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About Ovarian Cancer

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
Signs and Symptoms
Screening
Risk Factors
Lifestyle

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

The four most common signs and symptoms of ovarian cancer are:

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.

 

SCREENING

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.

RISK FACTORS

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.

Ovarian cancer risk calculator

PREVENTION

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

40-60%

BRCA1 carriers have a 40-60% risk of ovarian cancer, compared to 1.3% of the general population

Assess Your Risk

47%

The 5-Year Survival Rate of Ovarian Cancer

Only 20% 

of ovarian cancer cases are caught in the early stages

Sachia Powell

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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Talk to your Family

Talking to your family and identifying cancer in your family tree can be a good indicator of your health risks. Download our Family Tree Worksheet here.  Be sure to include yourself, children, parents, siblings, aunts, uncles, and grandparents.

Family Tree Worksheet

Get Educated

Know your body and be proactive about your health. Learn about your breast and ovarian health. Learn about the risk factors and signs & symptoms for breast and ovarian cancer.
Learn about these types of cancer

Trusted Healthcare Provider

Having a relationship with a health care provider you know and trust is one of the most important decisions you’ll make about your health care. Click here to find a provider
Find a Provider

Higher Risk in the Ashkenazi Jewish Population

In the general population, around 1 in 400 people carry a BRCA1 or BRCA2 mutation. People of Ashkenazi Jewish ancestry have a 1 in 40 chance of carrying a BRCA mutation, making them 10 times as likely to carry a BRCA mutation as someone in the general population. Whether you’re a man or a woman, if you have a BRCA mutation then there is a 50% chance of passing the mutation on to your children, whether they are boys or girls. It’s important to note that these mutations significantly increase risk, but are not a guarantee a person will get cancer.

Why is the Ashkenazi Jewish population at higher risk?

Over 90% of the BRCA mutations found in the Jewish community are one of three “founder mutations”. A founder mutation is a specific gene mutation in a population that was founded by a small group of ancestors that were geographically or culturally isolated. Because the population was isolated, the rate of founder mutations in descendants is much higher than it would be if the population were larger and co-mingling with more genetically diverse populations. A large expansion in the population caused the current high frequency of the mutations in the Ashkenazi Jewish population. If you are of Ashkenazi Jewish ancestry, the chance of carrying a BRCA gene mutation compared to the general population is increased tenfold. BRCA mutations can be passed down from either your mother’s or father’s side, and may be associated with any of the following cancers:
  • Breast cancer
  • Ovarian cancer, fallopian tube, peritoneal cancer
  • Male breast cancer
  • Prostate cancer
  • Pancreatic cancer
  • Colon Cancer

Ready to take action? Knowledge is power. Take this short quiz to be proactive about your health.

Genes 101

Our bodies are made of many tiny building blocks called cells. Our cells contain a copy of our genome – all of the DNA genetic code we inherited from our parents. Our genome is organized into 46 chromosomes, 23 inherited from mom and 23 from dad. Each chromosome has hundreds or thousands of genes. Each gene has the instructions to make a protein that may control the structure or function of cells, can determine many things including how tall we are or the color of our eyes. Genes also contain instructions for many things inside of us that we cannot see, such as how our bones are formed or how our heart works. Each gene is made up of molecules called nucleic acids (A, T, C, and G). The specific sequence of the nucleic acids holds the instructions that control all the components and their functions in cells.

If the DNA sequence is changed, like a spelling mistake, the instructions may not make sense. The technical term for this change is “mutation,” meaning there is a change to the usual genetic code that may change the instructions stored in the gene. A mutation in a gene that repairs DNA damage or controls cell growth can increase the risk of developing cancer.

Sporadic vs Hereditary Cancers:

Ovarian and breast cancer can be either sporadic or hereditary. Sporadic cancers make up the vast majority (85-90%) of ovarian and breast cancers and are not associated with family history of either cancer or inherited cancer-associated mutations. Sporadic cancers arise from genetic mutations acquired in some cells of the body by events part of normal metabolism and environmental factors. This type of cancer can happen to anyone. Most acquired gene mutations are not shared among relatives or passed on to children.

Hereditary (also known as inherited, or familial) cancers are those that occur due to genetic mutations that are inherited from mom or dad. Other blood relatives may also share these same gene mutations. Parents give one copy of each gene to their children. If a parent has a genetic mutation in a gene, each of their children have a 50% chance of inheriting that mutation. Therefore, even in families with hereditary cancer, not all family members inherit the mutation that is causing cancer, and their risk of cancer is similar to the average person in the general population. Individuals who are suspected to have a family history with high incidence of ovarian, breast, and other cancers may be offered genetic testing to try to find the specific genetic mutation that may put them at risk. Importantly, individuals who do not have a known genetic mutation but have high incidence of ovarian, breast, or other cancers in their families are still considered at higher risk for developing those cancers.

Hereditary cancers often occur at an earlier age than the sporadic form of the same cancer, so experts often recommend starting cancer screening at a younger age for individuals at high risk for hereditary cancer. Hereditary cancers can also be more aggressive than the sporadic form of the same cancer. Individuals who have inherited a gene mutation may be at a higher risk for more than one type of cancer.

BRCA 1 and BRCA 2: Most Common hereditary breast and ovarian cancer

The genes that are most commonly involved in hereditary breast and ovarian cancer (HBOC) are BRCA1 and BRCA2. These genes are named for their link to breast (BR) cancer (CA), but they are also linked to ovarian cancer risk as well as other cancers. Both women and men can inherit mutations in these HBOC genes. BRCA1 and BRCA2 are tumor suppressor genes that have a usual role in our body of providing instructions on repairing DNA damage and preventing cancer. When a family has an inherited mutation in BRCA1 or BRCA2, this leads to an increase in cancer risk. Not every man or woman who has inherited a mutation in the BRCA1 or BRCA2 gene will develop cancer, but people who have a mutation do have a significanlty increased chance of developing cancer, particularly cancer of the breasts or ovaries.

While breast and ovarian cancers are the most common cancers diagnosed in people with BRCA1 and BRCA2 mutations, the risk of some other cancers is also increased. Men with BRCA1 and BRCA2 mutations have a higher risk of early-onset prostate cancer than men without mutations in either gene. Other cancers seen at increased rates, particularly in individuals with BRCA2 mutations, include pancreatic cancer and melanoma. Researchers are continuing to find new genes that are involved in hereditary breast and/or ovarian cancer so it is important to follow up with a genetic counselor on a regular basis if hereditary breast and ovarian cancer is likely in your family.

Talk to your family about your health history and take the Assess Your Risk quiz here

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