September 26, 2016 | by Jay Fernandez
Though it only accounts for about 3 percent of all women’s cancers, ovarian cancer is the most deadly of those that affect the female reproductive system. More than 20,000 women are diagnosed with ovarian cancer each year in the United States, with about two thirds of those cases becoming fatal, making it the fifth leading cause of cancer death.
The good news is that incidence and mortality rates for ovarian cancer have decreased for nearly every group of women over the last 20 years. And new, potentially more effective treatments are being developed every day. The more frustrating news is that ovarian cancer remains one of the most challenging cancers to detect.
There are several kinds of ovarian cancer, depending on which type of cells the cancer attacks, and it does respond well to treatment if caught early. So it’s essential for women to become aware of potential risk factors, family histories of relevant cancers, telling symptoms and the limits of detection. (Fallopian tube cancer and primary peritoneal carcinoma are very similar to ovarian cancer and are treated much the same way.)
City of Hope is a national leader in the research and treatment of gynecological cancers, with doctors and researchers perpetually working to advance technologies and techniques, diagnostic tools and innovative treatments to improve detection and outcomes for patients. Ernest S. Han, M.D., Ph.D., assistant professor in City of Hope’s Division of Surgical Oncology, is a specialist in both minimally invasive surgery and drug therapy treatments for women suffering from ovarian cancer.
Here, Han helps illuminate five key facts about ovarian cancer and how women can be best informed.
1. There are some well-established risk factors.
The risk of ovarian cancer rises with age. Most cases occur in women over the age of 60, while approximately 90 percent of women who get ovarian cancer are 40 years or older. Women with a close relative that has had ovarian cancer are also at increased risk, as are those of an Ashkenazi Jewish background.
“Be aware of family history,” said Han. “Ten to 15 percent of ovarian cancers are genetically driven. Talk to your health care provider. Genetic testing may be offered.”
Women who have not given birth or who are infertile are at higher risk, as are women who have mutations in BRCA genes or who have battled other cancers, such as cervical, breast or colorectal cancer. Studies also suggest that taking estrogen alone for more than 10 years — typically as part of postmenopausal hormone replacement therapy — can elevate the risk of ovarian cancer. Obesity may also increase the risk.
2. It is possible to lower those risks.
Studies have shown that birth control pills (oral contraceptives), if taken for five years or more, may cut the risk of certain types of ovarian cancer in half, though they can have other negative side effects. Pregnancy and breastfeeding also appear to lower risk. Maintaining a healthy diet and body weight have an impact, while recent studies have linked regular exercise to both lowered risk and better outcomes during treatment.
Especially high-risk women — for instance, those with a widespread history of family members who have gotten ovarian and other gynecologic cancers — can have their ovaries and uterus removed. Tubal ligation has also been shown to lower the risk of ovarian cancer.
3. Early detection is difficult.
Unfortunately, symptoms of ovarian cancer often do not manifest until the cancer has advanced or spread to other areas. And there is not yet a screening test that is reliable or accurate, so doctors do not currently recommend them (which is true of all gynecologic cancers, except for cervical cancer).
“Right now, it’s very disappointing,” admitted Han. “There is a new test called Risk of Ovarian Cancer Algorithm, or ROCA, that has been marketed, but a recent announcement by the FDA recommends against the use of currently available tests to screen ovarian cancer. These tests are not accurate and reliable enough to warrant their use.”
At this time, doctors can only educate women to be aware of potential symptoms of ovarian cancer and have them promptly evaluated. Patients may undergo pelvic exams, blood tests and/or imaging tests as part of their health care provider’s evaluation. Researchers continue to look for new methods that could improve early detection.
4. Heightened body awareness is essential.
Since ovarian cancer is so difficult to detect, being vigilant and in tune with the state of one’s body is the best way to potentially catch it early. Common symptoms that have been found in women with ovarian cancer include bloating, pelvic or abdominal pain, feeling quickly full when eating and noticeable changes in urination. While these symptoms may be the result of something benign or other than ovarian cancer, the key is whether they represent a distinct and/or persistent change.
“The best thing we can do is monitor for symptoms,” said Han. “Be aware of your body: changes to appetite, pains in pelvic area, bloating. Keep in mind, though, these are not necessarily early symptoms of cancer.”
5. Most treatments for ovarian cancer entail a combination of surgery and chemotherapy.
Patients should strongly consider seeking out a gynecologic oncologist to develop an appropriate treatment plan. Gynecologic oncologists are specially trained doctors who focus on cancers that develop from the female reproductive tract.
Any treatment plan developed by one’s gynecologic oncologist is, of course, tailored to the individual patient, but ovarian cancer patients are commonly treated with both surgery and chemotherapy. A gynecologic oncologist will help the patient to decide whether it is appropriate to start with surgery or chemotherapy. Newer, more targeted drug therapies are being developed all the time, and City of Hope researchers are running a number of clinical trials to improve treatment.
“Immunotherapies are, of course, a hot topic — and that field is quickly evolving. There have been some dramatic results using these types of therapies in other cancers,” said Han. “At City of Hope, we are also using vaccines that target ovarian cancer-related proteins such as p53 and trying to harness the immune system to improve the fight against ovarian cancers.
Another relevant new treatment is hyperthermic intraperitoneal chemotherapy, which is essentially heated chemotherapy given during an operation. In the near future, we hope to use new imaging technologies to better detect cancers during an operation that may not be visible to the human eye.”
Learn more about City of Hope's ovarian cancer program. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.