Risk factors, symptoms, diagnosis and treatment of ovarian cancer

Ovarian cancer is the 9th most common cancer in women and although it only accounts for approximately 3 percent of cancers in women, it is responsible for the most deaths of any cancer involving the female reproductive tract. The American Cancer Society estimates 22,440 new ovarian cancers will be diagnosed and 14,080 deaths due to ovarian cancer will occur in the United States in 2017.

Who Is at Risk?

No one knows exactly what causes ovarian cancer, but factors that may increase risk include:

• Age. Women over age 55 are much more likely to be diagnosed with ovarian cancer than younger women.
• Family history. Women with a close relative (mother, daughter or sister) with ovarian cancer, as well as women with a family history of breast, uterine or colorectal cancers, may be at higher risk. If there is a strong family history of ovarian or breast cancer, genetic testing may be warranted to check for the presence of a specific gene mutation that increases risk.
• Personal history. Women who have already had breast, uterine or colorectal cancer and women who have never been pregnant appear to be at increased risk.

What Are the Symptoms?

Ovarian cancer symptoms are often mild or vague, and women may ignore or dismiss them. If you experience any of these symptoms, especially if they persist, it is very important to report them to your doctor:

• Heaviness in the pelvic area
• Lower abdominal pain, bloating or swelling
• Gas, nausea, vomiting or loss of appetite
• Diarrhea or constipation
• Urinary frequency or urgency

Diagnosis and Treatment

If you have ovarian cancer symptoms and a pelvic exam reveals an enlarged ovary and signs of fluid in the abdomen, your physician may order blood tests and perform imaging tests like computed tomography (CT) or magnetic resonance imaging (MRI) scans or an ultrasound.

As part of the initial work-up for ovarian cancer, all patients are recommended to undergo genetic testing to see if they have a mutation (i.e. BRCA gene mutation or Lynch syndrome) that predisposed them to developing ovarian cancer. Knowing this information can direct treatment options, guide screening to prevent other cancers and have implications for other family members.

Treatment options will depend on the cancer's stage, family planning considerations, and your individual health, but usually requires a combination of both surgery and chemotherapy. In recent years, technology has advanced to allow select patients to recover more quickly from surgery using a minimally invasive approach. This approach can involve laparoscopic and/or robotic-assisted methods and is usually reserved for staging of early ovarian cancers, but in appropriate circumstances, can be utilized for staging of more advanced cancers after initial "neoadjuvant" chemotherapy.

There have also been exciting new advances in the treatment of recurrent ovarian cancer, including the approval of targeted therapies (bevacizumab and PARP inhibitors) and ongoing research in immunotherapy and other novel agents.

Choosing Your Treatment Team

If you are diagnosed with ovarian cancer, it is important to make an appointment with a gynecologic oncologist as soon as possible. Gynecologic oncologists are trained in the comprehensive management of ovarian cancers, with care encompassing diagnosis, surgery, coordination of chemotherapy, support through survivorship, and palliative care at the end of life. In addition to your gynecologic oncologist, treatment requires a comprehensive team which will also include medical oncologists, pathologists, radiologists, nurse practitioners, physician assistants, registered nurses, and genetic counselors, to name a few.

When choosing a cancer center for your treatment, it is also important to consider the volume of ovarian cancer patients who are treated at the center. Studies have shown that hospitals treating high numbers of ovarian cancers have better outcomes. Specifically, hospitals that treat greater than 20 ovarian cancer cases per year and surgeons that operate on more than 10 cases per year result in significantly improved patient outcomes compared to lower volume hospitals. Here at Valley, our team saw 40 cases of ovarian cancer last year.