TEAL Is The New BLACK

Ovarian Cancer, it doesn't discriminate.

Education and Early Detection saves lives...

What is Ovarian Cancer?

Ovarian cancer is cancer that begins in the cells that make up the ovaries. Cancer that originates at another site (e.g., breast or colon) and spreads to the ovaries is not considered ovarian cancer.

There are many types of tumors that can start in the ovaries. Ovarian cysts are examples of other growths that can occur on the ovaries. Most ovarian cysts are not cancerous. They are fluid-filled sacs that form on the surface of the ovary. Cysts usually go away without treatment, but a doctor may recommend removal, especially if it seems to be growing, to ensure that they do not become cancerous. 

Symptoms

Historically ovarian cancer was called the "silent killer" because symptoms were not thought to develop until the chance of cure was poor.  However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population.  These symptoms include:

  • Bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (urgency or frequency)

Several other symptoms may include:  fatigue, indigention, back pain, pain with intercourse, constipation and menstrual irregularities.  Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist.  If ovarian cancer is suspected, medical experts suggest seeking a second opinion with a gynecologic oncologist before surgery is performed.

Symptoms are often associated with the location of the tumor and its impact on the surrounding organs. They tend to be non-specific and can mimic non-gynecologic conditions such as irritable bowel syndrome, etc. Many of us experience these symptoms from time to time - do not be alarmed! But if they persist and are unusual for you, then seek a professional opinion.

Risk Factors

All women are at risk for ovarian cancer, but the Alliance believes it is important for women (and their healthcare providers) to be aware of those factors that may put them at higher risk for the disease. These factors include the following:

  • Increasing age (56 percent of women diagnosed with ovarian cancer are older than age 65): Although ovarian cancer can strike women at any age, the incidence increases dramatically after the age of 50, peaking between the ages of 55 and 65. Though advanced stage diagnosis is a problem for all women, it is particularly acute for older women. Nearly two thirds of the women diagnosed with ovarian cancer over 50 are detected in late stage when the 5-year survival rate is only about 25 percent.  As a result, it is important that women continue regular gynecologic exams, even after childbearing is complete.

 

  • Having a family or personal history of ovarian, breast, or colon cancer: Personal and/or family history is the most significant risk factor for ovarian cancer. Approximately 5 to10 percent of ovarian cancer cases are associated with hereditary risk. Women can inherit risk from either parent, particularly if a first-degree relative has or has had breast, ovarian, colon, or uterine cancer. Some researchers believe that a family history of prostate cancer may also be linked to increased risk for ovarian cancer. Women with personal or family histories of these types of cancer are more likely to develop ovarian cancer before the age of 50.

 

  • Not bearing children: It is well established that ovarian cancer risk is reduced with each subsequent pregnancy. Consequently, women who do not bear children are believed to be at greater risk for ovarian cancer. Women who have experienced difficulty getting pregnant are at an increased risk of developing the disease as well.

Other possible, though still unproven, risk factors include:

  • Use of talc: Some research has shown a possible link between genital exposure to talcum powders with an increased risk of ovarian cancer. Talcum powder is produced from talc, which in its raw form is believed to contain the carcinogen asbestos. Although all talc products sold for domestic use have been federally mandated to be free from asbestos for almost three decades, some researchers advise using cornstarch based rather than talc-based products. More research is needed to definitively affirm or dismiss a connection between ovarian cancer and talc use in its current formulation.

 

  • Use of fertility drugs (some researchers believe that infertility itself may be the problem): Since the 1980s, an increasing number of American women have battled infertility with drugs. The possible correlation between fertility drugs and an increased risk of ovarian cancer has led researchers to conduct numerous studies in an attempt to establish the extended effects of such treatments. The results of these studies have been conflicting. Some studies identify certain fertility drugs as increasing a woman's risk for ovarian cancer, while others contend that it is not fertility treatments that increase the risk of ovarian cancer, but rather infertility itself. Consequently, more research is needed to determine the relationship between fertility drugs and ovarian cancer.

 

  • Hormone Replacement Therapy: Risk surrounding hormone replacement therapy (HRT) remains highly controversial. A recently released study, the largest to date, concluded that women who take unopposed estrogen for 10 or more years significantly increase their risk of developing ovarian cancer. Yet today, combination therapy (taking estrogen plus the hormone progestin) is far more common than estrogen-only therapy. More research is needed to determine if there is a link between the current formulation of hormone replacement therapy and ovarian cancer. In the meantime, a woman considering HRT should discuss the risks and benefits for her particular circumstances with her doctor.

SOURCE/Ovarian Cancer Alliance of Florida http://www.ocaf.org/

 

 

 

 

 

Frequently Asked Questions


Is it true that a woman who has had her ovaries removed cannot get ovarian cancer?

