Ovarian Cancer

In the United States, incidence of ovarian cancer ranks second among all gynecologic cancers. It causes more deaths than any other gynecologic cancer. In Colorado, ovarian cancer is the 5th most commonly diagnosed cancer in women and the 8th most common cause of cancer mortality. The cumulative lifetime risk is one in 60. In women with a personal or family history of breast or ovarian cancer, that risk increases significantly. Other risk factors include advancing age. The 5-year survival rate for ovarian cancer is approximately 50%.

The ovarian cancer plan for Colorado has four objectives. These objectives are aimed at improving 1) awareness, 2) education, and 3) advocacy. 4) Support for ovarian cancer survivors and caregivers is also an important component of the cancer plan. Women who have one first-degree relative with ovarian cancer but no known genetic mutation still have an increased risk of developing ovarian cancer. The lifetime risk of a woman who has a first degree relative with ovarian cancer is five percent (the average woman’s lifetime risk is 1.4 percent).

About 10 to 15 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease. The most significant risk factor for ovarian cancer is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). These genes are responsible for about 5 to 10 percent of all ovarian cancers.

Eastern European women and women of Ashkenazi Jewish descent are at a higher risk of carrying BRCA1 and BRCA2 mutations. Since these genes are linked to both breast and ovarian cancer, women who have had breast cancer have an increased risk of ovarian cancer.

Another known genetic link to ovarian cancer is an inherited syndrome called hereditary non-polyposis colorectal cancer (HNPCC or Lynch Syndrome). While HNPCC poses the greatest risk of colon cancer, women with HNPCC have about a 12 percent lifetime risk of developing ovarian cancer.

Gynecologic oncologists are physicians trained in recognizing and removing gynecological cancers. Research has shown that the five-year survival rate is greater when initial surgery for ovarian cancer is performed by a gynecologic oncologist. (NCI) The initial surgery and staging of ovarian cancer is critical to determining the appropriate course of treatment, and ultimately survival outcomes. A gynecologic oncologist is an obstetrician gynecologist who is further trained in oncology to specialize in the diagnosis and treatment of women with gynecologic cancers. To find a gynecologic oncologist in your area, visit the Women’s Cancer Network at www.wcn.org

Screening

Although a CA 125 blood test can be a useful tool for the diagnosis of ovarian cancer, in pre-menopausal women, it is not uncommon for a CA 125 count to be elevated due to benign conditions unrelated to ovarian cancer. Uterine fibroids, liver disease, inflammation of the fallopian tubes and other types of cancer can elevate a woman’s CA 125 level. (ACOG Patient Education – 1996) The CA 125 test is more accurate in postmenopausal women. It is also important to note that in about 20% of cases of advanced stage disease, and 50% of cases of early stage disease, the CA 125 is NOT elevated, even though there is ovarian cancer present. As a result, the CA 125 is generally only one of several tools used to diagnose ovarian cancer. One of the most important uses of the CA 125 test, however, is to evaluate progressive disease and tumor response in patients undergoing treatment, and to monitor the levels of women in remission for evidence of disease recurrence.

Symptoms

Symptoms are relevant, but they are not a definitive diagnostic tool. Since there is no single diagnostic tool for ovarian cancer, symptom awareness remains of key importance. Awareness of symptoms can help women get diagnosed sooner, hopefully at an earlier stage.

The use of oral contraceptives decreases the risk of developing ovarian cancer, especially when used for several years. Women who use oral contraceptives for five or more years have about a 50 percent lower risk of developing ovarian cancer than women who have never used oral contraceptives. Researchers believe that incidence of the most common type of ovarian cancer is heightened by the eruption of eggs from the ovaries. Multiple pregnancies, breast feeding, late puberty and early menopause can reduce risks.

Research and Clinical Trials

Clinical trials are carefully designed research studies that involve people. Some clinical trials are conducted to find ways to improve the medical care and treatment that is available to women with ovarian cancer. Some trials test ways to detect and prevent ovarian cancer or its recurrence. There are also clinical trials that study how to improve an ovarian cancer patient’s quality of life during and after treatment. The types of trials are:

• Phase 1 trials evaluate the safety of a treatment. These studies typically enroll fewer than 50 people who have different types of cancer these trials determine the safe dosage, delivery method and side effects of a drug.
• Phase 2 ovarian cancer drug trials test to see if the treatment works against ovarian cancer. These studies typically enroll about 100 women with ovarian cancer
• Phase 3 trials test the new treatment against the best existing treatment, also called the “standard of care” or “standard care.” These studies typically enroll hundreds to thousands of women to determine if the treatment is safe and effective against ovarian cancer. Phase III data is used to apply for FDA approval