How prevalent is ovarian cancer?
Ovarian cancer is a disease in which malignant or cancerous cells are found in the ovary. An ovary is one of two small almond-shaped organs located on each side of the uterus that produce female hormones and store eggs or germ cells. Ovarian cancer is the fifth leading cause of new cancer cases. In women age 35-74, ovarian cancer is the fourth leading cause of cancer related deaths. An estimated one woman in 55 will develop ovarian cancer during her lifetime. "The American Cancer Society estimates that each year approximately 25,500 new cases of ovarian cancer are diagnosed and 16,000 women die of ovarian cancer."
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What is the general outlook for women diagnosed with ovarian cancer?
Because each woman diagnosed with ovarian cancer has a different profile, it is impossible to give a general prognosis. If diagnosed and treated early, when the cancer is confined to the ovary, the 5 year survival rate approaches 93% (78-98 percent depending upon tumor type, stage, and grade.) Unfortunately, due to ovarian cancer’s non-specific symptoms, only 24% of all cases are found at this early stage. Because many ovarian cancers are not detected early, the overall 5 year survival rate for women with ovarian cancer is only between 35% and 49%, depending upon the type of tumor.
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Can ovarian cancer be prevented?
At present, there is no known method to prevent ovarian cancer, but some things appear to reduce a woman’s risk of developing the disease. They include:
- Oral contraception: Use of oral contraceptives for a total of 5 years (does not have to be continuous) can decrease the risk by as much as 60% (or 10% risk reduction per year of use up to 40-60% risk reduction with 5 or more years of usage); Risk reduction persists for 10 years.
- Breast-feeding and pregnancy: Having one or more children, particularly if the first is born before age 25, plus breast-feeding may decrease a woman’s risk.
- Tubal ligation: This is a surgical procedure in which the fallopian tubes are tied to prevent pregnancy. This procedure does reduce the relative risk of developing ovarian cancer (RR 0.33). Its use as a risk reduction strategy may be appropriate for high-risk individuals and should be discussed with your physician.
- Hysterectomy: A woman should not have a hysterectomy exclusively to avoid ovarian cancer risk, but if one is being performed for valid medical reasons and she has a family history of ovarian or breast cancer or is over age forty, she should discuss concurrent ovary removal with her physician. Hysterectomy also has been demonstrated to reduce the relative risk of developing ovarian cancer.
- Prophylactic oophorectomy: Oophorectomy is the surgical removal of one or both ovaries. Only recommended for certain high-risk patients, the operation eliminates the risk for ovarian cancer, but not the risk for a less common cancer called Primary Peritoneal Carcinoma. This cancer is similar to ovarian cancer in spread, presentation and treatment. Discussion with your physician is necessary to determine your individual risk and options for prophylactic surgery.
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Is ovarian cancer hereditary?
A woman can inherit an increased risk for ovarian cancer from either her mother or father’s side of her family, particularly if a “first degree” relative (mother, sister, or daughter) has, or has had ovarian, breast, or colon cancer. Furthermore, women with a strong family history of ovarian cancer are more likely to develop the disease at an early age (younger than 50). Women of Ashkenazi (Eastern European) Jewish descent are also at greater risk if they have an affected family member.
Studies show that inheriting a defect in the BRCA1 or BRCA2 gene can also increase a woman’s risk of developing ovarian cancer by about 13 to 50 percent. Normally, these genes help to prevent cancer, but if a woman has inherited a mutated BRCA1 or BRCA2 gene, her ovaries and breasts are more susceptible to the development of cancer.
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What are some of the risk factors linked to ovarian cancer?
While the presence of one or more risk factors may increase a woman’s chance of getting ovarian cancer, it does not necessarily mean that she will get the disease. A woman should be extra vigilant in watching for early symptoms. Risk factors include:
- Personal or family history of breast, ovarian, endometrial, prostate or colon cancer;
- Hereditary nonpolyposis colorectal cancer or syndrome;
- Increasing age;
- Unexplained infertility, no pregnancies and no history of birth control pill usage;
- Use of high dose estrogen for long periods without progesterone may be a risk factor;
- North American or Northern European heritage and/or Ashkenazi Jewish population;
- Living in an industrialized country.
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What are some of the symptoms or potential signs of ovarian cancer?
While the symptoms of ovarian cancer (particularly in the early stages) are often not acute or intense, they are not always silent; they whisper, so listen. Some ongoing symptoms of ovarian cancer include:
- Pelvic or abdominal pain or discomfort;
- Vague, but persistent gastrointestinal upsets such as gas, nausea, and indigestion;
- Frequency and /or urgency of urination in absence of an infection;
- Unexplained changes in bowel habits;
- Unexplained weight gain or weight loss, particularly weight gain in the abdominal region;
- Pelvic and/or abdominal swelling, bloating and/or feeling of fullness;
- Pain during intercourse;
- Ongoing unusual fatigue;
- Abnormal postmenopausal bleeding (this symptom is rare).
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What are some diagnostic tests that can be used to detect ovarian cancer?
No consistently reliable, accurate screening test to detect ovarian cancer exists. The Pap test does not detect ovarian cancer. The following tests are available:
- Mandatory annual vaginal exam for women age 18 and above and annual rectovaginal exam for women age 35 and above. (Physician inserts fingers in the rectum and vagina simultaneously to feel for abnormal swelling and to detect tenderness.)
- Transvaginal sonography for women, especially those at high risk or with an abnormal pelvic examination. (An ultrasound performed with a small instrument placed in the vagina.)
- Blood test to determine if the level of a tumor marker called CA-125 has increased in the blood for women at high risk or with an abnormal examination. Its role in postmenopausal women is superior to that in premenopausal women. (This test is not definitive because some non-cancerous diseases of the ovaries also increase the CA-125 levels, and some ovarian cancers may not produce enough CA-125 levels to cause a positive test.)
- If any of these tests are positive, consultation with a gynecological oncologist should be considered. CT scans, X-rays studied and/or samples of fluid from the abdomen or tissue from the ovaries may be performed.
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What are the treatment options for ovarian cancer?
Women should always discuss treatment options with a physician, because optimal treatment will vary depending on the stage of disease, the woman’s age, and the overall condition of her health. There are three main types of treatment for ovarian cancer:
- Surgery: Surgery to remove the cancerous growth is the primary method for diagnosis and therapy for ovarian cancer. It is best performed by a qualified gynecologic oncologist. (Call the Gynecologic Cancer Foundation at 1-800-444-4441 for a referral list or check NOCC’s website www.ovarian.org.)
- Chemotherapy: Chemotherapy relies on the use of drugs that travel through the bloodstream to kill cancerous cells both in and outside of the ovaries. It is used in the majority of cases as a follow-up therapy to surgery.
- Radiation Therapy: Radiation therapy uses high energy X-rays to kill cancer cells and shrink tumors (only rarely used in the treatm
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