Ovarian Cancer Awareness

from the University of Michigan Health System

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There is no screening test for ovarian cancer, like a Pap smear or mammogram. The CA125 blood test measures the amount of a certain protein that's often elevated with ovarian cancer. But the test is not foolproof. "There are a lot of benign conditions that can cause higher levels of CA125," Liu says. Early detection is a key area of research. U-M researchers are looking for markers in the blood that indicate ovarian cancer, an approach that could in time lead to a blood test to screen for ovarian cancer.

All women need yearly pelvic exams. Maybe your doctor says you don't need a Pap smear every year, but Pap tests just check for cervical abnormalities. A pelvic exam is not the same thing. In particular, older women should not discontinue their yearly gynecology visit as ovarian cancer is more likely to occur in women older than 60. "A pelvic exam is key because it's the best screening we have right now," says J. Rebecca Liu, M.D., assistant professor of obstetrics and gynecology at the U-M Medical School and a gynecologic oncologist at the U-M Comprehensive Cancer Center.

Survival rates are significantly better when ovarian cancer is diagnosed in an early stage. With stage I ovarian cancer, the earliest stage, 95% of women are alive five years after diagnosis. Only 30% of women with stage III or IV ovarian cancer survive five years. Some 70% of women have advanced disease when they are diagnosed.

Ovarian cancer is difficult to treat because it's often resistant to current treatments. It may respond to chemotherapy drugs initially, but when it recurs - which it usually does - the cells will no longer be killed by that drug. Researchers are focusing on new molecularly targeted therapies that hone in on and destroy the cancer cells, and they hope this will overcome the resistance. A clinical trial at U-M is looking at whether the drug Avastin, which has been successful for colon cancer, can improve survival in ovarian cancer.

It's most common in older white women. Most patients are older than 60 and post-menopausal. Women who have not had children are at higher risk. Women who have taken birth control for a number of years lower their risk.

A small number of ovarian cancers are hereditary. It's linked to the same genes that are linked to breast cancer, BRCA1 and BRCA2. If ovarian cancer runs in your family, particularly on your mother's side, and if family members were diagnosed at a young age, you might consider genetic testing. Learn more: Genetic Testing for Breast and Ovarian Cancer.

The best person to treat ovarian cancer is a gynecologic oncologist. These specialists are skilled in the comprehensive management of female reproductive cancers, including surgery and chemotherapy. Studies have shown gynecologic oncologists are two to three times more likely to provide surgical care consistent with national guidelines. Women with ovarian cancer treated by gynecologic oncologists have 10% to 25% better survival rates than women treated by general oncologists or gynecologists. While your regular gynecologist can perform diagnostic tests, if you are diagnosed with ovarian cancer, you should see a gynecologic oncologist.

The following risk factors may increase the risk of ovarian cancer:

Family history of ovarian cancer

A woman whose mother or sister had ovarian cancer has an increased risk of ovarian cancer. A woman with two or more relatives with ovarian cancer also has an increased risk of ovarian cancer.

• Inherited risk
  The risk of ovarian cancer is increased in women who have inherited certain changes in the following genes:
  
  
  • BRCA1 or BRCA2 genes.
  • Genes that are linked to hereditary nonpolyposis colorectal cancer (HNPCC; Lynch syndrome).
  
  Learn more: Genetic Testing for Breast and Ovarian Cancer.
  
  
• Hormone replacement therapy
  The use of estrogen -only hormone replacement therapy (HRT) after menopause increases the risk of ovarian cancer. The longer estrogen replacement therapy is used, the greater the risk may be. It is not clear whether the risk of ovarian cancer is increased with the use of HRT that has both estrogen and progestin.
• Fertility drugs
  The use of fertility drugs may be linked to an increased risk of ovarian cancer.
• Talc
  The use of talc may increase the risk of ovarian cancer. Talcum powder dusted on the perineum (the area between the vagina and the anus) may reach the ovaries by entering the vagina.
• Obesity
  Having too much body fat, especially during the teenage years, is linked to an increased risk of ovarian cancer. Being obese is linked to an increased risk of death from ovarian cancer.

The following protective factors may decrease the risk of ovarian cancer:

Oral contraceptives
The use of oral contraceptives ("the pill") lowers ovarian cancer risk. The longer oral contraceptives are used, the lower the risk may be. The decrease in risk may last up to 25 years after a woman has stopped using oral contraceptives.

Taking oral contraceptives increases the risk of blood clots. This risk is higher in women who also smoke. There may be a slight increase in a woman's risk of breast cancer during the time she is taking oral contraceptives. This risk decreases over time.

Pregnancy and breastfeeding
Pregnancy and breastfeeding are linked to a decreased risk of ovarian cancer. Ovulation stops or occurs less often in women who are pregnant or breastfeeding. Some experts believe that women who ovulate less often have a decreased risk of ovarian cancer.

Bilateral tubal ligation or hysterectomy
The risk of ovarian cancer is decreased in women who have a bilateral tubal ligation (surgery to close both fallopian tubes) or a hysterectomy (surgery to remove the uterus).

Symptoms do exist.
The most common symptoms of ovarian cancer are:

• Bloating
• Pelvic or abdominal pain
• Difficulty eating
• Feeling full quickly
• Frequent or urgent urinating

These are vague symptoms and often mistaken for gastrointestinal problems. U-M experts recommend women who experience these symptoms almost daily get checked out by your gynecologist.