Understanding Ovarian Cancer

Omar Cabrera, M.D., OB/GYN

September is National Ovarian Cancer Awareness Month, but how much do you know about the disease? In 2021, it’s estimated that over 1,700 Texas women will be diagnosed with ovarian cancer, according to the American Cancer Society.

While that number may seem small compared to the almost 21,000 Texas women who will be diagnosed with breast cancer this year, the survival rates are lower for ovarian cancer than any other cancer that affects women. It is expected that 14,000 women will die from ovarian cancer this year.

That’s why we spoke with Omar Cabrera, M.D., an OB/GYN and physician on the medical staff at Texas Health Women’s Care in Stephenville, a Texas Health Physicians Group practice, to better understand ovarian cancer including risk factors, symptoms and prevention.

 

What is Ovarian Cancer?

Ovarian cancer can originate in the ovaries or the nearby related structures, such as the fallopian tubes and the peritoneum. Women have two ovaries, one on either side of the uterus. Healthy cells in the ovary help to release an egg every month and make hormones.

“Most types of ovarian cancer are thought to arise from mutations that occur in the fallopian tube,” Cabrera adds. “But a smaller percentage of ovarian cancers arise directly from cell changes occurring in the ovary.”

There are three main types of ovarian cancers. The type of cell where the cancer begins determines the type of ovarian cancer you have. It’s important to remember while each cell can produce tumors, it may not always be malignant (cancerous).

Ovarian cancer types include:

Epithelial: this is the most common type of ovarian cancer and is derived from the cells on the surface of the ovary. This cancer type is thought to usually originate from the fallopian tube.

These are considered to be relatively slow-growing cancers. Women are usually about 60 years old at the time of the diagnosis. Women that have hereditary mutation tend to have ovarian cancer present about 10 years earlier. About 10-15 percent of patients with epithelial cancer have mutations is BRCA 1 or 2.

Germ cell: this cancer type is derived from the germ cell of the ovary. They are most common in women between 10 to 30 years of age. These are usually rapidly-growing cancers. Chances of survival for malignancies of this cell type tend to be better than with epithelial cancers.

For unknown reasons, they tend to be more common in Hispanic Americans and Asian/Pacific Islanders in the US. This ovarian cancer type may produce hormones such as hCG (which is elevated in pregnant women) or AFP. Women may present with symptoms of pregnancy, abdominal enlargement, abdominal pain, early puberty, or abnormal vaginal bleeding.

Sex cord-stromal cell: this cancer type arises from cells that surround immature eggs in the ovary. They are usually diagnosed at an early stage with most having a good prognosis. The average age of diagnosis is 50. Some cancers within this type produce excess male hormone which may produce an increase in acne, dark coarse hair, male pattern baldness, deepening voice, menstrual changes, or an enlargement in the clitoris. Others may produce excess estrogen which may lead to abnormal vaginal bleeding, uterine cancer, or early puberty.

 

What are the Risk Factors and Symptoms?

While most women who get ovarian cancer are not considered “high risk,” there are several factors that can increase a woman’s risk, such as:

  • Family history of ovarian, breast, or colorectal cancer
  • Having a hereditary cancer syndrome
  • Advancing age
  • Estrogen hormone replacement
  • High-fat diet
  • Obesity
  • Endometriosis

Unfortunately, when it comes to symptoms, many do not arise until the cancer has already progressed to a later stage, making it harder to treat.

“Epithelial ovarian cancer has been regarded as the silent killer considering that in about 65% of women it is detected in stage III or stage IV, where the cure rate is only about 18%,” Cabrera explains. “The tough part is that early stages of ovarian cancer are usually asymptomatic, and symptoms that do present for advanced disease may also be non-specific.”

Symptoms that are common signs of ovarian include:

  • Belly pain
  • Bloating
  • Nausea
  • Anorexia
  • Difficulty eating
  • Getting full quickly
  • Shortness of breath
  • A change in your bathroom habits, such as more frequent or urgent need to urinate and/or constipation.
  • Vaginal bleeding (particularly if you are past menopause), or discharge from your vagina that is not normal for you

 

Prevention

Because ovarian cancer tends to be symptomless in early stages, it’s extremely important to receive your annual exam every year — regardless of age. While ovarian cancer may not immediately appear to be a focus at your annual exam, your physician will discuss your family history of breast, gynecological, and colon cancers to also identify your risk for ovarian cancer.

Your physician will also perform a physical exam to rule out any concerns. If your physician believes you are at higher risk for ovarian cancer, a transvaginal pelvic sonogram and tumor marker testing of CA-125 may also be performed at your exam.

On the other hand, there is no simple or reliable test to screen for ovarian cancer in women who do not have an elevated risk for ovarian cancer or are experiencing symptoms. While the same screening tests can be performed as those for women at a higher risk, Cabrera notes that they can lead to unnecessary surgery due to the high percentage of false-positive results. For that reason, they are not recommended on low-risk patients.

Since there is no screening method that is able to provide early detection, it’s especially key to pay attention to your body and know what is normal for you. If you noticed any changes or have any symptoms related to ovarian cancer, or pelvic pain for at least 12 days per month, you should schedule a visit with your physician.

If you need help tracking unusual symptoms, the CDC has a great Symptom Diary to track your symptoms over a two-week period.

Other ways to lower your risk for ovarian cancer include:

  • The use of birth control pills containing both estrogen and progesterone for five or more years, or the use of progesterone IUDs
  • Having had a tubal ligation (getting your tubes tied), both ovaries removed, or a hysterectomy (an operation in which the uterus, and sometimes the cervix, is removed)
  • Having at least one full-term pregnancy
  • Breastfeeding has also been found to decrease the risk of ovarian cancer

While these options may help reduce the chance of getting ovarian cancer, they are not recommended for everybody, and risks and benefits are associated with each. For instance, if the use of birth control pills increases your risk of blood clots, stroke or other adverse effects, your doctor can discuss other options.

 

Treatment

Treatment for ovarian cancer depends upon its stage, and the stage is determined with surgery.

The stages of ovarian cancer are indicated using Roman numerals ranging from I to IV, with the lowest stage (I) indicating that the cancer is confined to the ovaries. The highest stage (IV) indicates that the cancer has spread to distant areas of the body.

For women with high-risk epithelial ovarian cancer, chemotherapy is recommended in addition to their surgery.

“The survival rate for ovarian cancer depends upon the type and the stage,” Cabrera adds. “With regards to epithelial cancers, the 5-year survival rates for stage I is about 90%, stage II is about 70%, stage III is about 40%, and stage IV is about 18%.”

If ovarian cancer is left untreated, the disease can spread to nearby organs such as the colon or more distant organs such as the liver, fluid around the lungs, or the brain.

 

The Takeaway

If you have a family history of ovarian cancer or breast cancer, talk to your provider about your risk of developing ovarian cancer. They may also refer you to a genetic counselor to discuss testing for certain gene mutations that increase your risk of breast and ovarian cancers.

Since ovarian cancer often goes undetected until later stages when it is harder to treat, it’s important to make an appointment with your physician if you have any signs or symptoms that worry you. Remember, while it may be easier said than done, if you have any symptoms don’t get ahead of yourself with worry. These symptoms can be caused by something other than cancer, but the only way to know for sure is to see your provider.

If you don’t have a healthcare provider but it’s time for your annual exam, visit TexasHealth.org/THPG to find a gynecologist, internal medicine physician or family medicine physician who can provide these potentially lifesaving tests.

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