Technically, women who have their ovaries removed cannot get ovarian cancer. There is a rare type of cancer called primary peritoneal carcinoma - a close relative to ovarian cancer that can develop without the ovaries.

Does ovarian cancer have symptoms in its early stages?

Many in the medical community and a number of medical texts still hold the incorrect belief that there are no symptoms in the early stages of ovarian cancer. While the symptoms for early stage ovarian cancer tend to be nonspecific and can mimic nongynecologic conditions, a large national study shows that an overwhelming majority of women diagnosed with ovarian cancer did have symptoms. The most common symptoms reported include: abdominal bloating or discomfort; increased abdominal size or clothes that fit tighter around your waist; increased or urgent need to urinate and pelvic pain. Additional signs and symptoms are: Persistent gas, indigestion or nausea; unexplained changes in bowel habits; unexplained weight loss or gain; loss of appetite; feeling full quickly during or after a meal and pain during sexual intercourse; a persistent lack of energy and low back pain of shortness of breath.

Source: A. Goff, M.D., Lynn Mandel, Ph.D., Howard G. Muntz, M.D., Cindy H. Melancon, R.N., M.N. 2000. Ovarian carcinoma diagnosis. Cancer 89, No. 10: 1097-0142

Prevention, Risk and Hereditary Factors


Is there an association between Hormone Replacement Therapy and ovarian cancer?


The latest interpretation of data resulting from the Women’s Health Initiative study suggests that postmenopausal women who take combined hormone replacement therapy (HRT) continuously may face a higher risk of ovarian cancer. While researchers say the findings shouldn't affect most women's decisions to take HRT to relieve moderate to severe menopausal symptoms, such as hot flashes, the possibility of an increased ovarian cancer risk support recently revised guidelines that call for the conservative use of hormone therapy.

Source: Anderson, G. The Journal of the American Medical Association (Vol 290:1739-1748).


Does the use of talc (talcum powder) as a feminine powder increases the risk of ovarian cancer?

A number of past studies found an increased risk of ovarian cancer from talcum powder use, but these studies were considered inconclusive because of limitations in the way data were collected and analyzed. More recent studies, such as one using data from Harvard University’s Nurses’ Health Study in 2000, find no overall risk of ovarian cancer from talc use and only a modest increase in one type of the disease – invasive serous ovarian cancer.

Source: Journal of the National Cancer Institute (Vol. 92, No. 3).I

If a family member has ovarian cancer, can genetic screening determine if other family members will get the disease?


Approximately one out of every ten ovarian cancer cases is hereditary.

Most hereditary ovarian cancer can be attributed to two genes, BRCA 1 and BRCA2. Women who inherit a mutation in these genes are at greater risk of developing epithelial ovarian cancer.

A thorough evaluation of family history (i.e., a history of breast, colon, or ovarian cancer) can identify women most likely to have a hereditary cancer risk, and genetic testing can determine if these mutations exist. Although having these mutations increases risk, it does not mean a woman will definitely get the disease . Furthermore, while genetic testing can indicate where there is increased risk and help determine appropriate monitoring, women should consider the psychological and possible insurance ramifications before proceeding with testing. Experts suggest that all genetic testing be done in conjunction with genetic counseling.

Source: Cancer Control, July, 1999; Genet Test, 2000


Is there any way to prevent ovarian cancer?


Currently there is no way of preventing ovarian cancer.

There are, however, several measures things that have been found to reduce a woman's risk of developing the disease. Oral contraceptives can reduce the risk of ovarian cancer by fifty percent if taken for at least five years. Research has also shown that pregnancy and breast-feeding significantly reduce ovarian cancer risk. (Br. J. Cancer, March, 2001)

Tubal ligation and hysterectomy reduce risk, though researchers are unclear exactly how. Finally, prophylactic oophorectomy (removal of the ovaries) also reduces the risk. (Gynecologic Cancer Foundation Slide Presentation, 2000) Health professionals recommend that all options be discussed thoroughly with a physician.

What are ovarian cysts?


Ovarian cysts are fluid-filled sacs on the surface of the ovary that are quite common in women during their childbearing years. Most cysts result from the changes in hormone levels that occur during the menstrual cycle and the production and release of eggs from the ovaries. Most are harmless and go away on their own. Your doctor will want to keep track of any cyst to be sure that it does not grow and become cancerous. (ACOG Patient Education: Ovarian Cysts, 1996)

What is endometriosis? Can it cause ovarian cancer?


Endometriosis is a chronic and often progressive disease that develops when endometrial tissue, which normally lines the inner surface of the uterus, grows outside of the uterus. These implants occur most frequently in the pelvic region and on the reproductive organs but can appear in other areas, such as the bladder, as well.

