A woman is diagnosed with advanced ovarian cancer. She is upset and crying. She asks her nurse how this could have happened. Which response by the nurse indicates an understanding of this illness?

Abnormal tissue has formed as a result of retrograde menstruation.

Since signs and symptoms are vague, metastasis can occur before a diagnosis is made.

A diet high in saturated fat is a risk factor for contracting this condition.

Getting an annual Pap smear could have identified the cancer at an earlier stage.