Ovarian cancer is
the deadliest form of gynecological cancer in the United States. It's the second most common after uterine cancer.
Your chance of survival greatly increases with early detection. Survival rates when detected during stage I
can be up to 90%, with a five-year survival rate of up to 70% when detected during stage II.
But unlike many other cancers, there's no preventive screening for early detection of ovarian cancer. Just women being in tune with their bodies and speaking up to their doctor when something doesn't feel right.
“Researchers have done many studies looking at ultrasounds and tumor markers, and nothing has panned out to help us find ovarian cancer earlier," explains
Amanda Jackson, MD, a gynecologic oncology specialist with The Christ Hospital Physicians. “Since women know their bodies better than anyone else, we want to be sure they are aware of ovarian cancer symptoms and alert their gynecologist or primary care doctor if they are concerned."
Ovarian cancer, ovarian cyst or something else?
Ovarian cancer symptoms mimic other gastrointestinal conditions and
ovarian cysts, so determining what is wrong can be difficult for women on their own.
“Unfortunately, ovarian cancer doesn't tend to have a lot of symptoms in its early stages," Dr. Jackson says. “That's why they call ovarian cancer a 'silent killer,' like pancreatic cancer. It tends to cause symptoms only when it's more advanced."
According to the American Cancer Society, the most common symptoms of ovarian cancer are:
Bloating or abdominal fullness
Change in bowel habits
Pelvic or abdominal pressure or pain
Trouble eating or feeling full quickly
Urinary symptoms such as urgency or frequency
Ovarian cancer symptoms tend to be persistent, occur more often or be more severe. It's important to make an appointment with your gynecologist or primary care provider to investigate the cause.
Family history and ovarian cancer
In some ways, genetics can be the exception for helping women determine early whether or not they are at an increased risk for ovarian cancer. Ovarian cancer often runs in families. Women's ovarian cancer risk increases if their mother, sister or daughter had or has ovarian cancer.
While an increased risk based on family history doesn't necessarily mean you will develop ovarian cancer, knowing that history should encourage women to be that much more vigilant in paying attention to their bodies, and it's a good reason to talk to your doctor.
When detailing family history, Dr. Jackson advises patients to tell their doctor about siblings, parents, grandparents, and aunts and uncles who have had any type of cancer. For example, if your grandmother and all her sisters had a specific type of cancer, it would raise a red flag.
The cancers in family members that raise the risk for ovarian cancers (besides ovarian cancer) include:
Breast
Colon
Melanoma
Pancreas
Uterine
A family history of the BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2) genes can determine cancer risks in women. BRCA genes produce proteins to repair damaged DNA. However, their mutations make cells more likely to divide and change rapidly. These changes can lead to conditions like ovarian cancer.
According to the National Cancer Institute, about 1.2% of women will develop ovarian cancer. However, those odds rise dramatically for those with BRCA mutations. Ovarian cancer occurs by ages 70 to 80 in:
If doctors determine women have a high risk of developing ovarian cancer, they will likely suggest genetic testing. If you have family history, you can also reach out to the
genetic counselors with The Christ Hospital Precision Health to see if genetic testing is right for you.
Diagnosing ovarian cancer
Pap smears detect cervical cancer, and mammograms find breast cancer early. For endometrial cancer, doctors often are tipped off because of unusual vaginal bleeding, especially after menopause, Dr. Jackson says.
Without a preventative screening test to detect ovarian cancer, the best chance for an early ovarian cancer diagnosis is for a gynecologist to discover an ovarian or abdominal mass during an annual pelvic exam.
Only 20% of ovarian cancers are found at an early stage before they have spread to other areas of the body, Dr. Jackson says. That means 80% of ovarian cancers are found at stages 3 or 4, which means they have spread to other organs.
Doctors diagnose ovarian cancer using:
The CA-125 (cancer antigen 125) blood test is a tumor marker associated with ovarian cancer. It isn't considered a screening tool because benign conditions and other gynecological cancers can increase CA-125 in the blood. It is also not always elevated in early ovarian cancer.
For women who have a very high risk of ovarian cancer, doctors may use the test to look for early signs of the disease. The blood test can also show the effectiveness of cancer treatment.
Treatment for ovarian cancer
Doctors most commonly use a combination of chemotherapy and surgery to treat ovarian cancer.
“If patients have a pelvic mass with no clear spread of cancer, we will do surgery first to determine a diagnosis," Dr. Jackson says. “Sometimes patients will present with cancer throughout the abdomen, and we will do a biopsy to get more information, then chemotherapy to shrink the cancer followed by more surgery and chemotherapy."
Most patients will have six cycles of chemotherapy every three weeks for 18 weeks. Some patients will have surgery in the middle of treatments to remove the cancer and then continue the rest of the treatments after surgery. Patients with a high-risk gene mutation will stay on a Parp inhibitor medication afterward, Dr. Jackson adds.
Generally, surgeries to treat pelvic masses without evidence of cancer spread can likely use minimally invasive techniques, including laparoscopic or robotic surgeries with small incisions. Even if a woman requires a hysterectomy, surgeons can use
minimally invasive approaches, and women can often go home that day or the next.
Metastatic ovarian cancer usually requires “open" surgery, using longer incisions rather than laparoscopic techniques. This more extensive surgery may be needed if the cancer has spread to the liver, spleen bladder or bowel so surgeons can remove as much cancer as possible, Dr. Jackson says.
Getting a second opinion for ovarian cancer
If you've been diagnosed with ovarian cancer, especially a form that is not responding well to treatment, you may benefit from a second opinion.
The Christ Hospital second opinion program helps you connect with physicians who specialize in your type of cancer so you can explore advanced treatment options and clinical research trials.
Through The Christ Hospital's membership in the
Dana-Farber Brigham Cancer Care Collaborative, you can also get expanded access to some of the world's brightest minds in cancer care and research to create treatment plans for exceptionally rare and difficult to treat forms of cancer.
If you have questions about finding a women's health specialist for your annual exam or advanced women's healthcare, contact our ezCare Concierge nurse navigator. It's a free service to review your healthcare questions, find an expert provider, and verify your insurance coverage.