What is ovarian cancer?
It's a cancer that strikes a woman's ovaries, the small almond-shaped organs that produce and release eggs. Unfortunately, the disease is characterized by symptoms so subtle that they often go unnoticed until the cancer has spread elsewhere. Most women who develop it, in fact, get a diagnosis only when the disease is far advanced. About 15 to 20 percent of ovarian cancer patients will survive more than 5 years after being diagnosed. If the cancer is caught early, however, the five year survival rate is 90 percent. The American Cancer Society estimates that over 20,000 women will be diagnosed with ovarian cancer in a given year.
Who's at the highest risk?
Women over 50 are most likely to develop this cancer, although it's found in younger women as well. You're also at higher-than-average risk if one or more of the following symptoms is true of you:
- You have a relative who's had endometrial, colon, or breast cancer, especially one in your immediate family.
- You've had endometrial, colon or breast cancer.
- You have the inherited BRCA1 or BRCA2 gene mutations (together, these seem to account for 16 to 60 percent of all ovarian-cancer cases).
Other possible risk factors include obesity, a high-fat diet and the use of talc in the genital area, but they remain unconfirmed.
In a study reported in the Journal of the National Cancer Institute, Norwegian researchers found a correlation between height and weight during a woman's teens and her chances of developing ovarian cancer as an adult. Teens whose body mass index (BMI) was in the top 15 percent or who were roughly 5 feet 7 inches (175 cm) tall or taller were at a greater risk for ovarian cancer later in life.
Researchers previously thought that women who took fertility drugs were at a higher risk for ovarian cancer. A comprehensive analysis of available data by University of Pittsburgh researchers released February 1, 2002 found no evidence of this, but subsequent studies have suggested that prolonged use of fertility drugs (particularly Clomid) may increase a women's risk. Research continues in this area.
Some research also suggests that estrogen replacement therapy (ERT) when used for many years may increase the risk of the disease -- an American Cancer Society study of more than 200,000 postmenopausal women found that women who continued to use ERT after 10 years were twice as likely to die of ovarian cancer as women who had never had estrogen replacement therapy. The link between ERT and ovarian cancer is further supported by a study of over 44,000 women reported in the July 17, 2002 issue of the Journal of the American Medical Association. In this study, women on ERT were found to have a 60 percent greater risk of developing ovarian cancer than women who had never used hormone replacement therapy.
According to a 1998 study, the rate of ovarian cancer that runs in families may be higher among Jewish women than among their non-Jewish counterparts -- a difference the researchers ascribe to the presence of more BRCA1 and BRCA2 genes in the Jewish families. Women who are Ashkenazi (Eastern European) Jews and have an immediate family member who's had the cancer are at significantly greater risk of getting it.
Factors that make ovarian cancer less likely are pregnancy, breastfeeding, and the use of oral contraceptives. A recent study found that oral contraceptives can cut the risk of ovarian cancer in half. And pills that are high in progestin cut that risk even further -- by another 50 percent, according to researchers at the Duke University Medical Center.
Is ovarian cancer always fatal?
No. The earlier the cancer is detected, the greater the chance that treatment will be successful.
What are the signs of ovarian cancer?
A new method of testing may greatly improve your chances of early detection. In a 2008 study conducted at the Fred Hutchinson Cancer Research Center, doctors found that women reporting symptoms of ovarian cancer who took a simple blood test improved their detection rates by 20 percent. If you consistently experience several of the following problems, make an appointment with your doctor to be on the safe side.
- Bloating, fullness, and pressure in the abdomen
- Pain in the abdomen, pelvis, or lower back
- Unexplained changes in your bowel movements
- Unexplained weight loss or weight gain, particularly weight gain in the abdomen
- Frequent or urgent urination
- Pain during intercourse
How will my doctor check for ovarian cancer?
First you'll have a pelvic exam. Your doctor will examine the area around your ovaries for unusual lumps and will check the ovaries themselves to see if they're swollen. You may also have a CT or CAT scan, ultrasound, or one of the other tests that provide your doctor with an image of your internal organs. A surgical procedure called a laparotomy is used to confirm the presence of cancer.
Can I be cured?
Yes, if your cancer is caught early. Women diagnosed at an early stage of the disease (they make up about 20 percent of all cases) are ordinarily treated successfully. According to the National Ovarian Cancer Coalition, most of them are cured. Unfortunately for women diagnosed in the later stages of the disease, the survival rate can be as low as 29 percent.
