Ovarian Cancer Awareness Month
As September is associated with ovarian cancer awareness, the following discussion helps us understand how to recognize symptoms, diagnostic testing, treatment options, and survivability.
Ovarian cancer can present very insidiously. Symptoms include abdominal bloating, early eating satiety, pelvic pain, fatigue, back pain, and change in bowel habits. A woman’s lifetime risk for ovarian cancer is 1.1%, and the risk for developing all new cancers is 1%. There are several types of ovarian cancer, but Epithelial ovarian carcinoma (EOC), which affects the cells that cover the outer surface of the ovary, is the most common type of ovarian cancer. In fact, by the time EOC is diagnosed, nearly 70% of women with this type of cancer are already in the advanced stages.
Ovarian cancer affects more women, typically between the ages of 55-64, with a median age for diagnosis at 63, and can also be genetically linked. Most genetically linked ovarian cancers can be traced to mutations within the tumor suppressor genes BRCA1 and BRCA2, which play a role in DNA repair. Women with Lynch Syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), can also have more instances of cancer than expected and at an earlier age, as Lynch syndrome is a hereditary condition that increases the risk of many kinds of cancer. Other possible factors contributing to the development of ovarian cancer include being overweight/obese, postmenopausal hormone replacement therapy, endometriosis, early menarche or late menopause, and nulliparity.
Let’s talk Statistics! Statistically, the American Cancer Society states ovarian cancer ranks 5th in cancer death in women. There is a 1:78 risk of getting ovarian cancer and a 1:108 chance of dying from ovarian cancer. It affects mainly older women; and is more common in white women than black women. The incidence has been falling over the past 20 years, and it is unknown if the decline is related to oral contraceptive usage, decreased use of post-menopausal hormone therapy, or other unknown factors.
There is no suggested average risk screening protocol. Tests that may be beneficial in diagnosing and staging ovarian cancer include ultrasound, CT scan, PET scan, MRI, laparoscopy, colonoscopy, and biopsy. Other blood tests like CA-125, alpha-fetoprotein, HCG, and LDH levels may be helpful. However, while the CA-125 blood test can be used to track treatment effectiveness, it is not a great resource for screening. Benign conditions such as endometriosis, cirrhosis, menses, PID, or fibroids may also raise this level. For familial cases, genetic testing and consultation are warranted as well. Once testing is complete, including biopsy, staging, and treatment options, five-year survival statistics can be discussed. On a side note, Fallopian tube cancers are rarer than ovarian, but despite better treatment options for ovarian, the 5-year survivability is still much lower than for ovarian cancer.
If one develops any new symptoms as discussed above or has a significant family history of breast/ovarian cancers, one should discuss further evaluation with their gynecologist or family physician. Surgical excision and debulking are the mainstay of treatment for ovarian cancer. Also, while chemotherapy is utilized, radiation is rarely used in treatments. Ovarian cancer-directed therapies are now more widely available. 5-year survivability has increased and is over 90% in earlier stages. So, if you have any of the above symptoms, family history, or concerns, please speak with your physician to determine if further evaluation would be necessary!!