Symptoms can be quite subtle

Ovarian cancer is tricky because it’s so hard to detect

WHO’S AT RISK

Though less common than breast cancer, ovarian cancer still affects thousands of American women — 21,290 new diagnoses of the disease are made each year, and doctors estimate that 1 out of every 70 women will develop ovarian cancer in her lifetime. “Ovarian cancer is a malignancy that affects only women, because it arises from the ovaries or fallopian tubes,” says Hayes. “While about 5-10% of ovarian cancers are genetic, the remaining 90% are thought to be sporadic; currently, we just don’t know an underlying cause for most women who are diagnosed.”

While there is much that remains unknown about the origins of ovarian cancer, doctors have identified some risk factors. “Women are at higher risk of developing ovarian cancer if they have endometriosis, a benign condition where the tissue of the uterus lining deposits in other areas around the abdomen, often causing pelvic pain, menstrual pain, and infertility,” says Hayes. “Certain ethnic groups are also at increased risk, including Ashkenazi Jewish women, who are more likely to carry the BRCA mutation.”

Doctors have also identified certain factors that can decrease a woman’s risk of developing ovarian cancer. “Women have a lowered ovarian cancer risk if they have been pregnant and given birth, have had a tubal ligation, or if they have taken oral contraceptives,” says Hayes. “Although we don’t know exactly how the mechanism works, we recommend oral contraceptives as a huge prevention strategy, both for women in the general population, as well as for women with the BRCA mutation.”

Most women are diagnosed with ovarian cancer after age 50. “Ovarian cancer is more common in post-menopausal women,” says Hayes. “But patients with a hereditary gene mutation like BRCA tend to develop cancer at a younger age.”

SIGNS AND SYMPTOMS

Ovarian cancer can be difficult to catch early. “Traditionally, we have thought of this cancer as the silent whisperer, and had not been able to diagnose it at early stages because there were no obvious symptoms,” says Hayes. “But what we now know is that there are very subtle symptoms: pelvic pain, bloating, constipation, increased urinary frequency, and early satiety. So if you experience these symptoms at an increased frequency over a short period of time, get it checked out.” In the absence of an effective screening mechanism, the majority of patients are diagnosed at advanced stages.

TRADITIONAL TREATMENT

Once the diagnosis of ovarian cancer is made, the next step is to discuss surgical options. “The mainstay of treatment is surgery to remove all visible tumor,” says Hayes. “Chemotherapy is also key, either before or after surgery.”

The goal of surgery is to remove all visible cancer cells. “This surgery entails removing the ovaries, the fallopian tubes, the uterus, lymph nodes, and disease from areas that ovarian cancer likes to travel to,” says Hayes. “Ovarian cancer often spreads within the abdomen, so we may need to remove the disease from parts of nearby organs like the liver, spleen, or bowel.”

The chemotherapy used to treat ovarian cancer can be delivered in a form that is intravenous or intraperitoneal. “We’ve found that it’s very effective to give chemo directly into the abdomen, through an intraperitoneal port,” says Hayes. “For women who receive the diagnosis of ovarian cancer, it’s really important to be treated by a gynecologic oncologist, because studies have shown that women treated by specialists have an increased survival rate.”

There are preventive measures available for women at high risk of developing ovarian cancer. “Talk to your doctor about prevention strategies like taking oral contraception pills until you have children,” says Hayes. “In women with a BRCA mutation, once your childbearing is complete and you are around age 35 to 40, we recommend removing the ovaries and tubes-this surgery reduces your risk by 85-90%, and also reduces the risk of breast cancer by 50%.”

RESEARCH BREAKTHROUGHS

Doctors are pushing forward to develop exciting new treatments for ovarian cancer. “Because we’ve identified the BRCA mutations, we’re moving toward targeted therapies like PARP inhibitors,” says Hayes. “We’re increasingly aware that there are many kinds of ovarian cancer on a molecular level, and we’re developing different drugs to target the different kinds of cancer.”

QUESTIONS FOR YOUR DOCTOR

If you have a family history of ovarian, breast, or colon cancer, ask “Should I be referred for genetic testing and counseling?” If you’ve been having subtle new symptoms like increased urinary frequency or early satiety, ask, “Can I have a workup for these symptoms?”

And if you do receive a diagnosis of ovarian cancer, then the question becomes, “Can you refer me to a specialist?” “What you want is a specialist who can develop the treatment plan that is right for you,” says Hayes. “The most important thing is that you have all the disease removed, down to microscopic levels.”