What's the treatment?
Ovarian cancer is usually treated with a combination of surgery and chemotherapy. Sometimes radiation therapy is also used. The surgery is generally what amounts to a radical hysterectomy -- removal of the reproductive organs and some lymph glands -- and it often takes place as soon as the cancer is found, during the laparotomy.
If you have surgery, chemotherapy usually follows. You may also have radiation therapy, in which a beam of radiation is targeted at the cancer and is used to eliminate it. The radiation treatments are painless, although you may find yourself much more tired than usual.
A blood test to measure something called CA-125, which is produced by ovarian cancer cells, may help your doctor track the effectiveness of your treatment. Since CA-125 is also produced in the body by conditions other than cancer, it shouldn't be used to diagnose the disease, according to the National Ovarian Cancer Coalition. However, researchers have found that once the disease is diagnosed and treated, the levels of CA-125 in your blood may indicate whether the disease is progressing or not.
Should I consider alternative treatments?
Increasingly, women with cancer are choosing to use alternative therapies in addition to the standard ones. Special diets, herbal treatments, and visualization exercises are among the increasingly popular complements to traditional approaches. If you do decide to supplement your treatment with alternative therapies, let your doctor know. It's especially important to tell him or her about the herbal remedies or supplements you're taking, since some of these can interact in a harmful way with prescription or over-the-counter drugs.
People who have cancer also need the support of their friends, their families, and often others who are facing the disease. Researchers at Stanford University have shown that participating in a support group for cancer patients may increase both your survival time and your quality of life. For these reasons, your doctor may encourage you to join such a group. If you'd like more information, contact the National Ovarian Cancer Coalition at http://www.ovarian.org or at its hotline at (888) OVARIAN.
Schildkraut JM, et al. Impact of progestin and estrogen potency in oral contraceptives on ovarian cancer risk. J Natl Cancer Inst 2002 Jan 2;94(1):32-38.
CA-125 Analysis. National Ovarian Cancer Coalition.
Rustin GJ, et al. Use of CA-125 to define progression of ovarian cancer in patients with persistently elevated levels. J Clin Oncol 2001 Oct 15;19(20):4054-7.
Other causes of rising in a CA-125. National Ovarian Cancer Coalition.
Olson SH, et al. Symptoms of ovarian cancer. Obstet Gynecol 2001 Aug;98(2):212-7.
Tobias DH, et al. Founder BRCA 1 and 2 mutations among a consecutive series of Askenazi Jewish ovarian cancer patients. Gynecol Oncol 2000 Aug;78(2):148-51.
Steinberg KK, et al. Increased risk for familial ovarian cancer among Jewish women: a population-based case-control study. Genet Epidemiol 1998;15(1):51-9.M
Rodriguez C, et al. Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women. JAMA 2001 Mar 21;285(11):1460-5.
Do We Know What Causes Ovarian Cancer? American Cancer Society.
Can Ovarian Cancer Be Prevented? American Cancer Society.
Gertig DM, et al. Prospective study of talc use and ovarian cancer. J Natl Cancer Inst 2000 Feb 2;92(3):249-52.
Ness RB, et al. Infertility, Fertility Drugs, and Ovarian Cancer: A Pooled Analysis of Case-Control Studies. Am. J. Epidemiol. 2002 155: 210-216.
Lacey JV et al. Long-term use of estrogen-only hormone therapy linked with increased risk of ovarian cancer. Journal of the American Medical Association. July 17, 2002. 288: 334-341.
Engeland A, et al. Height, body mass index, and ovarian cancer: a follow-up of 1.1 million Norwegian woman. J Natl Cancer Inst. 2003 Aug 20;95(16):1244-8..
What Are the Key Statistics About Ovarian Cancer? Revised 6-23-03. American Cancer Society.
American Cancer Society. What Causes Ovarian Cancer? February 2008.
National Ovarian Cancer Coalition. What is Ovarian Cancer?
National Cancer Institute. Genetic Testing for BRCA1 and BRCA2: It's Your Choice.
American Cancer Society. How is ovarian cancer found? June 2006.
National Ovarian Cancer Coalition. What Everyone Should Know About Ovarian Cancer. May 2006.
Fred Hutchinson Cancer Research Center. Symptom screening plus a simple blood test equals a 20 percent jump in early detection of ovarian cancer. June 2008.