Ovarian Cancer

What is Ovarian Cancer?

Ovarian cancer is a disease in which malignant or cancerous cells are found in the ovaries. An ovary is one of two small, almond-shaped organs located on each side of the uterus that store eggs or germ cells and produce female hormones estrogen and progesterone.

Cancer Basics

Cancer develops when cells in a part of the body (in this case the ovary) begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells.

Normally, cells in your body divide, and form new cells to replace worn out or dying cells and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to create new abnormal cells forming a tumor. Tumors can put pressure on other organs lying near the ovaries.

Cancer cells sometimes can travel to other parts of the body where they begin to grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells move into the bloodstream or lymph vessels of our body. Cancer cells that spread from other organ sites (such as breast or colon) to the ovary are not considered ovarian cancer

There are many types of tumors that can start in the ovaries. Some are benign, or noncancerous, and the patient can be cured by surgically removing one ovary or the part of the ovary containing the tumor. Some are malignant or cancerous. The treatment options and the outcome for the patient depend on the type of ovarian cancer and how far it has spread before it is diagnosed.

Symptoms

There are many signs and symptoms of ovarian cancer. The most common symptoms include:

  • Bloating
  • Pelvic or abdominal pain
  • Trouble eating or feeling full quickly
  • Urinary symptoms such as urgency (always feeling the need to go) or frequency (having to go often)

Other symptoms of ovarian cancer can include:

  • Fatigue
  • Upset stomach
  • Back pain
  • Pain during intercourse
  • Constipation
  • Menstrual cramps
  • Abdominal swelling with weight loss

If symptoms last more than a few weeks, it is important to go talk to your doctor, preferably your gynecologist.

What is the general outlook for women diagnosed with ovarian cancer?

In women age 35-74, ovarian cancer is the fifth leading cause of cancer-related deaths. An estimated one woman in 71 will develop ovarian cancer during her lifetime. The American Cancer Society estimates that there will be over 22,000 new cases of ovarian cancer diagnosed this year and that more than 15,000 women will die from ovarian cancer this year.

When one is diagnosed and treated in the earliest stages, the 5-year survival rate is over 90%. Due to ovarian cancer’s non-specific symptoms and lack of early detection tests, only 19% of all cases are found at this early stage. If caught in stage III or higher, the survival rate can be as low as 30.6%. Due to the nature of the disease, each woman diagnosed with ovarian cancer has a different profile and it is impossible to provide a general prognosis.

Source: American Cancer Society

 

Prevention, Treatment and Survival

There are many benefits of being active – weight loss, stronger muscles, increased energy, stress relief – but can exercise prevent, treat and help women deal with ovarian cancer? New studies show that exercise can cut ovarian cancer risks, boost energy during cancer treatment, and help fatigue and sleep in cancer survivors.

Exercise and Ovarian Cancer Prevention

A Canadian study in The International Journal of Cancer’s online edition, suggests that “women who participated in the highest levels of moderate-intensity exercise had a decreased risk of ovarian cancer compared to women with lower levels of moderate-intensity activity,” (Hitti, WebMD Health News). This may be because exercise can whittle away fat, especially around the waistline. Obesity is one of the causes that increases the risk of ovarian cancer. In the study, overweight and obese women benefited more than leaner women, however, women with normal BMI (body mass index) also had a lowered risk of ovarian cancer.

In another study performed at the Canadian National Enhanced Cancer Surveillance System (NECSS), doctors examined over 400 women with ovarian cancer and over 2100 healthy women to study the role of physical activity and the risk of developing ovarian cancer, (Stoppler/Shiel, MedicineNet.com). The study found that women who were moderately active, and/or who held jobs that kept them active, had a reduced risk for the development of ovarian cancer when compared to non-active women. “The authors of the study note that potential alterations in hormone and growth factor levels, enhancement of the immune system, and/or the reduction in obesity associated with moderate exercise may be responsible for the effect,” (Stoppler/Shiel, MedicineNet.com). This is a significant find as it suggests that alternations in lifestyles have the potential to reduce women’s risks of developing ovarian cancer.

