Ovarian Cancer Awareness Month: Silent Symptoms
Reviewed by: M. Yvette Williams-Brown, MD, MMSc
Written by: Abbi Havens
While it may not receive as much attention as other gynecologic cancers, ovarian cancer is serious business. It is the 11th most common cancer among women in the US, but the fifth leading cause of cancer-related death among women. When caught in the early stages, 94 percent of women survive ovarian cancer longer than five years. If caught later, it is the deadliest of the gynecologic cancers, which include cervical, uterine, vaginal and vulvar cancer. Why is it so deadly if it’s so treatable? Ovarian cancer is rarely detected early.
If you’re a menstruating person, you’ve likely experienced symptoms indiscernible from those associated with early ovarian cancer. Symptoms like back pain, abdominal cramps, indigestion and bloating that are common during your menstrual period are not likely to prompt a visit to the doctor’s office for most women. But if these symptoms persist for more than two to three weeks, they could be a sign of ovarian cancer. Because the potential signs of ovarian cancer are so vague and commonly experienced, the majority of ovarian cancer is diagnosed in the advanced stage.
Another reason ovarian cancer is so difficult to detect is the volume of space where ovarian cancer can potentially grow within the abdominal cavity. There is plenty of space for organs to move as a tumor grows in the pelvis and abdomen, which masks the symptoms of something amiss. When a tumor continues to expand, it begins to put pressure on the bladder and rectum and symptoms can become more prominent.
Unfortunately, there is currently no simple or reliable way to screen for ovarian cancer in an average-risk woman. It is a common misconception that pap smears, which screen for cervical cancer, also screen for ovarian cancer (they do not). Transvaginal ultrasounds may detect abnormalities with the ovaries but are discomforting for many patients, can be emotionally distressing and are not practical for widespread screening use. If ovarian abnormalities are found from any screening method, surgery is the only method of accurately diagnosing ovarian cancer. Along with MD Anderson and other study sites, UT Health Austin is currently involved in a clinical study to determine if a blood test known as the CA-125 test may improve early-stage ovarian cancer screening in post-menopausal women.
Types of Ovarian Cancer
Ovarian cancer is categorized into 30 different types, but there are three overarching types of ovarian cancer identified by the cell in which the cancer originates. According to the American Cancer Society, your ovaries contain three main types of cells that are each capable of creating tumors.
Germ cell ovarian cancer begins in the egg-producing cells (germ cells). Although this type constitutes less than two percent of all ovarian cancers, it is the type most commonly diagnosed in girls and young adults. Epithelial ovarian cancer begins in the layer of tissue that covers the outside of the ovaries. Approximately 90 percent of ovarian cancers fall into this category. Finally, stromal ovarian cancer begins in the ovarian tissue that produces estrogen and progesterone and constitutes approximately one percent of all ovarian cancers. Stromal ovarian cancers are often diagnosed in the early stages because the tumors tend to remain in the ovaries for a longer period of time before spreading.
Unfortunately, there are currently no screening methods available for more rare types of ovarian cancers including germ cell and stromal cell ovarian cancers.
Who is at risk of developing ovarian cancer?
Of course, the presence of a risk factor for ovarian cancer does not mean you will develop the disease. Likewise, women who are diagnosed with ovarian cancer may not possess any known risk factors. But certain factors, some modifiable and some not, may increase a person’s likelihood of developing the cancer and may indicate steps should be taken to lower your risk of ovarian cancer.
Family history of breast cancer, ovarian cancer or colorectal cancer. A family history of certain cancers including breast cancer, ovarian cancer and colorectal cancer is linked to a higher risk of ovarian cancer.
Child-bearing status. Women who have delivered at least one child, especially before the age of 30, have a lower risk of developing ovarian cancer. Women who never delivered a child or who first delivered a child after the age of 35 may have a higher risk of developing ovarian cancer. Breastfeeding may also lower the risk of developing ovarian cancer.
Genetic mutations. Those who possess an inherited genetic mutation on one of two genes called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) have a heightened risk of developing ovarian cancer. The risk of developing ovarian cancer is 40 to 60 percent by age 85 for women with the BRCA1 mutation. . Women with a BRCA2 mutation have a 50 to 85 percent risk of developing the disease by the age of 70. However, the vast majority of women diagnosed with ovarian cancer do not possess either genetic mutation.
Age. Although it does occur, ovarian cancer is rare in women under 40. Two-thirds of women diagnosed with breast cancer are over 55, and half of all women diagnosed with ovarian cancer are over 63. Ovarian cancer typically develops after menopause.
Obesity. Although information surrounding the connection is not entirely clear, obesity is linked to a higher risk of developing ovarian cancer. Obesity may affect the overall survival of a woman with ovarian cancer.
Contraception. Women who use birth control pills (oral contraceptives) have a lower risk of developing ovarian cancer and the risk is lower the longer the pills are taken. The lower risk extends for many years after a woman stops taking birth control pills. Other forms of contraception including IUDs and tubal litigation are also tied to a lower risk of developing ovarian cancer.
Fertility treatment. IVF (in vitro fertilization) is connected to an increased risk of developing ovarian tumors known as low malignant potential or borderline tumors. Research does not necessarily indicate a connection between fertility drugs and invasive ovarian cancer.
Many additional hereditary and genetic factors as well as additional syndromes may affect risk of developing ovarian cancer including PTEN tumor hamartoma syndrome, hereditary nonpolyposis colon cancer, Peutz-Jeghers syndrome and MUTYH-associated polyposis.
Treating Ovarian Cancer
Every patient’s experience with ovarian cancer is unique, and treatment is determined based on the grade and stage of the cancer. Grading is not the same process as staging, which determines how much a cancer has spread. A cancerous tumor receives a grade based on how much the tissue inside the tumor resembles normal, noncancerous tissue (the higher the grade, the less the tumor resembles healthy tissue). Surgery to remove as much of the cancerous tumor as possible is usually the first step to treating and diagnosing ovarian cancer. Some women may require removal of the ovaries, uterus, cervix and fallopian tubes. Lymph nodes and some parts of the intestine may also need to be removed.
Depending on the outcome of the surgery, chemotherapy may be required to kill any cancer cells that remain in the body. Although chemotherapy drugs are most often administered through an IV, in cases of ovarian cancer, they may be administered directly into the abdomen in order to come into direct contact with the area where the cancer is most likely to spread. In some instances, chemotherapy is used prior to surgery to shrink tumors in order to improve the success of the tumor debulking surgery.
Unfortunately, treating ovarian and other reproductive cancers often has an impact on a patient’s fertility. Fertility is not a concern for the majority of patients diagnosed with ovarian cancer who are post-menopausal, but for girls and young adults diagnosed with ovarian cancer, premature loss of fertility can be devastating. UT Health Austin’s Cancer Fertility Preservation service helps patients determine the best possible method of achieving their family goals.
The symptoms of ovarian cancer are difficult to discern. Listen to your body and pay attention to what’s normal for you, because the symptoms of ovarian cancer can be incredibly subtle. If something seems off, contact your doctor. If a concerning symptom turns out to be nothing more than a particularly painful menstrual cramp or bloating from a little too much pizza, better safe than sorry!