According to the U.S. Centers for Disease Control and Prevention, ovarian cancer causes more deaths each year than any other gynecologic cancer.
That’s because ovarian cancer, often called a “silent killer” or “the whispering cancer,” is extremely hard to diagnose and detect because the symptoms can be connected with so many other health conditions. Unfortunately, ovarian cancer is usually diagnosed at advanced stages, making it more difficult to treat.
September is Ovarian Cancer Awareness Month. During this time, I encourage women to become familiar with the risk factors and symptoms associated with ovarian cancer, and to reach out to their gynecologist with any concerns.
What are the ovaries and what is ovarian cancer?
The ovaries are two small glands located on each side of the uterus. The ovaries produce the hormones estrogen and progesterone. They also store and release eggs. Ovarian cancer occurs when there is abnormal cell growth in or near the ovaries.
There are three different types of ovarian cancer: epithelial, germ cell, and sex cord stromal cell. Epithelial ovarian cancer is the most common, characterized by cells growing on the surface of the ovary. Germ cell ovarian cancer affects the cells inside the ovaries that produce eggs. Germ cell ovarian cancer is rare, usually affecting girls and women under age 30. Sex cord stromal cell ovarian cancer is also rare.
In addition, borderline ovarian tumors are abnormal cell growths that are not cancer; we usually perform surgery to remove the ovary to cure this condition.
What are the symptoms of ovarian cancer?
One of the reasons ovarian cancer is so challenging to diagnose is that the symptoms of ovarian cancer are similar to symptoms of many other medical conditions, including many that are non-cancerous.
Symptoms of ovarian cancer may include:
- Bloating. If bloating is connected to gas, the abdomen will usually get smaller in the morning. But if the abdomen seems to be getting bigger day after day, reach out to your gynecologist. Fluid buildup can cause the belly to become swollen and distended, and this can be a sign of ovarian cancer.
- Abdominal pain, particularly pain that is persistent
- Nausea and/or vomiting
- Loss of appetite
- Frequent urination
- Painful intercourse
- Menstrual irregularities and/or unusual vaginal bleeding
Many women may experience some or all of these symptoms at some point in their lives. But if symptoms persist for at least two-three weeks, seek medical care. Again, these symptoms don’t necessarily mean you have ovarian cancer, but it’s important to get checked and find the cause.
Is there a regular screening test for ovarian cancer? How is it diagnosed?
We use mammograms to screen for breast cancer, and Pap smears to screen for cervical cancer, but there is no regular screening test for ovarian cancer. The Pap test does not detect ovarian cancer!
During a routine gynecologic exam, the gynecologist will feel for masses and pain in the ovaries and fallopian tubes. If we feel a lump or there is pain on the sides of the pelvis, we have several choices for next steps, usually starting with imaging studies such as an ultrasound or CT scan.
Many patients concerned about ovarian cancer ask about a blood test called CA-125. This test detects the amount of cancer antigen in the blood. However, patients often have elevated results for non-cancerous conditions like a pelvic infection or endometriosis, so we often use this test as a baseline rather than a diagnostic tool. If a patient does have ovarian cancer and undergoes treatment, we can re-run this test to see how well the treatment is working.
It’s also important to note that the overwhelming majority – as many as 90 percent — of ovarian cysts are benign.
What are the risk factors for ovarian cancer?
Though ovarian cancer can occur at any age, women are at greater risk of ovarian cancer in their 50s and 60s, after menopause — with the median age of diagnosis at 63.
Risk factors for ovarian cancer may include:
- Having a BRCA1 or BRCA2 gene mutation. (BRCA stands for breast cancer, but these mutations are also connected to an elevated risk for ovarian cancer.)
- A family history of ovarian, breast, or colon cancer, especially among first-degree relatives (parents, children, and siblings). Patients with a strong family history of these cancers should have annual gynecologic exams.
- Smoking or alcohol consumption
- Exposure to certain chemicals, such as talcum powder
- Exposure to significant levels of radiation, such as from several CT scans, MRIs, and X-rays
- Never having been pregnant
- Having undergone fertility treatments
- Using hormone replacement therapy
We have found that risk decreases among women who use birth control pills. Some studies have also connected a lower risk of ovarian cancer for women who have had had C-sections and pelvic surgeries. Many women also have a reduced risk if they breast fed.
However, having had the HPV vaccine does not help prevent ovarian cancer. The HPV vaccine helps protect against cancers of the cervix, vagina, vulva, anus, penis, and back of throat.
How is ovarian cancer treated?
Treatment for ovarian cancer may include surgery, chemotherapy, radiation therapy, immunotherapy, and hormone therapy. There are several different forms of surgery, and the approach we used is based on how far the cancer has spread. In a salpingo-oophorectomy, a gynecologist surgeon or gynecologic oncologist may remove one ovary and fallopian tube, or both ovaries and fallopian tubes. In a hysterectomy, the gynecologic surgeon or gynecologic oncologist removes the uterus, as well as possibly the cervix.
In women who still want to have children, we may be able to treat the cancer by performing fertility-sparing surgery. That means the gynecologic oncologist removes solely one ovary and fallopian tube, leaving the second ovary and fallopian tube intact.
When detected and treated early, five-year survival rates for the different types of ovarian cancer range from 93 percent to 98 percent.
If you have a family history of ovarian, breast, or colon cancer, or have any ovarian cancer symptoms for more than two weeks, reach out to your physician to discuss next steps.
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