What to know about ovarian cancer

Clinical Editor: Megan Dodson, PA-C

People are familiar with mammograms for breast cancer screening and pap tests for cervical cancer screening, but there are many questions when it comes to ovarian cancer. Ovarian cancer is the second most common gynecologic cancer in the U.S., accounting for more deaths than any other female reproductive cancer. But unlike cervical and breast cancer, there is no routine diagnostic screening for ovarian cancer. As a result, it’s especially important to educate yourself on the risk factors and common symptoms so you can better recognize the signs of the disease and protect your health. Here’s everything you need to know about ovarian cancer:

All tests have their benefits and harms, and this is especially true for cancer screening. Ovarian cancer can be detected by using a combination of imaging and lab tests, but these tests are not as helpful in assessing average risk individuals with ovaries. The tests we have available are not as accurate in detecting early cases of ovarian cancer and misinterpretation of these results can lead to potentially harmful procedures. Because of this, there is no great test to screen average risk individuals with ovaries who do not have any symptoms.

Located on each side of the uterus, the ovaries are responsible for producing eggs, as well as the hormones estrogen and progesterone. Ovarian cancer occurs when uncontrollable, malignant cell growth takes place in one of the ovaries, or in the nearby fallopian tubes, creating a tumor. There are over 30 types of ovarian cancers, categorized by the kind of cell in which the cancer began. The 3 main cell types include:

• Epithelial tumors, which form in the tissue covering the outside of the ovaries. Approximately 90% of ovarian cancers are epithelial tumors
• Germ cell tumors, which start in the cells that produce eggs. This type of tumor is rare.
• Stromal tumors, which begin in the hormone-producing cells.

Some of these tumors are benign and may not cause any symptoms or harm, while others may be cancerous and spread to other parts of the body.

In its early stages, ovarian cancer may not present any symptoms. Those with more advanced ovarian cancers may experience the following:

• Bloating
• Pelvic or abdominal pain
• Feeling full quickly or trouble eating
• Frequent or urgent need to urinate
• Change in bowel habits, such as constipation

It’s important to note that these symptoms are frequently the result of other less harmful health issues and do not necessarily mean you have cancer. They can also be symptoms of other kinds of cancer. When caused by ovarian cancer, these symptoms tend to persist and grow more severe over time. If you have persistent symptoms, it will be important to check in with your primary care provider. They will be able to help you rule out any other potential causes, as well as run the appropriate diagnostic tests.

While everyone with ovaries is at risk of ovarian cancer, some individuals are more likely to develop the disease than others. Unique risk factors that may increase your chances of developing ovarian cancer include the following:

• Age: Risk of ovarian cancer increases with older age and most ovarian cancers develop after menopause. According to the American Cancer Society, half of all ovarian cancer cases occur in those 63 and older.
• Family history: You may be at higher risk of ovarian cancer if a close family member (including your mother, sister, aunt, or grandmother) on either your mother or your father’s side has been diagnosed with disease. The risk increases if multiple relatives have had ovarian cancer. A family history of breast or colorectal cancer may also increase your risk of ovarian cancer.
• Genetic factors: Several inherited gene mutations are also linked to higher risk of ovarian cancer. One example is a mutation on the BRCA1 or BRCA2 genes, which are also associated with a higher risk of breast cancer. If the BRCA1 or BRCA2 gene mutations run in your family, you may be more likely to develop ovarian cancer. According to the American Cancer Society, these genes are 10 times more common in those who have a Ashkenazi Jewish background.
• Breast cancer: People who have had breast cancer may have a higher risk of developing ovarian cancer as well. This may be due to mutations in the BRCA genes.
• Reproductive history: Those who have never given birth or had their first full term pregnancy after age 35 have an increased risk of ovarian cancer. Some studies suggest that fertility treatment with in vitro fertilization may increase risk of borderline ovarian tumors or tumors with low potential for malignancy, though more research is needed.
• Endometriosis: Having certain kinds of endometriosis may increase the potential for developing ovarian cancer.

As there is no reliable screening test for ovarian cancer, it’s especially important to pay attention to your body and discuss any unusual symptoms with your primary care provider.

If you are at high risk for ovarian cancer because of a significant family history of breast or ovarian cancer or an inherited genetic syndrome, or if you are experiencing persistent or severe symptoms, your provider may recommend a pelvic exam or order imaging or lab tests. During a pelvic exam, your provider will press down on your abdomen to assess the size and shape of your ovaries and uterus. Your provider may also order a transvaginal ultrasound or a blood test known as a CA-125. A transvaginal ultrasound uses sound waves to create an image of the ovary and detect tumors. It cannot, however, determine whether a tumor is cancerous. Meanwhile, a CA-125 test measures the levels of the protein, CA-125, that’s often found on the surface of cancer cells. Some people with ovarian cancer have higher-levels of CA-125, although other conditions can cause high levels as well.

If an ovarian cancer diagnosis has been made, other tests will be ordered to determine if the cancer cells have spread to other parts of the body and what stage it is. Your provider will likely refer you to a gynecologic oncologist who specializes in treatment of cancer in the female reproductive system. Treatment will largely depend on your age, health history, and the type and stage of the cancer. Treatment for ovarian cancer typically includes a combination of surgery, chemotherapy, targeted therapy or hormone therapy.

While the thought of ovarian cancer may be scary or overwhelming, it’s important to remember that you are not alone. Your primary care provider is there to guide you, answer any questions you may have, and support you through any necessary treatment or follow-up care. At One Medical, we will work with you to develop a care plan based on your unique health needs and goals. Schedule a visit with one of our primary care providers today if you think you are at risk for ovarian cancer or have any other questions about your health.

Originally published September 23, 2020