The American Cancer Society estimates that about 21,000 women will be diagnosed with ovarian cancer this year, and although it’s rare, it’s also the deadliest of all female reproductive cancers.
Unlike breast, uterine, and cervical cancers which have screenings and can be detected early, only about 20 percent of ovarian cancer cases are diagnosed before they’re advanced.
The good news is that if ovarian cancer is diagnosed and treated early, 94 percent of women will live five years or more. Another recent study in the Journal of Obstetrics and Gynecology also found that up to a third of women will survive at least 10 years.
The disease that whispers
“In years past we used to call ovarian cancer the silent killer but it’s really not completely silent, at least in some patients,” said Dr. Edward Tanner, an assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine in Baltimore, Maryland.
Ovarian cancer is now dubbed the “disease that whispers” because although the symptoms are vague and can mimic symptoms of other conditions or diseases, most women will report that they noticed them.
In fact, research shows that women diagnosed with ovarian cancer have new symptoms crop up in recent months. They also tend to occur frequently, every day or every other day and at least 12 times a month, and are more severe.
The most common signs of ovarian cancer include:
• Bloating or a swollen abdomen
• Increased abdominal size
• Urinary frequency, urgency or difficulty
• Problems eating, such as feeling full quickly after a meal
• Constipation, diarrhea
• Pelvic pain or pressure
• Pain anywhere in the abdomen
• Vaginal bleeding
• Back pain
• Painful sex
• Weight loss
• Changes in menstruation
The other problem with ovarian cancer is that it can develop quickly, even in between visits to the OB-GYN. Nevertheless, all women should have a yearly well woman visit and pelvic exam.
“As an oncologist, I do see patients that have ovarian cancer diagnosed on an annual visit where it’s caught early, perhaps several months earlier than it would have been caught if the patient hadn’t had an annual exam,” Tanner said.
Causes of ovarian cancer
The only cause of ovarian cancer that researchers have identified is the BRCA1 and BRCA2 “breast cancer” genes. Studies show that 39 percent of women with the BRCA1 mutation, and 11 to 17 percent of those with the BRCA2 mutation will develop ovarian cancer by 70-years-old.
Other factors that are associated with the risk for ovarian cancer include endometriosis, obesity, early onset of periods or late menopause, and not having children.
“We know what elevates your risk but even having a genetic mutation doesn’t guarantee that you’re going to get ovarian cancer,” said Dr. Barbara A. Goff, a gynecologic oncologist at Seattle Cancer Care Alliance, and a professor of gynecologic oncology at the University of Washington School of Medicine in Seattle.
The future of early detection
For more than 20 years, researchers have been looking for an effective way to screen women for ovarian cancer without success.
Currently, the UK Collaborative Trial of Ovarian Cancer Screening,a large clinical trial, is looking at the combination of the CA-125 blood test and a pelvic and transvaginal ultrasound as an early screening tool. Early results published in May found that regular blood tests detected 86 percent of ovarian cancer. Final results are due out later this year.
“Until we have results, we can’t really say whether it’s going to be helpful or not,” Tanner said.
Other areas that researchers are investigating are the role of genetics as prevention and at the fallopian tubes.
Since it’s believed that many ovarian cancers start in the fallopian tubes rather than in the ovaries, it may be advantageous to remove the fallopian tubes and keep the ovaries intact in women who are having surgery, such as a tubal ligation, Goff said.
According to the American College of Obstetricians and Gynecologists (ACOG) position statement, although this protocol is promising, they can’t recommend it as the standard of care.
“What we don’t know yet is if there are some risks associated with that practice,” Goff said, citing complications or early menopause.
How to prevent ovarian cancer
Studies show that long-term use of the birth control pill and breastfeeding may reduce a woman’s risk because it reduces the rate of ovulation. Plus, studies show the more children a woman has, the lower her risk.
“It’s not the only factor that plays a role. It’s protective but it’s not the golden bullet,” said Dr. Oliver Zivanovic, a surgical oncologist at Memorial Sloan Kettering Cancer Center in Commack, New York.
Unlike other cancers that can be prevented with a healthy diet and exercise, unfortunately ovarian cancer hasn’t been shown to have the same link.
Nevertheless, leading a healthy lifestyle, which includes regular doctor visits is always a good idea.
If you have any of the signs of ovarian cancer, listen to your body and your intuition and make an appointment with your primary care physician or ob-gyn immediately.
“Don’t let your doctor say it’s just irritable bowel syndrome or a urinary tract infection, Zivanovic said. “When these things are not going away despite the fact that you’ve been treated, it’s a red flag.”