Ovarian cancer: Symptoms and why it’s hard to diagnose

Ovarian cancer is the presence of malignant cells in the ovaries. There are three types:

1. Epithelial, which are cancers that affect the outer surface of the ovary and comprise 90 percent of ovarian cancers.
2. Stromal tumors in cells that produce the hormones.
3. Tumors in germ cells, which produce the eggs.

How it’s detected

Unfortunately, detection is a challenge because we don’t have a screening for ovarian cancer or an equivalent like we have with a mammogram, which is a good screening for breast cancer, or a pap smear, which is a good screening for cervical cancer.

What we’re left with is trying to work with early detection and identify the patient risk because of their symptoms or because of their family history or, if known, any type of genetic predisposition to these types of cancers.

Usually the patient that we target will be someone who has a family history of ovarian cancer itself or a family history of breast cancer and sometimes colon cancer.

Who typically gets ovarian cancer

The typical age is 63.

Of most patients who have ovarian cancer, probably only 10 to 20 percent are hereditary. The rest show up with no specific gene problem, there’s no hereditary gene in the family that causes them to have the ovarian cancer.

Only a small subgroup of patients have a history. Those that do have a family history usually have the cancers early in life. When young patients get it, we suspect they are carrying a genetic predisposition to the cancer.

Symptoms

Some common complaints among women are sometimes overlooked as possible signs of ovarian cancer because they’re so common and can be produced by other benign things.

Some of those include bloating, pelvic pain or urinary symptoms such as urgency, which is the need to go to the bathroom quite frequently. Especially if the symptoms are new and have been going on for a few months, that raises a red flag as a possibility of ovarian cancer and should be referred to an OB/GYN. Also, family history should be explored.

There are some ovarian cancer tendencies and we can test for the BRCA 1 or 2 genes, the breast cancer genes. Also, the patient’s heritage is something else we look at. A patient from an Eastern European or Ashkenazi Jewish background has a higher chance of carrying one of these gene mutations.

Can ovarian cancer be prevented?

There’s nothing right now that can prevent ovarian cancer, but women who make some lifestyle choices can reduce their risk:

• Have their children before the age of 26.
• Breastfeed their babies.
• Use birth control pills for at least six months, which decreases the risk by 10 percent. The longer they use the pill, the lesser the risk.
• Once their family is complete, elect for permanent contraception with a tubal ligation, the removal of the fallopian tubes vs. a partial resection of the tube.

There are some new recommendations for patients who are already affected by the presence of one of those breast cancer genes:

• Those who have BRCA 1 or 2 genes are at high risk of developing ovarian cancer early in their life. So on those patients, we recommended that if they have completed their family, they have a risk-reduction surgery by removing the tubes and ovaries. That involves a minimally invasive procedure that takes less than an hour, is low risk and can be done in an outpatient setting.
• If they’re under 35, patients with the BRCA 2 gene are encouraged to keep their tubes and ovaries until they are 45. We then recommend discussing the possibility of risk-reduction surgery by removing the tubes and ovaries.

Biggest danger with ovarian cancer

Ovarian cancer doesn’t happen as frequently as other cancers, but the reason we talk so much about it is that the mortality is high.

There’s not an easy way to sample the organ because it’s deep inside the woman’s body and we don’t have a noninvasive way to screen the population. So usually when the patient has symptoms or we discover it during another procedure, it’s usually in stage 3 or higher.

The lifetime risk of ovarian cancer is 1.4 percent, compared with breast cancer, which is 10 times more. We have made a big improvement in early detection of breast cancer but not so much on ovarian cancer.

It’s the nature of the organ. There’s no way to sample the organ. That’s fighting our efforts to detect it early and treat it early.