Ovarian cancer is the deadliest gynecological cancer.
Ovarian Cancer Overview
Ovarian cancer is the leading cause of gynecological cancer-related deaths among people with ovaries between the ages of 35 and 74. It’s known as a “disease that whispers” because, while symptoms do exist, they’re often vague and mimic other conditions.
ABOUT OVARIAN CANCER
Ovarian cancers can originate from cells in the fallopian tubes or one of several cell types found in the ovary. There are many subtypes of ovarian cancer that can develop from different cell types and tissues, but the vast majority of ovarian cancers are epithelial tumors, meaning the tumor starts from the cells that cover the outer surface of the ovary. Germ cell tumors start from the cells that produce the eggs. Stromal tumors start from structural tissue cells that hold the ovary together and produce estrogen and progesterone. While some of these tumors are benign and never spread beyond the ovary, malignant tumors can spread to other parts of the body and be fatal.
SIGNS AND SYMPTOMS
While these symptoms are all normal to experience and are usually not a sign of anything serious, contact your trusted healthcare provider if you experience any of them progressively or persistently for more than two weeks.
There is currently no recommended screening for ovarian cancer for those at average risk (those without personal or family history of ovarian or breast cancer).
For those who are at high risk, preventative options such as bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes) and chemoprevention (oral contraceptives) may be options to prevent or reduce the risk of ovarian cancer. For people at high risk who chose to delay or decline preventative measures, screening with blood tests that look at the rate of change of the CA-125 biomarker over time and transvaginal ultrasound may be used to try to detect ovarian cancer early.
Having ovaries and getting older are the biggest risk factors for ovarian cancer.
Certain individuals with a personal or family history of ovarian, breast, and other cancers may be at higher risk for ovarian, breast, and other types of cancers.
In some cases, mutations in known cancer-causing genes may have been identified by genetic testing. In other cases, there may be no known genetic mutation, but the personal or family cancer history still renders the individual and their close relatives at higher risk for ovarian and breast cancer.
Identifying individuals who may have a known or unknown genetic predisposition to cancer is important for both prevention and early detection of cancer. Several United States medical and public health organizations provide guidelines to determine if someone may be at a higher risk for ovarian, breast, and other cancers due to familial or genetic factors. Individuals who may be at high risk should seek out a genetic counselor or other clinician with genetics training to undergo comprehensive risk assessment and genetic testing if warranted.
Below we provide a checklist to determine if an individual may be at higher cancer risk and should seek out genetic counseling. An important factor in determining personal ovarian and breast cancer genetic risk is knowing your family history.
If you or a close family member have had any of the following:
- Breast cancer at age ≤ 50
- Ovarian, fallopian tube, or primary peritoneal cancer at any age
- Relative with known mutation in a breast, ovarian, or other cancer susceptibility gene
- Two separate breast cancer diagnoses
- Breast cancer and ovarian, fallopian tube, or primary peritoneal cancer in the same person
- Male breast cancer
- Triple negative breast cancer at age ≤ 60
- Ashkenazi Jewish ancestry
- Pancreatic cancer
- Metastatic prostate cancer
- Prostate cancer with high grade (Gleason score ≥7) and Ashkenazi Jewish ancestry
If two or more members from the same side of your family have:
- Two or more separate breast cancers diagnoses
- Breast cancer and ovarian, fallopian tube, or primary peritoneal cancers
- Prostate cancer
- Pancreatic cancer
If three or more members from the same side of your family have:
- Been diagnosed with breast, ovarian, or other types of cancers
A higher number of ovulations in a lifetime is associated with a higher ovarian cancer risk. Several factors can impact the number of ovulations a person has, like age at menstruation and menopause, hormone-based birth control, an increased number of pregnancies, and breastfeeding (which stops some women from ovulating).
Hormone-based birth control can reduce the risk of ovarian cancer by 33 to 50%.
Certain kinds of hormone replacement therapy (HRT) can impact the risk for ovarian cancer. HRT with estrogen alone increases the risk for ovarian cancer and HRT with estrogen and progesterone increases the risk of both breast and ovarian cancer. People considering hormone-based birth control and HRT should have an open discussion with their physician about their personal and family health history to make a shared decision on whether HRT after menopause is right for them.
Endometriosis is a common disease, occurring in 5 to 15% of reproductive age people with ovaries and 3 to 5% of those who are postmenopausal. It is a benign gynecologic condition that is defined by the presence of endometrium or endometrial-like tissue outside of the uterus (mainly in the pelvis), causing chronic inflammation. The main symptoms of endometriosis are chronic pelvic pain, menstrual cramps, and infertility. Those with endometriosis have a 2 to 3 times higher risk of ovarian cancer. People with endometriosis who do get ovarian cancer are usually diagnosed at a younger age and at an earlier stage and tend to have a good prognosis and higher chance of survival.
Those with infertility also have a higher risk of ovarian cancer, regardless of whether or not fertility drugs are used. Studies that have looked at the ovarian cancer risk from infertility treatment have had mixed results with some showing a link and others not.
These lifestyle choices have been scientifically shown to be associated with reduced cancer risk:
- Maintaining a healthy weight
- Eating a balanced diet with fruits and vegetables
- Being physically active — at least 30 minutes of exercise, 5 times per week
- Abstaining from tobacco — no form is safe
- Drinking alcohol in moderation — 1 drink/day for people with ovaries
BRCA1 carriers have a 40-60% risk of ovarian cancer, compared to 1.3% of the general population
The 5-Year Survival Rate of Ovarian Cancer
of ovarian cancer cases are caught in the early stages
Ovarian Cancer Survivor & Rivkin Education Team Member
“I had no family history of cancer, and no troublesome symptoms – just some minor low back pain and pants that were a bit too tight. I’m grateful to my gynecologist who advocated for me and recommended further testing which led to a diagnosis of stage IIA ovarian cancer.”
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