Earlier this summer, I learned something about ovarian cancer from a widower.
The Burt Lake man had lost his wife to the disease, and while interviewing him for another article, he offered some advice: If I, or other women, ever feel unusual, uncomfortable bloating, it’s worth seeing a doctor.
Looking back, it was a sign his healthy wife commented upon, but neither of them realized it was likely a symptom signaling something was amiss. She ultimately died from the cancer in 2004.
Recent research suggests that together, the four symptoms of bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; and urinary urgency or frequency may be associated with ovarian cancer.
Because it is estimated that more than 15,000 women will die in the U.S. from ovarian cancer each year, Dr. Jim Jeakle, MD, of Charlevoix Women’s Health, assisted the News-Review with sharing information about this form of cancer, in recognition of September as national Ovarian Cancer Awareness Month.
PNR: Who is most at risk for ovarian cancer?
Dr. Jeakle: There are several types of ovarian cancer. The most common is referred to as epithelial ovarian cancer. It is the fifth leading cause of cancer death in women in the United States, accounting for 15,000 deaths annually. The lifetime risk in the general population is 1.4 percent. It is more common in Caucasian women.
There appears to be an association between ovulation and ovarian cancer. Factors associated with fewer ovulations over the course of a lifetime generally decrease the risk. These would include: pregnancy, which reduces the risk by 25 to 50 percent, use of the oral contraceptive pill and breastfeeding. Hysterectomy with or without removal of the ovaries and tubal ligation also reduce risk.
In contrast, first period occurring before age 12, menopause after age 50 and not having children are all associated with more ovulations and slightly increase one’s risk for ovarian cancer.
A personal history of breast cancer increases risk. Age is also a risk factor, as women are most frequently diagnosed in their 50s. Other factors including environmental factors, smoking, obesity and diet are more controversial and have failed to show a strong association.
Unfortunately, we have no control over the biggest risk factor, and that is family history. A family history of one affected relative increases the risk over the general population three-fold. This would be referred to as familial ovarian cancer and carries much less risk than women with hereditary ovarian cancer. Hereditary ovarian cancer typically occurs with two or more affected first degree relatives (a mother or sister) …
While it is true we can’t change our family history, early preventative strategies for those at highest risk can make a big difference in preventing cancer. These interventions include prophylactic surgery, chemoprevention and aggressive screening with physical exams, blood tests and ultrasound.
PNR: What is the prognosis for someone diagnosed with ovarian cancer?
Dr. Jeakle: Prognosis is related mostly to the stage at diagnosis. Cure rates are as high as 90 percent with surgery alone when the cancer is confined to the ovary. This is considered stage 1 disease.
However, the five-year survival drops to about 35-40 percent for stage 3 disease. Unfortunately, stage 3 is when 70 percent of ovarian cancer is diagnosed, because symptoms can be nonexistent and vague in the early stages.
What is needed is a good screening test which would allow for early detection in the low-risk population, but unfortunately this is not yet available. There are clinical trials under way looking at different screening modalities and hopefully something will become available soon, because it would have a dramatic impact of survival. However, because of a lack of an effective screening test, early identification of symptomatic women has become a goal of the current approach to this disease.
PNR: What are the symptoms of ovarian cancer?
Dr. Jeakle: Symptoms include bloating, feeling full, urinary frequency, increasing abdominal girth or pain. It does become confusing for women, because many healthy women feel many of these symptoms associated with their monthly cycles.
The difference is when the symptoms persist and become daily and more severe than typical premenstrual symptoms. This should be brought to the attention of your doctor. First, a pelvic exam can be done to detect a mass. If symptoms persist and the pelvic exam is normal, with no other obvious gastrointestinal disorder to account for the symptoms, the most useful test to rule out ovarian cancer is a pelvic ultrasound. The ovaries are easily visualized with ultrasound.
Women should be reassured though that most ovarian cysts resolve on their own and surgery is only needed when certain clinical criteria are present. Even at the time of surgery, most ovarian masses, especially in the premenopausal age group, will prove to be benign. However, even benign ovarian masses can grow quite large and removal can be a necessity.
PNR: How is ovarian cancer diagnosed?
Dr. Jeakle: Although ultrasound, CT, MRI and blood tests can strongly suggest the possibility of ovarian cancer, the diagnosis is made at the time of surgery. This is because quite often a pelvic mass can look quite worrisome based on preoperative testing, but still turn out to be benign at the time of surgery. Needle biopsies are avoided because both benign and malignant mass can be partially fluid filled and leaking the fluid with a needle poke is to be avoided as this can change the stage of the disease if it turns out to be cancer, thus changing the prognosis and treatment.
PNR: How is it treated?
Dr. Jeakle: The standard treatment is to remove the uterus, tubes and ovaries and any other visible disease and determine the extent of disease. This is typically followed by chemotherapy for disease beyond stage 1. Radiation has no role.
PNR: How does ovarian cancer affect a younger woman's ability to have children?
Dr. Jeakle: For most patients, their surgery will cause sterility, because the uterus, tubes and ovaries are removed. For young patients with early stage 1 disease, they may elect to keep their opposite ovary and uterus to conceive a child, but most would recommend removing these remaining organs by about age 35 or sooner.
Dr. Jeakle on genetic testing for ovarian cancer:
Those women with two affected first-degree relatives most likely have an identifiable mutation in a gene involved in DNA repair, and their lifetime risk is dramatically increased. This type of hereditary cancer accounts for about 12-15 percent of ovarian cancers.
The genes can be inherited from the maternal or paternal side of the family. These genes are found 1 in 1,000 people in the general population with a higher frequency (1 in 50) in people of Eastern European descent.
The two most common genes are referred to as BRCA1 and BRCA2 and carriers have a 25-50 percent lifetime risk of ovarian cancer. Depending on the particular gene, there can also be an associated risk of breast or colon cancer.
The decision to have genetic testing should not be taken lightly. Genetic testing can cause emotional turmoil and family discord, and may have an impact on future medical care and insurability.
Thus, it is important for the patient, her doctor and family to carefully consider whether to undergo such testing. A thorough family history with a genetic counselor is generally recommended as a first step when testing is being considered. Quite often, once family medical records are reviewed, it is determined that testing isn’t indicated.
When indicated, testing should be done on the relative who has the cancer whenever possible. Testing for these genes is usually not covered by insurance and can run in excess of $3,000. However, once the gene is identified in one family member, multiple family members can then be tested for that specific gene at a much lower cost.
Many women don’t seek help until the disease has begun to spread, but if detected at its earliest stage, the five-year survival rate is more than 93 percent.