In spite of the high prevalence of endometriosis in women the world over, researchers have been unable to determine its cause. Endometriosis can cause pain and scarring, and it is believed that 20 percent to 40 percent of women diagnosed with this chronic disease are infertile. (National Cancer Institute)

Researchers hypothesized that the most likely link between endometriosis and ovarian cancer is the association between endometriosis and infertility. It is well established that ovarian cancer risk is reduced with each pregnancy. Consequently, women who do not bear children, whether by choice or due to infertility issues, are believed to be at greater risk for ovarian cancer. (The Gynecologic Sourcebook, Third Edition)

Do fertility drugs increase your risk of developing ovarian cancer?


Use of fertility drugs does not increase a woman's risk of getting ovarian cancer. On the other hand, the scientists did find an association between ovarian cancer and certain causes of infertility itself, such as endometriosis.

"Some women who receive fertility treatments develop ovarian cancer because of underlying conditions that cause infertility, not because of the treatments themselves," said Roberta Ness, MD, MPH, of the University of Pittsburgh's School of Public Health.

Source: American Journal of Epidemiology (Vol. 155, No. 3: 217-224).

Is there a link between breast cancer and ovarian cancer?


Both breast and ovarian cancer can be caused by mutations in the BRCA1 and BRCA2 genes. Women with a family history of breast and ovarian cancer, or a personal history for either, particularly if diagnosed before age 50, should be aware of increased risk for the other. Women who have had breast cancer before the age of 50 are twice as likely to develop ovarian cancer, as are women who have not. (NCI - What You Need To Know About Ovarian Cancer, 1998) Additionally, ovarian cancer has also been linked to colon cancer (via different genes).

Screening Tools, Detection and Treatment


Does an elevated CA 125 level always indicate that ovarian cancer is present?


Not always. Although a CA 125 blood test can be a useful tool for the diagnosis of ovarian cancer, in premenopausal women, it is not uncommon for a CA 125 count to be elevated due to benign conditions unrelated to ovarian cancer. Uterine fibroids, liver disease, inflammation of the fallopian tubes and other types of cancer can elevate a woman's CA 125 level. (ACOG Patient Education - 1996) The CA 125 test is more accurate in postmenopausal women. It is also important to note that in about 20% of cases of advanced stage disease, and 50% of cases of early stage disease, the CA 125 is NOT elevated, even though there is ovarian cancer present. As a result, the CA 125 is generally one of several tools used to diagnose ovarian cancer. One of the most important uses of the CA 125 test, however, is to evaluate progressive disease and tumor response in patients undergoing treatment, and to monitor the levels of women in remission for evidence of disease recurrence.

What is a clinical trial?


Clinical trials are carefully designed research studies that involve people. Clinical trials are conducted to find ways to improve the medical care and treatment that is available to women with ovarian cancer. Some trials test ways to detect and prevent ovarian cancer or its recurrence. There are also clinical trials that study how to improve an ovarian cancer patient’s quality of life during and after treatment.

Is the blood marker LPA (lysophosphatidic acid) an effective screening tool for ovarian cancer?


LPA or lysophosphatidic acid is a substance that stimulates the growth of ovarian tumors. One small study found that levels of LPA in blood plasma are elevated in about 90% of women with early ovarian cancer. There are clinical trials going on presently to determine the effectiveness of LPA in detecting ovarian cancer. (JAMA, August 26, 1998) However, it is still to early to know if this test will be a good screening tool. This test is not yet available to the public.

Who is best trained to treat ovarian cancer?


Gynecologic oncologists. Research has shown that the five-year survival rate is greater when the initial surgery is performed by a gynecologic oncologist. (NCI) The initial surgery and staging of ovarian cancer is critical to determining the appropriate course of treatment, and ultimately survival outcomes. A gynecologic oncologist is an ob/gyn who is further trained in oncology to specialize in the diagnosis and treatment of women with gynecologic cancers. To find a gynecologic oncologist in your area, visit the Women's Cancer Network website at www.wcn.org and select "Find a Doc," or call 1-800-444-4441.

If there are no accurate screening tools, how is ovarian cancer diagnosed?


An exploratory surgical procedure called laparotomy is generally required for the definitive diagnosis of ovarian cancer. During this procedure, cysts or other suspicious areas must be removed and biopsied. After the incision is made, the surgeon assesses the fluid and cells in the abdominal cavity. If the lesion is cancerous, the surgeon continues with a process called surgical staging to ascertain how far the cancer has spread
 
SOURCE/Ovarian Cancer National Alliance http://www.ovariancancer.org/