According to the American Cancer Society, approximately 19,880 women will receive a new diagnosis of ovarian cancer this year and 12,810 women will die from it. It is the fifth most fatal cancer in women and the most deadly to affect the female reproductive system.
For Ovarian Cancer Awareness Month in September, University of Minnesota Medical School expert Colleen Rivard, MD, talks about the subtle signs and risk factors of ovarian cancer.
Q: What is ovarian cancer?
Ovarian cancer is the second most common and deadly gynecological malignancy in the United States. It is a malignant tumor that originates from the ovaries or fallopian tubes.
There are three main types of ovarian cancer:
- Germ cell tumors arise from the cells that give rise to the oocytes of the ovary.
- Stromal tumors arise from the supporting cells of the ovary that surround the oocytes.
- Epithelial cancers, which are by far the most common and deadly, are the points we will focus on today. Among epithelial tumors, the most common are serous carcinomas, which we further divide into low-grade and high-grade.
Q: What are the subtle symptoms of ovarian cancer?
One of the biggest problems with ovarian cancer, and the reason it is so deadly, is that there are often no symptoms in the early stages and by the time women develop subtle symptoms, the cancer has already spread. Most ovarian cancers are diagnosed in stages three and four, at which point it is very difficult to cure.
The most common symptoms are abdominal symptoms, including pain, swelling or distention, changes in appetite or early satiety, and changes in bowel or bladder habits. These symptoms are often nonspecific and can mimic other health conditions, such as digestive conditions, esophageal reflux, or urinary problems.
Q: What are the risk factors for developing ovarian cancer and the current treatment options available?
In general, the biggest risk factor for ovarian cancer is age, with the vast majority of epithelial cancers occurring in women 60 years of age and older.
Other risk factors include infertility, endometriosis, polycystic ovary syndrome, nulliparity, early menarche, or late menopause.
There are also several genetic mutations and syndromes that are associated with a significant increase in the risk of developing ovarian cancer. These include hereditary breast and ovarian cancer syndrome and Lynch syndrome.
There are also a number of other genetic mutations that we know lead to an increased risk of ovarian cancer. In fact, these genetic mutations lead to up to 25% of ovarian cancer diagnoses and, therefore, it is recommended that all women diagnosed with ovarian cancer receive genetic counseling and testing. These mutations can also impact the treatment a patient receives.
The mainstay of initial treatment for ovarian cancer is currently a combination of surgery and chemotherapy. Unfortunately, in 85% of patients, their tumors will recur and in these situations, the mainstay of treatment is chemotherapy or enrollment in a clinical trial.
Q: If someone is diagnosed with ovarian cancer, what should they know about the diagnosis?
An ovarian cancer diagnosis can be very overwhelming for a patient and I think it can be helpful to diagnose and treat one step at a time. I think it is also very important for a patient to have a lawyer who is a family member or friend who can attend visits with them to help them remember and understand all the information discussed. We also have the Minnesota Ovarian Cancer Alliance (mnovarian.org), which has great resources for patients, families, and providers. September is also National Ovarian Cancer Awareness Month and we have just organized the MOCA to raise money for research into the early detection and treatment of ovarian cancer.
Q: What are you doing in your research and practice to deepen our understanding of ovarian cancer and patient relationships?
Over the past 10 years we have made many important breakthroughs in the treatment of ovarian cancer, including PARP inhibitors and immunotherapy. As a division of gynecological oncology, we are committed to accessing and enrolling patients in clinical trials, as this is the best way to improve outcomes for ovarian cancer patients.
Colleen Rivard, MD, is a gynecological oncologist at U of M Medical School and M Health Fairview. She is also a member of the Masonic Cancer Center.