10 Things You Didn’t Know About Ovarian Cancer
Prevention is really what we ultimately want.Ivy Wilkinson-Ryan, MD
September is Ovarian Cancer Awareness month. Each year, more than 22,000 women in the United States are diagnosed with this disease that forms in the ovaries of the female reproductive tract. Advancements in research offers new understanding about this disease, and new treatments. “Prevention is really what we ultimately want,” says Ivy Wilkinson-Ryan, MD, a gynecologic oncologist and ovarian cancer immune therapy researcher at Norris Cotton Cancer Center (NCCC). “Beyond that, being able to offer women a more consistent shot at a cure either up front or for recurrence would be amazing. We’ve gotten to a place where for some women, ovarian cancer is a chronic illness—they’re on and off chemotherapy for years, sometimes tens of years, which is a huge improvement—but our plan is to find a cure.” Here are 10 things you may not know about this type of cancer.
About 1 in 78 women in the United States will be diagnosed with ovarian cancer. The National Cancer Institute reports that ovarian cancer is the eighth most common type of cancer and fifth leading cause of cancer death in women in the United States. The overall relative five-year survival rate is 46 percent. Ovarian cancer is most common in post-menopausal women ages 55–64 but can occur in younger, pre-menopausal women as well.
About ten percent of ovarian cancers are caused by inherited BRCA1 and BRCA2 gene mutations. Genetic testing may be a good option for women with a family history of ovarian, fallopian tube or peritoneal cancer as well as breast cancer to find out if they carry either of these mutations. “For women with inherited risk, preventative measures, such as taking out the ovaries, are available,” says Wilkinson-Ryan.
Ovarian cancer is difficult to detect and diagnose early because there are few signs or symptoms before it has spread outside of the ovaries. “Women don’t often pay attention to these symptoms that can include bladder irritability, changes in bowel function, or bloating, because they are common symptoms women experience throughout their lives. If you notice an increased frequency in any of these symptoms, tell your doctor. They may schedule a pelvic ultrasound to look at your ovaries.” Eight out of 10 diagnoses occur after the cancer has advanced. Survival rates are higher if the cancer is detected before it has spread.
The most common risk factors for ovarian, fallopian tube and primary peritoneal cancer include:
- Family history – A woman whose mother or sister had ovarian, fallopian tube or primary peritoneal cancer or who has two or more relatives with ovarian cancer is at increased risk.
- Inheritance of changes in BRCA1, BRCA2 or other genes – The risk of ovarian cancer is also increased in women who have certain inherited syndromes.
- Hormone replacement therapy – There is a slightly increased risk of ovarian cancer in women who are taking or have recently taken hormone replacement therapy.
- Weight – Being overweight or obese is linked to an increased risk of ovarian and many other types of cancer.
- Endometriosis – Women who have endometriosis have a slightly increased risk of ovarian cancer. Endometriosis is a non-cancerous condition in which tissue that resembles endometrial tissue grows in other areas in the abdomen.
Protective factors for ovarian, fallopian tube and primary peritoneal cancer include:
- Oral contraceptives – Taking “the pill” lowers the risk of ovarian cancer. The decrease in risk may last up to 30 years after a woman has stopped taking oral contraceptives.
- Tubal ligation or salpingectomy – Studies have shown that tubal ligation (surgery to close both fallopian tubes) or salpingectomy (surgery to remove one or both fallopian tubes) are linked with a decreased risk of ovarian cancer. Some women at higher risk may elect to have their fallopian tubes and/or ovaries removed as a preventative measure.
- Being pregnant – Women who have had a full-term pregnancy have a decreased risk of ovarian cancer compared to women who have not been pregnant. “Multiple full-term pregnancies further decreases the risk,” says Wilkinson-Ryan.
- Breastfeeding – Breastfeeding is linked to a decreased risk of ovarian cancer.
Chance of recovery and treatment options for ovarian cancer depend on many factors including:
- The type of ovarian cancer and how much cancer there is.
- The stage and grade of the cancer.
- Whether all of the tumor can be removed by surgery.
- Whether there are changes in the BRCA1 or BRCA2 genes.
- The patient’s age and general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
New ways to prevent ovarian cancer are continuously being studied in clinical trials. “Currently, prevention has to do with identification and proper screening of at-risk patients and removal of ovaries when they’re not being used anymore,” says Wilkinson-Ryan.
New therapies used to treat ovarian cancer are now available. “We have seen FDA approval of new drugs for ovarian cancer in the last two to three years after being stagnant in that area for a long time,” notes Wilkinson-Ryan. “Very recently, a new class of therapies has been implemented for patients with BRCA mutations, called PARP inhibitors. This is one of the first steps we’ve seen toward personalized medicine.”
Even newer treatments for ovarian cancer are being studied in clinical trials. New chemotherapies and immunotherapies (using the patient’s immune system to fight cancer) are also being tested in clinical trials, as well as targeted molecular therapies and vaccine therapy. “The paradigms are, do you give someone chemotherapy that kills dividing cells? Do you target a specific mutation? Do you rev up the immune system against the cancer? We’re looking at them all,” says Wilkinson-Ryan. “We’re analyzing tons of genetic data to understand what the specific mutations are. Trials are ongoing to match those mutations with certain combinations of agents that can target them.” Patients may want to think about taking part in a clinical trial and can enter clinical trials before, during or after starting their cancer treatment.
- Ovarian cancer is best treated by a gynecologic oncologist. “Doctors who specialize in treating ovarian cancer and other cancers of the female reproductive tract are called gynecologic oncologists,” explains Wilkinson-Ryan. “We have them here at NCCC but a problem nationwide is that women with gynecologic cancers don’t get referred to a gynecologic oncologist. From a surgery standpoint, there is data supporting better outcomes for patients who are treated by gynecologic oncology specialists.”
Each individual’s genetic makeup, family history, environment, habits and behaviors are different. Your providers can assess your individual ovarian cancer risk factors and make recommendations that are appropriate for you.