Ovarian Cancer: The Silent Killer

Ovarian cancer, also known as “The Silent Killer,” is one of the most dangerous cancers for women. Every year, almost 22,000 women are diagnosed with ovarian cancer and more than 14,000 women will die from it. In women ages 35-74, ovarian cancer is the fifth-leading cause of cancer-related deaths and it is estimated that one in 74 women will be diagnosed with ovarian cancer during her lifetime. According to the American Cancer Society, only 20-30 percent of women who have been diagnosed with late-stage ovarian cancer are alive five years later.

If caught early, ovarian cancer has a high rate of survival. However, the insidious nature of this cancer means that it often remains undetected until it has progressed rapidly. Dr. Sumbal Nabi, who specializes in internal medicine and oncology at INTEGRIS Bass Baptist Health Center in Enid, says, “Typically, ovarian cancer symptoms aren’t apparent in the early stages of the disease, or they might appear as common stomach and digestive issues that are often mistaken for minor ailments.”

Fortunately, there are ways to educate yourself on ovarian cancer and learn how to recognize the signs of this disease.

What is ovarian cancer?

Ovaries are the reproductive glands found in women, producing eggs (ova) for reproduction that travel through the fallopian tubes into the uterus. There are two ovaries, one on either side of the uterus, serving as the main producers of the female hormones estrogen and progesterone.

Ovarian cancer begins in the ovaries, but can quickly spread throughout the body. There are three main types of cells in the ovaries: epithelial, germ and stromal, and each of these cells can develop into a different type of tumor. Many of these tumors are benign (non-cancerous) and can be treated by removing either the ovary or the part of the ovary that contains the tumor.

However, many of these tumors are malignant (cancerous) and can fatally spread to other parts of the body if not treated early. Dr. Nabi says that women are more likely to experience symptoms once the disease has spread beyond the ovaries and has further progressed, and thus, in most cases, remains undiagnosed until it has reached an advanced stage. According to the American Cancer Society, only about 20 percent of cases are diagnosed at an early stage.

What are the symptoms of ovarian cancer?

Many women often brush aside the symptoms of ovarian cancer because they can sometimes be confused with symptoms you may experience during your menstrual cycle or with other less serious conditions.

Common symptoms of ovarian cancer include:

• Bloating
• Pelvic or abdominal pain
• Trouble eating or feeling full quickly
• Feeling the need to urinate urgently or often

Other symptoms may include:

• Fatigue
• Upset stomach or heartburn
• Back pain
• Pain during intercourse
• Constipation
• Menstrual changes

If you experience any of these symptoms and they persist for more than two weeks, it is important to not brush them aside and schedule an appointment with your primary care physician for a physical evaluation.

Who is most at risk for ovarian cancer?

There are many factors at play when it comes to a woman’s risk for ovarian cancer, including ethnicity, genetics and age.

Ethnicity

White women have the highest risk for ovarian cancer, followed by Hispanic, Asian/Pacific Islander, black and American Indian/Alaska Native women. Of these women, white women followed by black women have the highest death rates from this type of cancer.

Genetics

Between 20 to 25 percent of women diagnosed with ovarian cancer have a genetic disposition to the disease. There are two genetic mutations that are most likely to contribute to ovarian cancer: BRCA1 and BRCA2. These genes are also attributed to breast cancer, so if a woman has a personal or familial history of breast cancer, she is more likely to be at risk for ovarian cancer.

Lynch Syndrome, an inherited syndrome also called hereditary nonpolyposis colorectal cancer (HNPCC), is another known genetic link to ovarian cancer. Women with a history of Lynch Syndrome have about a 12 percent risk of developing ovarian cancer in their lifetime.

In addition to these genetic mutations, family history is also a large contributor to a woman’s risk of developing ovarian cancer. Even with no known genetic mutation, if a woman has a first-degree family connection to the disease (grandmother, mother, daughter or sister), her risk of ovarian cancer is five percent. A family history of breast cancer, colon cancer, uterine cancer and rectal cancer can all increase a woman’s risk for ovarian cancer as well.

