Unmasking The Silent Killer: Ovarian Cancer

Referred to as a “silent killer”, ovarian cancer is the second leading and deadliest gynecologic cancer in the United States.¹ Dr. Alfred Hong, Obstetrics and Gynecology Specialist at CHA HPMC explains why it is so deadly and what you should know.

Ovarian cancer symptoms are very subtle, thus it’s hard for someone to notice until it’s too late. What would be the warning signs we shouldn’t ignore?
Unfortunately, ovarian cancer symptoms are not as obvious as other cancer symptoms due to the fact that the ovaries are located deep in the pelvis. Compared to say, skin cancer/melanoma where a patient might notice a skin lesion/discoloration and can have it biopsied or in the case of breast cancer, where a patient might feel a lump and have that evaluated. By the time ovarian cancer is detected (when symptoms develop), it is usually in the advanced stages (stage 3/4).

Having said this, there are some symptoms that a patient can be on the lookout for. These include, but are not limited to:

• early satiety (a feeling of being full early in the meal)
• pelvic pain or pelvic fullness (sometimes unilaterally or in general)
• bloating or increase in abdominal size

Also, one must pay attention to family history of ovarian cancers (blood related), breast or even colon cancer, as there can be an inherited genetic condition where there is a high risk for breast and/or concurrent colon cancers for members of the same blood-related family.

What kinds of preventive testing are available?
Unfortunately, there are no preventive tests available at this time.

There are a couple of exceptions. If you aware that you are a carrier of one of these genetic mutations that are known to cause hereditary ovarian cancer (+/- breast/colon cancers) such as BRCA-1/2, a risk reduction surgery is an option whereby both ovaries and fallopian tubes are removed prophylactically. This will drastically reduce your lifetime risk of developing ovarian cancer.

Another exception might be to take some birth control pills to reduce your risk if you are a carrier of BRCA-1/2 mutations. This may also reduce your risk of developing ovarian cancer. Those that are not positive for BRCA 1/2 can also reduce your risk of developing ovarian cancer by taking birth control pills as well.

Finally, avoiding hormone replacement therapy after menopause may also reduce your chance of developing ovarian cancer later in life.

None of these will absolutely reduce your risk in total, but may help to reduce your risk overall.

Can annual exams like a pap smear catch ovarian cancer?
Pap smears are not used to screen for ovarian cancers. They are used to screen for cervical cancers.

However, annual well-woman exams are vital because a pelvic exam may, in some instances, detect pelvic or ovarian masses if large enough. Also, a patient may discuss with her Ob-Gyn at that time if she is having any of the symptoms mentioned above, that may warrant further testing.

Unfortunately, there is no screening test for ovarian cancer. There are, however, certain blood tests that can help clue us in to determine the likelihood of a patient having ovarian cancer if abnormal physical findings are present, as well as some imaging tests that may aide in the diagnosis (pelvic ultrasounds, pelvic MRIs, etc…).

Does no family history mean you are in the clear?
Although a strong family history of ovarian cancer is certainly worrisome, and can sometimes increase a patient’s lifetime risk of developing ovarian cancer by as much as 80% if carrying certain inherited genetic mutations (BRCA-1), a negative family history does not mean the patient will never develop ovarian cancer.

Even without a strong family history, an average patient may have a lifetime risk of 1-2%. Of course this risk may be increased with other factors such as hormone replacement therapy in older patients.

How can ovarian cancer be treated? Is it curable?
Ovarian cancer is treatable if caught early enough (lower stages). But it will depend on the stage of the cancer. If it is advanced, then there is a lower likelihood that it can be cured. If caught early enough, there is an excellent prognosis and the five-year survival rate is over 90%.

Options for treatment include surgery, chemotherapy, and/or radiation. The type of treatment will depend on the stage and type of ovarian cancer. Your gynecologic oncology surgeon will discuss with the best treatment plan at the time of diagnosis.
 
 
¹https://www.cdc.gov/cancer/ovarian/statistics/index.htm
 
 
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