For women, ovarian cancer is a frightening malady because of its insidious nature. It’s been called a silent killer because once symptoms appear, the disease is often widespread. The key to overcoming this fear is understanding the reality of the disease and dispelling myths.
The American Cancer Society states, “Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. A woman’s risk of getting ovarian cancer during her lifetime is about 1 in 75. Her lifetime chance of dying from ovarian cancer is about 1 in 100.” Juxtapose this with the most common cancer in women, breast cancer, where a woman’s lifetime risk is 1 out of 8. Even when you consider total cancer deaths, ovarian ranks low compared to breast, lung, and colorectal. So indeed ovarian cancer is a fierce adversary, but realistically there is a much lower incidence of this type of cancer than many others.
One reason ovarian cancer is so feared is its delayed presentation of symptoms. Unlike many illnesses which telegraph their appearance early with notable symptoms, ovarian cancer often doesn’t produce noticeable problems until relatively late in its development. And when it does, the symptoms are nebulous and rarely initially recognizable as ovarian in nature. For example, a common symptom of ovarian cancer is abdominal bloating. Unfortunately, this same symptom can be associated with everything from bad sushi to irritable bowel syndrome. Common symptoms associated with ovarian cancer include:
Pain during sex.
Abdominal swelling with weight loss
As you can see, virtually all women will experience at least one of these symptoms intermittently. The distinguishing factor often is a persistence or continual worsening of symptoms.
Unlike the Pap smear for cervical cancer, there are no good screening tests for ovarian cancer. There is some evidence that a combination of various blood tests and a pelvic ultrasound may suggest an early ovarian cancer, yet these have not yet been shown to be useful enough in a low risk population to be promoted as a screen for everyone. Certainly these tests (and others like a CT scan) can help steer the diagnosis in someone with unexplained symptoms, but we are still woefully lacking in a universal screening test for ovarian cancer.
There are some folks who are at a higher risk for this disease and therefore warrant closer monitoring. Risk factors for ovarian cancer include a family history, menstruating at an early age (before 12), having not given birth to any children, a first child after 30, menopause after 50, and having never taken oral contraceptives (taking birth control pills actually reduces the risk of ovarian cancer). Of special interest is the genetic relationship between various female cancers like breast and ovarian. About 10 to 15 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease. The most significant risk factor for ovarian cancer is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). These genes are responsible for about 5 to 10 percent of all ovarian cancers. Eastern European women and women of Ashkenazi Jewish descent are at a higher risk of carrying BRCA1 and BRCA2 mutations. Since these genes are linked to both breast and ovarian cancer, women who have had breast cancer have an increased risk of ovarian cancer. These can be detected with a blood test and many insurances will cover this in high risk women. There is an ethical debate regarding someone who tests positive for these mutations. Do you prophylactically remove the ovaries as a preventative tool? There are no clear cut answers at this stage as not everyone who has these mutations will develop cancer. The utility in this knowledge allows the individual to make a rational decision based on a variety of factors.
Treatment of ovarian cancer is often a combination of surgery and chemotherapy. Much of the treatment depends on the extent of the disease noted during the surgical removal of the cancerous tissue. This cancer tends to spread both by local growth in the pelvis and through the bloodstream and lymphatics, so it can metastasize or reoccur in distant parts of the body. There have been advances in treatment, especially in chemotherapeutic agents, and one of the most exciting ares of research is in various immunological techniques. These approaches literally label the cancer cells with tags that allow a chemotherapeutic agent to selectively attack the bad cells while leaving the good cells alone. Many women are successfully propelled into remission with these and other techniques, so there is expanding hope as research develops.
Ovarian cancer is a serious and scary disease, but it is not the death sentence it once was.