Ovarian Cancer: What All Women Need to Know

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Ovarian Cancer What All Women Need to Know
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Presentation Objectives

• Realize the impact of ovarian cancer
• Recognize the early symptoms
• Understand the risk factors
• Know the proper steps to take if you or someone
  you know has persistent symptoms and where to go
  for more information

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What is Ovarian Cancer?

• A growth of abnormal malignant cells that begins
  in a womans ovaries
• These ovarian cancer cells can metastasize or
  spread to other organs in the pelvis or abdomen

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The Female Reproductive System
Reprinted with permission from the American
Cancer Society
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What Causes Ovarian Cancer?

• The causes of ovarian cancer remain unknown
• Current theories
• Repeated wear and tear which occurs during
  monthly release of an egg may create a situation
  in which genetic errors can occur
• Increased hormone levels before and during
  ovulation may stimulate the growth of abnormal
  cells

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Impact of Ovarian Cancer

• Strikes 1 in 69 women
• Is the 2nd most common gynecologic cancer
• Each year, approximately 20,000 women are
  diagnosed with the cancer
• In 2007, it is estimated that 22,430 women will
  be diagnosed
• Majority of women diagnosed have no family
  history of disease
• Affects all women, regardless of race or ethnicity

Sources American Cancer Society. (2007). Cancer
Facts and Figures 2007. Available at
www.cancer.org. National Cancer
Institute. (2006). SEER Cancer Statistics Review,
1975-2003. Available at http//seer.cancer.gov.
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Impact of Ovarian Cancer

• Is the deadliest gynecologic cancer
• Ranks as the 5th leading cause of cancer death
  among American women
• Kills about 15,000 women each year
• In 2007, it is estimated that 15,280 women will
  die

Sources American Cancer Society. (2007). Cancer
Facts and Figures 2007. Available at
www.cancer.org. National Cancer
Institute. (2006). SEER Cancer Statistics Review,
1975-2003. Available at http//seer.cancer.gov.
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Impact of Ovarian Cancer

• Overall 5-year survival rate is 45
• This rate is even lower for black women at 40
• Close to 75 of women are diagnosed at an
  advanced stage after the cancer has spread beyond
  the ovary
• When detected early, survival rates greatly
  improve
• 5-year survival rate is 93 for early-stage
  disease

Source National Cancer Institute. (2006). SEER
Cancer Statistics Review, 1975-2003. Available at
http//seer.cancer.gov.
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Compared to Breast Cancer
Source National Cancer Institute. (2006). SEER
Cancer Statistics Review, 1975-2003. Available at
http//seer.cancer.gov.
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What Do the Numbers Tell Us?
EARLY DETECTION CAN SAVE LIVES
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The Challenge

• Currently, there is no screening test for the
  early detection of ovarian cancer
• The Pap test or smear does NOT screen for ovarian
  cancer
• Most women are not aware of the symptoms or risk
  factors

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What All Women Need to Know

• Even in its early stages
• Research indicates that 95 of women with ovarian
  cancer had symptoms and even 90 of women with
  early-stage disease experience symptoms

OVARIAN CANCER CAUSES SYMPTOMS
Sources Goff BA, et al. (2000). Ovarian
carcinoma diagnosis. Cancer, 89 2068-2075.
Olson SH, et al. (2001). Symptoms of
ovarian cancer. Obstet Gynecol, 98 212-217.
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Symptoms of Ovarian Cancer

• Bloating
• Pelvic and abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms (urgency or frequency).

If a woman has a combination or many of these
symptoms for more than a few weeks and they are
persistent and unusual for her, she should see a
health care professional, preferably a
gynecologist.
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Other Symptoms Commonly Reported

• Fatigue
• Indigestion
• Back pain
• Pain with intercourse
• Constipation
• Menstrual irregularities
• NOTE These symptoms are not as useful in
  identifying ovarian cancer because they are found
  in equal frequency in women who do not have the
  disease.

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Symptoms of Ovarian Cancer

• Symptoms will vary from woman to woman
• Associated with the location of the tumor and its
  impact on the surrounding organs
• Mimic other conditions such as irritable bowel
  syndrome
• Many of us experience these symptoms from time to
  time do not be alarmed!
• If they persist or worsen, see a medical
  professional

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How is Ovarian Cancer Diagnosed?

• Pelvic examination, including a complete
  rectovaginal examination
• Transvaginal or pelvic ultrasound
• CA-125 blood test

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How is Ovarian Cancer Diagnosed?