Age and Reproductive History

While women of any age can be at risk for ovarian cancer, ovarian cancer rates are highest in women aged 55-64 years old.

Women who started menstruating at an early age (before 12 years old) are also at an increased risk, as well as women who:

• Have not given birth to any children
• Had her first child after 30
• Went through menopause after 50
• Have never taken oral contraceptives
• Have experienced infertility (regardless of whether she has used fertility drugs)
• Have used menopausal hormone therapy

Ovarian cancer and fertility

Many women who are at risk or have had ovarian cancer are concerned about their ability to have children in the future. "Considerations of fertility-sparing options in the treatment of ovarian cancer are concerns for gynecological oncologists, as it can limit your ability to have children in the future," Dr. Nabi says.

“Certain treatments, such as a surgery, can put you at risk for infertility or premature menopause,” according to Dr. Nabi. "After your diagnosis, you may feel overwhelmed with information and your choices concerning your diagnosis, treatment and next steps, but it is important that you have a discussion about fertility before treatment starts because your options will significantly decrease after it has begun."

While preserving fertility can be a balancing act between patients’ wishes and maintaining safe clinical practices, there is an increasing amount of research available on fertility-preserving options for women with early-stage gynecological cancer.

Prevention and treatment options for ovarian cancer

While there is no guaranteed way for women to prevent ovarian cancer, as it affects women of all ethnicities and medical histories, there are some methods that have been shown to help reduce the risk of developing this form of cancer.

Prevention

The use of an oral contraceptive, especially when taken for several years, has been shown to reduce the risk of ovarian cancer by up to 50 percent compared to women who have never used oral contraceptives. Pregnancy and breastfeeding are also linked to reducing the risk of ovarian cancer, as does having multiple children before the age of 26.

While more extreme, some women opt to remove their ovaries and fallopian tubes, which greatly reduces the risk of ovarian cancer. This procedure comes with its own set of risks, so it is important to speak to your doctor to discuss whether or not this is a good option for you.

According to Dr. Nabi, it can be difficult to routinely check for ovarian cancer. “Many people mistakenly believe that a Pap smear test can detect ovarian cancer. In fact, at this time there is no reliable routine screening test for ovarian cancer, so women with a family history of the disease or other risk factors should talk to their doctor about genetic testing and other steps to monitor or help reduce their risk.”

Treatment

When ovarian cancer has been diagnosed, the patient’s cancer care team will most likely recommend one or more of the following treatment options:

• Surgery
• Chemotherapy
• Radiation therapy

"Surgery to remove the cancerous growth is the most common method of diagnosis and therapy for ovarian cancer," Dr. Nabi says. "Chemotherapy is the treatment of cancer using chemicals designed to destroy cancer cells or stop them from growing. The goal of chemotherapy is to cure cancer, shrink tumors prior to surgery or radiation therapy, destroy cells that may have spread, or control tumor growth. Radiation therapy, although rarely used for ovarian cancer, uses high-energy X-rays to kill cancer cells and shrink tumors."

Dr. Nabi shares that some women with ovarian cancer turn toward the whole-body approach of Integrative Medicine therapy to enhance their fight against the disease, as well as relieve stress and lessen side effects, such as fatigue, pain and nausea.

She also says, "Many women undergoing treatment for ovarian cancer choose to participate in clinical trials. Through participation in these trials, patients may receive access to new therapy options that are not available to women outside the clinical trial setting. As we move to 'personalized medicine,' the treatment options are tailored according to the patient’s clinical, social, psychological and lifetime needs that best fit her situation and goals."

Fight ‘The Silent Killer’ with doctor check-ups

Ovarian cancer may have a grim diagnosis when found late, but for women with symptoms, scheduling a check-up can help find and fight this disease sooner.