Ovarian cancer is a disease of vague symptoms, which can be similar to those of stomach problems. Unlike cancers of the breast, colon, or cervix, there is no reliable general screening test that can detect ovarian cancer early. Fortunately, advances in treatment are extending the time that women with ovarian cancer can live disease-free, according to Ephraim Resnik, MD, gynecologic oncologist at Highland Medical, P.C.
According to the American Cancer Society, ovarian cancer ranks fifth in cancer deaths among women, but accounts for more deaths than any other gynecologic cancer of the female reproductive system. It is estimated that 14,070 women die from ovarian cancer in the United States annually, and 22,240 new cases of ovarian cancer are diagnosed each year.
Who is at Risk?
About 10 percent of women with ovarian cancer have an identifiable risk factor, such as a mutation of the BRCA1 or BRCA2 gene, or a strong family history of ovarian or breast cancer. “The other 90 percent of cases arise in women with no identifiable risk factors,” Dr. Resnik says.
Can Ovarian Cancer be Prevented?
There are no known lifestyle factors that can decrease the risk of ovarian cancer. About one-third of ovarian cancers start developing in the fallopian tubes and spread to the ovaries. These cancers tend to be aggressive and lethal. To reduce the risk of developing this type of ovarian cancer, women who are already having surgery for another reason may be advised to have their fallopian tubes removed at the same time if they have finished having children. “For instance, if you’re having your appendix removed, or having intestinal surgery, you could have your fallopian tubes removed at the same time,” Dr. Resnik says. “It’s a quick procedure that doesn’t entail additional risks.”
Women who have the BRCA1 or 2 gene also may consider surgery to remove the fallopian tubes and ovaries once their childbearing is complete.
What are the Signs of Ovarian Cancer?
“Symptoms of ovarian cancer are extremely vague,” Dr. Resnik says. “By the time they develop, it’s often a sign the cancer is relatively advanced.”
- Increasing abdominal size
- Pelvic or abdominal pain
- Trouble eating or feeling full quickly
- Upset stomach or heartburn
- Back pain
- Pain during sex
- Constipation or menstrual changes
Diagnosing Ovarian Cancer
Most cases of early, treatable ovarian cancer are found accidentally, Dr. Resnik says. “A woman may go for a gynecologic exam, and the doctor will feel something and order an ultrasound, which shows an ovarian mass,” he says. “Most of these are benign, but if it’s cancerous and the woman hasn’t felt any symptoms yet, her chances of successful treatment are good.”
If a woman has frequent or persistent symptoms of ovarian cancer, the doctor will perform a pelvic exam, and may order an ultrasound of the ovaries. If a growth is found on the ovary, the doctor may order a blood test to measure the level of a protein called CA-125. The test may be used to monitor changes that might happen in a woman’s cancer growth over time, and to see how well she is responding to treatment.
There is a widespread misconception that CA-125 can be used as a general screening test for ovarian cancer, Dr. Resnik says. “It has been proven again and again in major studies that neither CA-125 nor ultrasound nor a combination of the two are predictive enough to be used for general screening for ovarian cancer,” he says. “Women with ovarian cancer can have a normal CA-125 test, and women without ovarian cancer can have an abnormal test. This can lead to anxiety, stress, and unnecessary surgery.”
Treatment for ovarian cancer generally involves a combination of surgery and chemotherapy. “Some women receive surgery first, while others receive chemo first, depending on a number of factors including their overall health,” Dr. Resnik says. Surgery usually is recommended to remove the uterus, ovaries, and fallopian tubes. Lymph nodes and tissues in the pelvis and abdomen may be removed if they are found to have cancer. In some cases of early-stage disease, minimally invasive surgery can be done.
Newer treatments include targeted therapy and immunotherapy. Targeted therapy is a type of cancer treatment that uses drugs or other substances to identify and attack cancer cells while doing little damage to normal cells. Women with mutations in a BRCA gene may be treated with a type of targeted therapy called PARP inhibitors. “With targeted therapy we can prolong the duration until a woman relapses,” Dr. Resnik says.
After a woman is treated for ovarian cancer, she needs regular checkups to make sure the cancer has not returned. Dr. Resnik says, “Most recurrences occur within the first 24 months of a woman’s initial diagnosis, so frequent follow-up after treatment is very important.”