• If tests suggest the presence of ovarian cancer,
  insist on a referral to a gynecologic oncologist
• Gynecologic oncologists are specialists in
  treating ovarian cancer
• To find one in your area, use the Find a Doctor
  resource of the Womens Cancer Network at
  www.wcn.org

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Risk Factors

• Most women with ovarian cancer do not have any
  known risk factors
• However, there are several factors that may
  increase risk of ovarian cancer
• Having one or more of these risk factors doesnt
  mean that ovarian cancer will develop, but the
  risk may be higher compared to the average woman

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Risk Factors

• Inherited genetic mutations
• Often exhibited by a family or personal history
  of breast, colorectal or ovarian cancer
• Family history of ovarian cancer
• Age
• Reproductive history and infertility
• Hormone replacement therapy
• Obesity

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Inherited Genetic Mutations

• Most significant risk factor is an inherited
  mutation in BRCA1 or BRCA2 genes
• Women of Ashkenazi Jewish descent are at high
  risk of carrying BRCA1 and BRCA2 mutations
  however risk for the mutations is not exclusive
  to this group of women
• Lower risk with inherited disease called
  hereditary nonpolyposis colorectal cancer (HNPCC)

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Family History of Ovarian Cancer

• Ovarian cancer can occur in more than one family
  member but NOT as a the result of a known
  inherited gene mutation
• Women who have one first-degree relative (mother,
  daughter or sister) with ovarian cancer, but no
  known genetic mutation, are still at increased
  risk of developing the disease

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Increasing Age

• Most ovarian cancers develop after menopause
• About 69 of women diagnosed are age 55 or over
• A womans risk of ovarian cancer increases with
  age through her late 70s
• Although most cases of ovarian cancer are
  diagnosed in women over age 55, the disease can
  occur in younger women

Source National Cancer Institute. (2006). SEER
Cancer Statistics Review, 1975-2003. Available at
http//seer.cancer.gov.
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Reproductive History and Infertility

• Women at increased risk if
• Started menstruating at an early age (before age
  12)
• Had no children
• Had first child after age 30
• Experienced menopause after age 50
• In addition, research indicates that infertility
  increases the risk of ovarian cancer, even
  without use of fertility drugs

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Hormone Replacement Therapy (HRT)

• Women who use menopausal hormone therapy are at
  an increased risk for ovarian cancer
• Risks differ according to HRT taken and
  hysterectomy status
• Women who have not had a hysterectomy and use
  estrogen plus progestin for five or more years
  are at an increased risk
• Women who had a hysterectomy and use estrogen
  alone for 10 or more years are at an increased
  risk
• HRT has other health risks so consult a doctor to
  evaluate the risks and decide whats best

Source Lacey JV, et al. (2006). Menopausal
hormone therapy and ovarian cancer risk in the
NIH-AARP Diet and Health Study Cohort.
Journal of the National Cancer Institute, (98)19
1397-1405.
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Obesity

• The research in this area has not been totally
  conclusive
• Recent studies suggest
• Overweight/obesity in early adulthood is
  associated with an increased risk of ovarian
  cancer
• A higher rate of death from ovarian cancer in
  obese women
• Maintain a healthy weight and active lifestyle to
  ensure overall health

Sources Olsen, CM, et al. (2007). Obesity and
the risk of epithelial ovarian cancer A
systematic review and meta-
analysis. Eur J Cancer, 43(4)690-709.
Pavelka, JC, et al. (2006). Effect of
obesity on survival in epithelial ovarian
cancer. Cancer, 107(7)1520-4.
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Risk Reduction

• Oral contraceptives or birth control pills
• Tubal ligation or hysterectomy
• Pregnancy and breast feeding
• Removal of the ovaries or prophylactic
  oophrectomy

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Risk Reduction

• If you or someone you know is concerned about
  risk of ovarian cancer, talk with a health care
  professional
• A health care professional can help identify ways
  to reduce risk as well as decide if consultation
  with a genetic counselor would be appropriate
• Women who are at high risk should develop a plan
  for regular monitoring with their provider

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Remember

• There are early symptoms of ovarian cancer
• The main symptoms are
• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms (urgency or frequency)
• If a woman has a combination or many of these
  symptoms for more than a few weeks and they are
  persistent and unusual for her, she should see a
  health care professional, preferably a
  gynecologist.

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Take Action

• Know if you are at high risk
• Share this information with others and women in
  your community
• All women from every walk of life should know
  about this
• Encourage anyone for whom ovarian cancer is
  suspected or diagnosed to see a gynecologic
  oncologist

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