Exercise Beneficial During Treatment

Although doctors have been advising cancer patients to take it easy before and during treatment, many studies show that moderate physical activity can benefit cancer patients. New guidelines from the American College of Sports Medicine (ACSM) suggest that cancer patients “be as physically active as possible before and during treatment,” (Laino, WebMD Health News).

Kathryn Schmitz, Ph.D., MPH, is the lead author of the guidelines and associate professor of epidemiology and biostatistics at Abramson Cancer Center for the University of Pennsylvania School of Medicine. She encourages physical activity but also to know your body’s limitations. “No one is saying you should go out and run a marathon during chemotherapy,” she says. “You know your own body, do what’s comfortable.”

During a discussion at the annual meeting of the American Society of Clinical Oncology, the ACSM panel came up with recommendations of different types of exercises that can be beneficial during and after cancer therapy. Walking was one exercise that seemed to be beneficial for the entire cancer patient population, even during treatment. But, it is important to know that not all moderate-intensity activity is for everyone and patients should still consult their doctor before starting any type of exercise regimen.

Yoga May Help Fatigue, Sleep in Cancer Survivors

A new study suggests that yoga may help cancer survivors sleep better and have more energy. The study, led by Karen Mustian of the University of Rochester Medical Center in New York says, “We really don’t have any good remedies for fatigue for cancer survivors.” The fact that many patients take drugs to help them sleep led her to develop a study of 400 cancer survivors, half of which did yoga twice a week for one month while the other half were inactive. Those who did yoga were able to cut back on sleeping pills and slept better; nearly twice the improvement of survivors who didn’t do the exercises (Laino, Medicine.net).

Resources

Yoga Helps Fatigue, Sleep in Cancer Survivors – May 21, 2010
Exercise May Cut Ovarian Cancer Risk – May 16, 2005
Exercise May Help Prevent Ovarian Cancer – January 5, 2007
New Guidelines Call for Physical Activity Before, During, & After Treatment – June 9, 2010

Ovarian cancer causes more deaths than any other cancer of the female reproductive system, with 1 in 70 women developing the disease over their lifetime. While the median age for ovarian cancer is approximately 63, several other factors can increase the risk, and it is important to remember that women of all ages are at risk. Having one or more of the following factors does not necessarily mean a woman will develop ovarian cancer, but all women should be aware of their individual risk and with the help of a doctor can determine the best approach to reducing risk and staying healthy.

Increasing age:

Women become more at risk as they get older, especially once they reach their 60s. The risk continues through their late 70s.

Family History

Women are more at risk if they have:

  • An inherited genetic mutation in the breast cancer gene 1 (BRCA1) or the breast cancer gene 2 (BRCA2)
  • An inherited syndrome called hereditary colorectal cancer (HNPCC/Lynch Syndrome)
  • Family history of breast cancer before the age of 50
  • Family history of ovarian cancer (risk is increased if it is a mother, daughter or sister; this risk in turn is further elevated if ovarian cancer developed prior to menopause)
  • Family history of uterine or colon cancer before the age of 50
  • Family history of Fallopian Tube, Peritoneal or Endometrial Cancers

Medical History

Women are more at risk if they have a personal history of breast, endometrial or colon cancer.

Menstrual History

Women are more at risk if they started menstruating before the age of 12.

Infertility

Women are more at risk if they:

  • Have had no children
  • Are unable to have children
  • Had their first child after the age 30
  • If fertility drugs, specifically Clomid, are used for more than a year without a resulting pregnancy, risk is increased

Menopause and Hormone Replacement Therapy

Women can be more at risk if they:

  • Experienced menopause after the age of 50
  • Have used a combination of estrogen and progestrin hormone replacements for menopause symptoms for five years or more
  • Risk increases if used for ten or more years

Eastern European Women and Women of Ashkenazi Jewish Descent

Women of this descent are more likely to carry the mutated BRCA1 and BRCA2 genes.

Obesity

The risk of death by ovarian cancer is increased by up to 50 percent in the heaviest of women, according to an American Cancer Society study.

