By Stacey N. Akers, MD
Roswell Park Cancer Institute
Despite encouraging treatment advances for many other types of cancer, ovarian cancer remains a challenge. One reason why: there is no screening test for detecting ovarian cancer in otherwise-healthy women, so tumors are usually discovered in the late stages, when treatment options are limited.
But research is giving us reason to be hopeful. Thanks to gene sequencing, researchers are gaining important new insights into how ovarian cancer develops and spreads—and which women are most likely to develop the disease. At the same time, physician-scientists, including my Roswell Park colleague and department chair, Dr. Kunle Odunsi, are developing exciting new treatment approaches that harness the natural defenses of a woman’s own immune system to recognize and attack cancer cells.
As we apply those latest findings and await the next big treatment advances, it is important to recognize that self-education is also critical to understanding and taking steps to reduce your risk of ovarian cancer.
Five Things You Should Know about Ovarian Cancer
1. Your personal and family medical history may increase your risk of ovarian cancer.
A history of cancer—either your own or that of a blood relative— can be a “red flag” warning about your risk of many cancers, including ovarian cancer.
If your mother, daughter, or sister has had ovarian cancer, you may have an increased risk of the disease. You may also be at higher risk if you or a blood relative has had breast, uterine, or colorectal cancer. Be sure to alert your gynecologist or primary care provider about a family history of these types of cancer. If appropriate, you may be referred for genetic counseling and testing. If it turns out that you are indeed at increased risk for ovarian cancer, a genetic counselor can describe options for reducing that risk.
You may also be at greater risk if you are older—most women diagnosed with ovarian cancer are over 55—or if you have never been pregnant. Remember, however, that risk factors do not tell us everything. Many women with one or more of these risk factors will never develop ovarian cancer, and many others who do get the disease have no known risk factors other than advancing age.
2. If you are at very high risk, you may be a candidate for preventive surgery.
About 15 percent of all cases of ovarian cancer are linked to inherited mutations of the BRCA1 and BRCA2 genes. While ovarian cancer affects only about 1.5 percent of women, individual risk can be as high as 40 percent among those who have inherited the BRCA1 mutation. Because these women are at high risk of developing both breast and ovarian cancer, they may opt to have their breasts and/or ovaries removed.
A new and important study suggests that preventive, or prophylactic, oophorectomy (removal of the ovaries) by age 35 is an effective strategy for reducing the risk of ovarian cancer in women who have tested positive for a BRCA1 mutation. This is major surgery that should be considered only in consultation with a trusted gynecologist. If you are at high risk for ovarian cancer, talk to your provider to see if preventive surgery is a recommended option for you.
Another strategy, called conservative management, uses magnetic resonance imaging, mammograms, and pelvic ultrasound to monitor your health closely if you are at high risk, with the aim of catching the disease in its early, more treatable stages, if it develops.
3. Ovarian cancer is one of the most diverse forms of cancer, with more than 30 different types.
Because there are so many different types of ovarian cancer, pathologists play an especially crucial role in the accurate diagnosis of the disease. Different types of ovarian cancer may respond differently to the same treatment, so identifying the correct type is key to creating the appropriate treatment plan.
By looking at the biopsied tissue under a microscope, a pathologist can also determine whether the tumor is benign (not cancer) or malignant. There are three main categories of ovarian cancers:
- Those that develop from the surface epithelium, or the cells found in the lining of the ovaries
- Germ cells, or those that are destined to form eggs
- Stromal cells, which release hormones and connect the different structures of the ovaries
Each of these three main types of ovarian cancer (and their subtypes) behaves very differently and requires a different treatment regimen.
Remember to ask your doctor to discuss the diagnosis with the pathologist—and do not be shy about requesting a copy of your pathology report.
4. Early diagnosis is key, so do not ignore any new or unexplained symptoms.
Early detection can make a significant difference in the outcome for women with ovarian cancer. Women who are diagnosed in the early stages have a wider range of treatment options and usually fare much better than those diagnosed at an advanced stage.
Keep in mind that the symptoms of ovarian cancer are the same as those of other disorders and diseases. Women sometimes write them off, assuming that they signal less serious illnesses.
Watch out for these common symptoms of ovarian cancer:
- Pressure or pain in the abdomen, pelvis, or back
- A swollen or bloated abdomen
- Nausea, indigestion, gas, constipation, or diarrhea
- Feeling tired all the time
- Shortness of breath
- Feeling the need to urinate often
Pay attention to your health, and promptly discuss any new or unexplained symptoms with your gynecologist and/or primary medical provider.
5. The type of specialist you see may affect the outcome of the diagnosis.
Research shows that women with ovarian cancer who receive care from gynecologic oncologists— physicians who specialize in diagnosing and treating cancers of the female reproductive organs, including the ovaries, cervix, and uterus—have significantly better outcomes than those who are not.
Only a gynecologic oncologist is specially trained to perform surgery for ovarian cancer. Even if a gynecologist has already performed surgery on you, it is not too late to consult a gynecologic oncologist.
The Foundation for Women’s Cancer offers an online tool that can help you find a gynecologic oncologist in your area: foundationforwomenscancer.org/find-agynecologic-oncologist.
Dr. Stacey N. Akers is a Gynecologic oncologist at Roswell Park Cancer Institute (RPCI), a National Cancer Institute–designated comprehensive cancer center in Buffalo, New York. Board-certified in obstetrics and gynecology, she is a graduate of the University of South Alabama College of Medicine and completed a fellowship at RPCI. For additional resources, including a link to the Familial Ovarian Cancer Registry, the oldest and most comprehensive database of its kind, visit roswellpark.org/cancer/ovarian/ prevention-detection, e-mail firstname.lastname@example.org, or call (877) ASK-RPCI [877-275-7724].