Cancer of the ovary

PHILIP S. CHUA M.D FACS, FPCS

‘Women who could not get pregnant or who use fertility drugs appear to have a higher risk for ovarian cancer…’

ROUGHLY 1 in 72 (1.39%) women born today will have cancer of the ovary. in The American Cancer Society estimated for 2011 that about 21,990 women were diagnosed with ovarian cancer and about 15,460 died from it.

Ovarian cancer is the ninth most common malignancy among females and ranks fifth in cancer deaths among them. It accounts for 3% of all cancers in women.

What is ovarian cancer?

The ovaries are twin organs that produce women’s eggs and the main source of the hormones estrogen and progesterone. The malignancy of the ovary is called ovarian cancer.

What are the risk factors?

Heredity: Women with a family history of cancer of the ovaries, breast or colon have a greater chance of acquiring ovarian cancer. Experts believe that about 10 to 15% of cancer of the ovary and the breast are induced by the inherited genetic changes, including BRCA 1 and BRCA 2 gene mutations. Those with a strong family history should ask their physician whether a closer follow-up is needed.

Gender: All women, simply because they are women and have ovaries are at risk to a varying degree for developing ovarian cancer. This fact alone should motivate all females to be on guard for any signs or symptoms of this cancer.

Age: This is the strongest risk factor for ovarian cancer. It has a higher probability after menopause. The use of postmenopausal hormone therapy may also increase the risk. The association appears strongest among those who take estrogen without progesterone for at least 5 to 10 years. It is not clear if taking the combination of the two drugs also increases the risk. The younger the relative who developed ovarian cancer, the greater the risk is for the female to have cancer of the ovary. The highest incidence (23.1%) is found between the age 55 and 64, and second highest (19.7%) among those age 65 to 74; 19.1% for those between 45-54; 18.2% between 75-84; 8% for age 85 and older. Those who are under 20 have 1.2% incidence; between 20-34, 3.5%; and, 35 to 44, 7.3%. The median age is 63.

Obesity: Moderately overweight or obese women are at a higher risk for ovarian cancer than normal weight women. The heavier they are, the higher the risk is. The death rates for this cancer are likewise greater for obese women. It behooves not only women but men and children, to maintain a normal weight through healthy lifestyle.

Infertility and Drugs: Women who could not get pregnant or who use fertility drugs appear to have a higher risk for ovarian cancer, compared to women who have had children, women who breastfed, and women who have used oral contraceptives

What are the symptoms?

The most common complaints are a sense of bloating, abdominal or pelvic pains, discomfort in eating and fullness, and urinary frequency or urgency. The other symptoms can include back pains, pain during sex, upset stomach, menstrual changes, constipation, changes in bowel habits, persistent fatigue, and unexplained weight loss or weight gain. While these could also be symptoms for other conditions, when they persist for a week or two, gynecologic consultation is prudent.

Why is ovarian cancer harder to diagnose?

Unfortunately, the ovaries are so tiny (size of an almond) and buried deep in the abdomen that even with a tumor, they are not easily palpable by the examining hand of the physician. Only when the cancer has grown into a huge mass that it could be felt. In view of this, only about 19% of ovarian cancer are discovered before the cancer has spread to other organs, 81% diagnosed in more advanced stages.

What are the screening tests?

Before the ovarian cancer causes obvious symptoms or detected in routine gynecologic exam, there are two screening procedures that can be used: 1. Blood test for elevated levels of a protein called CA-125; 2. Ultrasound of the ovaries. Sadly, when used for females of average risk, these screening tests have not been found to save lives. So, they are recommended only for women with strong risk factors.

How is diagnosis made?

Today, with all the advances in medical technology, 77% of ovarian cancer are diagnosed when they are in an advanced stage because some symptoms are so subtle, either ignored or misinterpreted. Unfortunately, even routine pelvic exams have not been helpful when it is in its early stage and still treatable. The earlier the diagnosis is made, the greater the chance for survival from this deadly cancer. In spite of this, routine pelvic exams can still be valuable for the physician in detecting any variations or changes from baseline conditions. Vaginal exam is recommended annually for women age 18 and older. For those 35 and older, annual recto-vaginal exam (checking the rectum and vagina at the same time) is preferred. If the screening tests are suspicious of ovarian cancer, CT scan and or biopsy may be needed to confirm the diagnosis.

What is the treatment?

In recent years, the management of ovarian cancer has been more effective, especially with early detection. The initial treatment after diagnosis is usually surgery called optimal debulking, removing as much of the cancer tissues as possible, or optimal cytoreduction. The need for chemotherapy depends on the stage of the cancer. It behooves the patient to discuss in detail with her attending physician the proposed treatment and all its details and ramifications.

What is the prognosis?

This depends a lot on how early diagnosis was made, and whether the cancer is Stage I (confined to the ovary or both ovaries), or the cancer has spread to other organs in the abdomen (Stage III), or has spread to organs outside the abdomen (Stage IV). About 75% (3 out of 4) of ovarian cancer patients live for at least one year after diagnosis. Forty-six percent are still alive at least after 5 years. If diagnosed and treated before the cancer has spread outside the ovary, the 5-year survival rate is 94%.