Male Hormones

The use of male hormones, known as androgens, and the specific use of the drug Danazol (used to treat endometriosis), has been linked to an increased risk of ovarian cancer.

Information gathered from the American Cancer Society, the National Ovarian Cancer Alliance and the Women’s Cancer Network.

Risk Reduction and Prevention

Women of all age are at risk. Although there is no way to prevent ovarian cancer, there are ways to reduce one’s risk.

Oral Contraceptives

Using birth control pills can significantly decrease the risk of ovarian cancer, especially those who have used them for five years or more. The use of birth control pills can reduce risk up to 50 percent.

Gynecologic Surgery

Both tubal litigation (having your “tubes tied”) and hysterectomy can reduce risk, however these surgeries should only be considered if they are necessary and not specifically to reduce the risk of ovarian cancer. In addition, those who are high at risk because of a strong family history can consider a bilateral oophorectomy, in which both ovaries and fallopian tubes are removed.

Genetic Counseling and Genetic Testing

This helps women to find out if they carry one of the gene mutations putting them at increased risk for ovarian cancer. Detecting the genetic mutation can help women to begin dialogue with their doctors about further prevention and can reducing their risk to the best of their abilities.

Sources:

American Cancer Society “Detailed Guide: Ovarian Cancer” 8/27/2009
The Gynecologic Cancer Foundation (GCF)
National Institutes of Health

It is important to understand what your CA-125 is and how it is used. The CA-125 is a sugar associated protein called a glycoprotein found in the blood. It is commonly referred to as a tumor marker because it provides information about a disease’s biological state and its level can be measured when obtained from the blood. However, to be more accurate from a scientific standpoint, it is considered a tumor associated protein. Why? Because an elevated CA-125 level does not always mean a woman has ovarian cancer. CA-125 levels can sometimes be misleading.

The CA-125 is used several ways once a woman has been diagnosed with ovarian cancer, and during the course of her treatment and follow up care. According to Drs. Herzog and Coleman, there are four primary roles for CA-125 assessment that have been established with varying degrees of clinical use and reliability.

The first role is to inform outcome. There are studies that have shown the CA-125 level can be linked to both short-term and long-term outcomes when evaluating population trends. From a trending perspective, it can indicate if surgery will be “optimal”, the likelihood all disease will be gone at the first evaluation, time until the tumor could recur as well as the tumor’s response to various modes of therapy.

The second role is to detect recurrent disease. This is when Drs. Herzog and Coleman felt the CA-125 is most reliable and useful; when it is used to detect the recurrence of ovarian cancer in a woman previously diagnosed and treated for the disease. While there are exceptions to everything, in most cases when the CA-125 value rises over a series of tests there is a very strong possibility that a patient is experiencing a recurrence of the disease.

However; it is possible to have a recurrence without a rise in the CA-125 value and it is possible to have a rise in the CA-125 value and not experience a recurrence.

The third role is to monitor treatment. In this instance the CA-125 can be a reliable tool when used in conjunction with a thorough history and physical exam to monitor a patient’s treatment. This is true when a woman has an elevated initial CA-125 value. It is also important to keep in mind that the CA-125 is just one piece of this overall evaluation when determining if treatment is effective or not.

The fourth role is to screen for ovarian cancer. As we all know early detection leads to a higher cure rate. Since there is not an effective screening test for ovarian cancer, the CA-125 level can play a role in this process. If the level is used on its own, this is not true. But when used as an ingredient with other markers in a recipe for early screening, it can be used more successfully.

Drs. Herzog and Coleman want women with ovarian cancer to keep in mind that their CA-125 test is only one indication of how well they are responding to treatment. There are many other variables that should be considered and individualized for each patient. The best course is to sit down with your doctor and the rest of your medical care team and ask questions about the CA-125 test and your individual results. Asking questions provides you with the ability to stay informed and, in some cases, resist the urge to make assumptions about how your numbers are being interpreted and utilized.

