March 22, 2014

Mark Taylor, MD
Obstetrics and Gynecology (OB/GYN), Primary Care
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Ovarian cancer has long been known as a silent killer because there are few symptoms that present themselves until the disease has reached an advanced stage when it is least curable. And, unlike breast cancer which uses mammograms, and cervical cancer which uses pap smears as screening tools, ovarian cancer does not have a good screening test. Therefore, 75 percent of all ovarian cancers are diagnosed in stage three or four, and the outcome is grave. The five year survival rate for ovarian cancer is 45 percent compared to nearly 80 percent for breast cancer and 70 percent for invasive cervical cancer.

One in 80 women will be diagnosed with ovarian cancer in her lifetime. The life-long age of diagnosis is 63. It is the second most common malignancy and fifth leading cause of cancer death in women.

The American Cancer Society, along with several medical societies, has agreed on a set of symptoms that may help with earlier detection.


 – Nausea and vomiting

 – Persistent swelling

 – Bloating or abdominal distention

 – Pressure or pain in the abdomen

 – Gastrointestinal upset or bowel changes

 – Difficulty eating or feeling full

 – Frequent or urgent need to urinate

 – Abdominal pain

 – Lethargy/Weakness

 – Weight loss or weight gain

 – Pelvic pain

These symptoms are common and may mimic other disorders. Most often, they do not indicate ovarian cancer and may be mistaken for other diseases including gallbladder disease, a benign tumor, inflammatory bowel disease and liver failure. However, if a woman experiences two or more of these symptoms that occur simultaneously and increase in severity over time, she should be checked by her physician.

Early Detection and Diagnosis
Early detection of ovarian cancer is crucial. Still, only 20 percent of ovarian cancer is found before it has spread. Diagnosis of ovarian cancer is most commonly made at a woman’s regular gynecological exam. The best index for diagnosis is suspicion by her physician which makes the annual exam a key component to early detection and diagnosis. During the pelvic exam, the physician palpates a woman’s ovaries for the presence of ovarian abnormalities such as ovarian cysts or fibroid tumors. If the physician finds any abnormalities, he or she may follow-up with additional tests. The cure rate, if found early, is colossal and, if diagnosed in stage one or two, is nearly 90 percent compared to 45 percent in stage three or four. But 75 percent of women are still diagnosed in the advanced stages, when the prognosis is poor.

Although a woman’s best defense to early detection is her annual exam, a physician may recommend that a woman with a family history of ovarian, breast, colorectal or endometrial cancer participate in a genetic risk assessment. This enables physicians to provide an individualized and quantified assessment of risk, as well as options for tailored screening and prevention strategies including prophylactic surgical intervention.Risk assessment may include a CA 125 blood test. CA 125 is a protein made by the body in response to many different conditions. Many women with ovarian cancer have abnormally high levels of CA 125 in their blood. However, a number of non-cancerous conditions also cause elevated CA 125 levels, and many women with early-stage ovarian cancer have normal CA 125 levels. Because of this lack of specificity, the CA 125 test isn’t used for routine screening in average-risk women and is of uncertain benefit in high-risk women.

HE4, or human epididymis protein 4, is another relatively new tumor marker for ovarian cancer. The test is used to monitor the recurrence and progression of ovarian cancer. The most promising advancement is a combination of markers and hormones which is similar to the quad screening, which is a test a woman takes while she is pregnant to help diagnose certain birth defects.

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Initial treatment for suspected ovarian cancer is surgery to confirm diagnosis and determine its stage. Many times a physician may suspect an isolated tumor but during surgery finds that the cancer is wide-spread. This discovery may change treatment options and decisions. Chemotherapy almost always follows surgery and its success is largely based on getting rid of as much of the tumor as possible during the surgical procedure.

It is not completely clear what causes ovarian cancer. But, there are certain factors that may reduce the risk of developing ovarian cancer.

 – Oral contraceptives or “the pill”: Anything that interrupts incessant ovulation month after month, year after year, including the birth control pill is shown to reduce the risk of ovarian cancer. The longer a woman is on the pill, the more protected she is from developing ovarian cancer. If she is on the pill for seven or more years, there is a six-fold risk decrease in developing the disease.

 – Pregnancy and breast-feeding: Having at least one child lowers the risk of developing ovarian cancer and the more times a woman is pregnant, the more protected she is from the disease. Breast-feeding and the longer a woman breastfeeds may reduce the risk.

 – Surgical procedures: Having a woman’s “tubes tied” helps reduce the risk ovarian cancer. Hysterectomy is also shown to reduce the risk of ovarian cancer. In both procedures, the blood flow to the ovaries may be diminished which may reduce the risk of ovarian cancer.

 – Annual exam: Recently changed recommendations regarding the frequency of pap smears still does not mean that a woman does not need a yearly exam. Purely feeling a mass during a pelvic exam may help detect ovarian cancer.

 – Infertility and treatment drugs: Infertility may increase the risk of ovarian cancer but treatment of infertility may not.

 – Pain relievers: Regular use of aspirin or other pain relievers in postmenopausal women leads to lower estrogen levels, which could contribute to a reduced risk of ovarian cancer.

There are certain factors that may increase a woman’s risk of developing ovarian cancer.

Inherited gene mutations: While the majority of women who develop ovarian cancer don’t have an inherited gene mutation, the most significant risk factor for ovarian cancer is having an inherited mutation in one of two genes called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). Women with the BRCA1 mutation have a 35 to 70 chance of developing ovarian cancer than do women without this mutation, and for women with a BRCA2 mutation, the chance is between 10 and 30 percent. For most women, the overall lifetime risk is about 1.5 percent, according to the American Cancer Society. You’re at particularly high risk of carrying these types of mutations if you’re of Ashkenazi Jewish descent.

Family history: Sometimes, ovarian cancer occurs in more than one family member but isn’t the result of any known inherited gene mutation. Having a family history of ovarian cancer increases your risk of the disease by 10 to 15 percent.

A history of breast cancer: If you’ve been diagnosed with breast cancer, your risk of ovarian cancer also is elevated.

Age:Ovarian cancer most often develops after menopause. Your risk of ovarian cancer increases with age through your late 70s. Although most cases of ovarian cancer are diagnosed in post-menopausal women, the disease also occurs in premenopausal women.

Smoking: Smoking is shown to increase the risk of ovarian cancer

Obesity: Women who are obese have a greater risk of developing ovarian cancer. Obesity may also be linked to more-aggressive ovarian cancers, which can result in a shorter time to disease relapse and a decrease in the overall survival rate.

Talc on surgical gloves: The use of talc on surgical gloves is controversial as to its risk in developing ovarian cancer; nonetheless, the use of talc on surgical gloves has been largely abandoned.