individual signs see ovarian cancer symptoms, and for the one that most often gets dismissed see is bloating a sign of ovarian cancer.

The obvious conclusion from this book is that women should be screened for ovarian cancer. The evidence says the opposite, and the reason is worth understanding.

The US Preventive Services Task Force recommends against screening for ovarian cancer in asymptomatic women who are not known to have a high-risk hereditary cancer syndrome. That is a D grade, issued in February 2018. The tests assessed were transvaginal ultrasound, serum CA-125, the Risk of Ovarian Cancer Algorithm, and pelvic examination.

Three large trials found no reduction in ovarian cancer deaths among screened women. Meanwhile false-positive rates across screening rounds ranged from about 4 percent to about 44 percent, and false positives led to surgical removal of ovaries in women who did not have cancer, with major surgical complications in up to 15 percent of those operations. That is the arithmetic behind the D grade: no lives saved, real harm done.

Two things sit outside that recommendation. First, tests used to investigate symptoms are diagnostic, not screening, and the D grade says nothing against them. Second, women with a relevant history are assessed differently. USPSTF gives a B grade to risk assessment for BRCA-related cancer in women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or with ancestry associated with BRCA1/2 changes, using one of several validated family-history tools to decide who is referred for genetic counselling and possible testing. Women without such a history receive a D grade for routine risk assessment.

NCI lists ovarian cancer risk factors including family history in a first-degree relative, inherited changes in BRCA1 or BRCA2, and Lynch syndrome. See ovarian cancer risk factors and BRCA gene changes for what those assessments involve.

Radner was told it was stress for ten months. Ovarian cancer still has no screening test, which is why the timeline matters more than the jokes.

One last point the book cannot supply. Nothing in the USPSTF statement or in NCI's summary suggests that a woman with persistent symptoms should wait for a screening programme that does not exist. The two pieces of guidance work together: no routine test for people who feel well, and prompt investigation for people who do not.

It suits anyone who has been told for months that their symptom is nothing, and anyone who wants company in that specific frustration. It suits readers who came for the comedy and will stay for the rest.

It does not suit someone looking for current ovarian cancer information, and it does not suit a reader who wants a calm, ordered book. It is neither.

• It's Always Something — edition record (Internet Archive)
• USPSTF — Ovarian Cancer: Screening
• USPSTF — BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing
• NCI — Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ) Patient Version
• NCI — Symptoms of Cancer

This page discusses It's Always Something for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care.