This article was originally published in Coping® with Cancer magazine, September/October 2009: CA-125, What Does This Test Mean to You by Dr. Thomas J. Herzog and Dr. Robert L. Coleman. Dr. Herzog is a professor of Clinical Obstetrics and Gynecology at Columbus University and the Director of Gynecologic Oncology at the Herbert Irving Comprehensive Cancer Center in New York, NY. Dr. Robert L. Coleman is the director of clinical research in the Gynecologic Oncology Dept. at the University of Texas, M.D. Anderson Cancer Center in Houston Texas.

Early Detection of Ovarian Cancer May Become Possible
The New York Times: December 17, 2015

The Ovarian Cancer Institute and Georgia Tech Develop a Procedure to Detect Early-Stage Ovarian Cancer
Business Wire: November 17, 2015

Uterine Transplants May Soon Help Some Infertile Women in the US Become Pregnant
The New York Times: November 13, 2015

American Cancer Society, in a Shift, Recommends Fewer Mammograms
The New York Times: October 20, 2015

Dual Chemotherapy Boosts Survival Rates for Ovarian Cancer Patients
Columbus Dispatch: August 3, 2015

Kathy Bates’ Fight For Survival
Future of Cancer Care: 2015

BRCA Gene Datashare Will Help Detect Cancer Risk
USA Today: April 21, 2015

‘Dancing With The Stars’ Contestant Waltzes To Promote Ovarian Cancer Awareness
ABC News: April 7, 2015

University of Queensland Research Targets Ovarian Cancer
The University of Queensland: March 2, 2015

Desperate Patients Cheer Replacement for Cancer Drug Doxil
MSNBC: February 21, 2012

Traitorous Immune Cells Promote Sudden Ovarian Cancer Progression
Science Daily: February 20, 2012

Victory for Women With Ovarian Cancer: Congress Agrees to Fund Needed Research, Education Programs for Fiscal Year 2012
Ovarian Cancer National Alliance : December 20, 2011

Depression After Cancer May Keep Some From Follow-Up Care
HealthDay News : September 23, 2011

RNA Sequencing Study Uncovers Recurrent Gene Fusion in Ovarian Cancer
GenomeWeb Daily News : September 21, 2011

Glow in the Dark Cells Help Detect Ovarian Cancer
ABC News : September 20, 2011

Gene Therapy Destroys Leukemia in 3 Patients (To Be Tested Ovarian Cancer)
FOX Health News : August 8, 2011

Scientists Find New Ovarian Cancer Gene
FOX Health News : August 8, 2011

Gene “Map” of Ovarian Cancer Yields New Clues to Treatment
HealthDay: June 30, 2011

Symptoms of Ovarian Cancer Vague, Tests Unreliable
Columbus Dispatch: June 26, 2011

Study Finds Ovarian Screening Tests Don’t Improve Survival
HealthDay: May 18, 2011

AstraZeneca, Exelixis Cancer Drugs Show Promise
Dow Jones Newswires: May 18, 2011

Award-winning Free CPD Tool Now Updated to Help GPs Get Up to Speed with New NICE Guidance on Diagnosing and Treating Ovarian Cancer
Medical News Today: May 17, 2011

Exercise is Springboard to Recovery for Olympic Cancer Patient
USA Today: April 20, 2011

New Research Pointing To Possible Treatments
CBS Los Angeles: March 8, 2011

Massillon Woman Raising Ovarian Cancer Awareness
The Independent: October 3, 2010

Understanding Ovarian Cancer Symptoms
WNBC TODAY: September 23, 2010

5 Gene Variants Linked to Ovarian Cancer
OCRF: September 20, 2010

Two Gene Mutations Mark Ovarian Cancer
Reuters: September 9, 2010

Breast, Ovary Removal Found to Raise Cancer Survival Rates
The Los Angeles Times: August 31, 2010

Health Law Requires Continued Coverage For Patients In Clinical Trials
Kaiser Health News: August 24, 2010

FDA Drug Approval Process
The Diane Rehm Show: August 19, 2010

Kilroy Wants $900 Million Loan Fund for Cancer Work
The Columbus Dispatch: July 27, 2010

FDA Panel Urges Limits For Avastin
New York Times: July 21, 2010

CA-125 Shows Continued Promise
WNBC TODAY: May 21, 2010