Listening to the body, being aware of individual risks are especially important when it comes to ovarian cancer.
As a woman, you’re most likely aware of ovarian cancer, but you’re unlikely to think that much about it. It’s easy not to; we’ve been taught that it’s the “silent killer,” rarely diagnosed until it’s too late for effective treatment. The most we can do is hope we don’t get it, right? How common is it, anyway?
More common than you might think. An estimated one out of every 78 women will be diagnosed with ovarian cancer in her lifetime, yet there seems to be so much mystery surrounding what is considered by medical experts to be the deadliest gynecological cancer for women.
To help create awareness and understanding, we discuss here the myths vs. the facts of ovarian cancer, important advances in treatments and how much further researchers have to go to find a cure.
Ovarian cancer is often called silent. Why do people think there are no symptoms?
Ovarian cancer was previously thought of as a silent disease because it is typically diagnosed in the late stages of disease when most symptoms appear. On the other hand, if detected early, most ovarian cancers can be cured but early disease is usually asymptomatic.
What are the symptoms?
We now know that ovarian cancer is not silent. Many women complain of symptoms such as persistent abdominal bloating and swelling, loss of appetite and feeling full easily, changes in bowel and bladder habits and irregular vaginal bleeding. The symptoms are common and could be due to other causes. However, if the symptoms persist over weeks, we recommend a gynecologic evaluation.
What are the most effective ways to diagnose it?
Current methods of diagnosing ovarian cancer early are not very effective. It is typically diagnosed by a patient’s symptoms, and sometimes by examination of a large abdominal mass, but often it is diagnosed on imaging with a transvaginal ultrasound or CT scan after the patient develops symptoms. The diagnosis is confirmed by biopsy or surgical resection.
To date, we do not have an effective method of screening for ovarian cancer.
Some sources suggest the CA-125 blood test. Others say it’s ineffective. Which is it?
The CA-125 blood test is not a good screening test in isolation because sometimes it is elevated in women who do not have ovarian cancer, and sometimes it is not elevated in women who do have it.
Clearly we need more research, and a screening study led by Dr. Arthur C. Fleischer is starting soon at Vanderbilt University Medical Center.
CA-125 and transvaginal ultrasound tests are still used to help diagnose ovarian cancer, but these are not screening tests for the general population. Ongoing research is needed for new strategies and approaches to early detection.
Are there certain risk factors or demographics more prone to ovarian cancer?
Ovarian cancer occurs most often after menopause. Some reproductive factors, such as breastfeeding and birth control pills, reduce ovarian cancer risk. In contrast, infertility is associated with an increased risk. One of the risk factors is a strong family history of ovarian and breast cancer. Inherited mutations in genes such as BRCA1 and BRCA2 predispose women to developing ovarian cancer.
There is something called hereditary breast and ovarian cancer syndrome, although there are some with a family history of just breast cancer or just ovarian cancer who are at higher risk. We’ve known for a very long time that women who were at higher risk for developing ovarian cancer include those who have the mutations in BRCA1 and BRCA2. Insurance does cover testing, but it’s important to seek specialty care for this.
Any provider can order these labs. Vanderbilt Health, however, offers multi-disciplinary teams that include highly trained genetics counselors who perform critical counseling to the patient that accompanies the testing. This important because genetic tests have implications for an entire family.
Why is the mortality rate so high?
Ovarian cancer is the leading cause of gynecological cancer death in the United States. The high mortality rate is due to the fact that it is typically diagnosed only once it has become widespread within the peritoneal cavity. If diagnosed early, at stage 1, most ovarian cancers can be cured.
Most symptoms that are usually associated with ovarian cancer are when the disease is already at a stage 3 or 4. Nevertheless, women need to be aware of what those symptoms are and to seek help as early as possible.
People are really not aware of these cancers. They’re very aware of breast cancer, but not as aware of other deadly cancers out there. For ovarian cancer, the family history link only accounts for about 10 percent of women who develop it.
What are some of the most effective treatment therapies available now, either new or otherwise?
Treatment of ovarian cancer combines aggressive surgery to remove as much tumor as possible and chemotherapy given through the veins. Depending on the extent of the cancer, sometimes the surgery is performed first followed by six cycles of chemotherapy. Other patients may receive chemotherapy first to shrink the cancer and make it more amenable to surgical resection, followed by additional chemotherapy to clean up any cancer that may be left behind.
One of the biggest advances in therapy has been the addition of a class of drugs called PAPR inhibitors as maintenance therapy after the completion of initial therapy in patients who have inherited a BRCA 1 or 2 gene mutation or whose tumors have a BRCA1 or 2 mutation or other cause to have defects in DNA damage repair. These medications are typically pills that are taken once or twice a day for two to three years.
In the SOLO-1 trial, women with a BRCA1 or BRCA2 mutation who had advanced ovarian cancer that had responded to primary therapy were randomized to receive maintenance therapy with olaparib or placebo. The time until the cancer recurred was increased from 13.8 months in women receiving placebo to 56 months in women treated with olaparib for 24 months after their chemotherapy was completed.
This is an important reason why all women with advanced-stage ovarian cancer should undergo both genetic and tumor testing to see if they might be among the women who might benefit most from these medications.
Does Vanderbilt have any clinical trials for ovarian cancer patients?
Vanderbilt is a National Comprehensive Cancer Center site, one of only a few in the country, and has a large portfolio of clinical trials for people diagnosed with all types of cancer, including ovarian. Several clinical trials are open specifically for women diagnosed with recurrent ovarian cancer.
Is there anything you can do to reduce your risk or prevent ovarian cancer?
Approximately 1 in 78 women will develop ovarian cancer over her lifetime. For some women the risk is increased because of a strong family history of ovarian and breast cancer.
According to the Foundation for Women’s Cancer, it is important for a woman to learn about individual risk, which includes understanding and awareness of her family history. Personal history of infertility and not bearing children are risk factors. Pregnancy and use of oral contraceptive pills decrease the risk.
It is important for women to listen to their bodies for symptoms, such as bloating, abdominal swelling and pain, difficulties eating or feeling full quickly. If the symptoms last for more than a few weeks it is important to seek evaluation by gynecologist.
Unfortunately, there is no effective screening test. More research is urgently needed. If a woman develops symptoms that persist and her gynecologist or other provider considers that ovarian cancer is a possibility, it is important to seek care from a gynecologic oncologist, a specialist in this area.
- The Vanderbilt-Ingram Cancer Center is a national leader in patient care and research. Vanderbilt offers the region’s most complete range of oncology care, from advanced imaging to team-based treatment options to genetic cancer medicine and the latest in therapies being studied in clinical trials. Learn more here or call for an appointment: 615-936-8422 or toll-free 877-936-8422.
- Need to find a gynecologist or just have more women’s health questions? Visit the Vanderbilt Center for Women’s Health or call 615-343-5700 for more information.