September is National Ovarian Cancer Awareness Month.  Ovarian cancer ranks fifth in cancer deaths among women. To better serve your patients and help save lives, now is the time to review current information available on statistics, causes and prevention.

Ovarian Cancer Awareness – Fight Like a Girl!

Ovarian Cancer Awareness groups utilize this acronym: BEAT to highlight the four of the signs and symptoms of this typically “silent” disease.  (Only 15% of ovarian cancer cases are diagnosed in an early stage.)

Bloating that is persistent

Eating less and feeling fuller

Abdominal pain

Trouble with your bladder

Additional indicators for concern are: excessive dark and coarse hair growth, painful sex, back pain, abnormal menstrual cycle, nausea or vomiting, fatigue, constipation, and increased gas.

Ovarian Cancer Statistics:

 Each year, approximately 250,000 women worldwide are diagnosed with ovarian cancer resulting in 140,000 deaths.

Each year, more than 22,000 women in the US get ovarian cancer; that translates to a one in 100.  The American Cancer Society estimates 15,000 deaths from ovarian cancer in the United States annually, a rate that has changed little in the last 50 years. 

  Even though there are no definitive causes, it is known that the chances of developing the disease are greatly influenced by family history:

There is a 5 in 100 chance for women with one relative that has the disease.  The chance increases to 7 in 100 if two or three relatives have been diagnosed. 

Besides genetic influences, other factors thought to increase ovarian cancer risk include:

Women with lower birthrates and giving birth later in life.

Women who take Estrogen replacement without Progesterone for more than 5 years.

Women who have had breast cancer or have a family member with breast cancer.

Women from middle to advanced ages.  (Most Ovarian cancer related deaths occur in women over 55 years of age.)

Ovarian Cancer Screening: 

Any woman with signs of ovarian cancer, especially if they are considered high risk, should be offered by their physician these tests: 

Pelvic Exam:Women age 18 and above should have a mandatory annual vaginal exam. Women age 35 and above should receive an annual rectovaginal exam (physician inserts fingers in the rectum and vagina simultaneously to feel for abnormal swelling and to detect tenderness).

Transvaginal Sonography:This ultrasound, performed with a small instrument placed in the vagina, is appropriate especially for women at high risk for ovarian cancer or for those with an abnormal pelvic exam.

CA-125 Test:This blood test determines if the level of CA-125, a protein produced by ovarian cancer cells, has increased in the blood of a woman at high risk for ovarian cancer or with an abnormal pelvic examination.  (ACA-125 test can be useful, but can be inaccurate. This test should be utilized with other testing for diagnosing ovarian cancer.)

Ovarian Cancer Diagnosis, Staging and Treatment:

A woman with any positive results should consult with a gynecologic oncology specialist immediately.  Additional testing may be ordered such as a CT scan and X-Rays. The most accurate way to confirm ovarian cancer is with a biopsy.

     Surgery

The initial surgery is typically performed via laparotomy to obtain tissue for biopsy, but may also include debulking of the visible cancerous tumor, removal of one or both ovaries and fallopian tubes (salpingo-oopharectomy) and often the removal of the uterus (hysterectomy).  From this procedure the gynecologic oncologist can determine the staging of the cancer and the cell pathology can be analyzed.  All of this information is crucial in planning the appropriate treatment strategy.

Subsequent surgical interventions may be required in the following instances:

"Second-look" surgeries are on occasion performed via laparotomy or laparoscopy as a follow-up for women whose cancer responds to chemotherapy.  It allows the physician to investigate whether any cancer remains in the abdominal cavity and will require further treatment.

Additional debulking surgerycan in some cases be indicated to reduce cancer symptoms and improve the effects of chemotherapy.

In the case of recurrent ovarian cancer, surgery is used toremove the new measurable disease after a reasonable disease-free interval or to remove bowel or ureteral obstruction caused by the recurrence.

     Radiation therapy

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors (only rarely used in the treatment of ovarian cancer in the United States).

     Chemotherapy

In the majority of ovarian cancer cases, chemotherapy is administered post-surgery to either destroy cancer cells or stop them from growing both in and outside the ovaries. (For cases that require the shrinking of the tumor prior to debulking surgery, neoadjuvant chemotherapy is used.)

    Follow this link to the American Cancer Society dedicated web page for Ovarian Cancer Information: http://www.cancer.org/cancer/ovariancancer/index

Besides helping your patients, share this information with colleagues, family and friends.  You never know whose life it may save!