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August 30, 2011 > Get the Facts About Ovarian Cancer

Get the Facts About Ovarian Cancer

Free Washington Women's Center Education Class Will Discuss Risk Factors and Treatment Options

The American Cancer Society estimates approximately 21,900 new cases of ovarian cancer this year, with about 15,460 deaths from ovarian cancer. The ninth most common cancer in women - excluding skin cancer - it ranks as the fifth leading cause of cancer death in women.

"Cancer of the ovaries actually strikes only 1 to 2 percent of women," says Dr. James Lilja, a gynecologic oncologist on the medical staff at Washington Hospital. "Unfortunately, there is a relatively high death rate with ovarian cancer because the early stages of the disease usually produce no symptoms, so it is difficult to detect until the cancer is fairly advanced and harder to treat."

In observance of Ovarian Cancer Awareness Month in September, the Washington Women's Center will be offering a free class on the topic, led by Dr. Lilja. The class is scheduled for Thursday, September 29 from noon to 1 p.m. in the Women's Center Conference Room at 2500 Mowry Avenue, Suite 150 in Fremont. Medical oncologist Dr. Vandana Sharma, who is Medical Director of the Cancer Genetics Program at Washington Hospital, also will be available to answer questions regarding chemotherapy and cancer genetics.

Dr. Lilja notes that the most common form of ovarian cancer involves the epithelial cells that cover the outer surface of the ovaries. "When people talk about ovarian cancer, this type is what they're thinking about since it represents nearly 90 percent of ovarian cancer cases," he says. "Germ cell cancers that start from the cells that produce eggs and stromal cancers that start from cells that produce the female hormones are very rare."


Risk Factors

More than half of women diagnosed with ovarian cancer are over age 60. "Most ovarian cancers develop after menopause," Dr. Lilja explains. "It's important to remember, however, that it can happen to women in their reproductive years, too. The youngest patient I ever had with epithelial cell ovarian cancer was actually 13 years old - but that is extremely rare."

In addition to aging, a family history of ovarian cancer, breast cancer or colorectal cancer also can increase the risk of developing ovarian cancer.

"Between 10 to 20 percent of ovarian cancers occur in women who have inherited certain gene mutations, such as the BRCA1 and BRCA2 gene mutations that also are associated with breast cancer," says Dr. Sharma. "There are other inherited gene mutations, such as those connected with the Lynch syndrome, which involves increased risk for endometrial, colon and ovarian cancer. Cancers associated with these gene mutations tend to develop earlier in life, and we usually see multiple generations affected."

Other risk factors associated with ovarian cancer may include:

* Early age of first menstruation
* Late menopause
* Few or no pregnancies
* Obesity

"Some studies have tried to link ovarian cancer with the use of fertility drugs, but the data are not convincing," Dr. Lilja asserts. "Also, studies on a possible link between ovarian cancer and using hormone replacement therapy after menopause are not definitive. As for preventive measures, one interesting observation is that taking birth control pills for five years or more seems to lower the risk for ovarian cancer, but we don't know why it works. Some studies show that having your fallopian tubes tied - a tubal ligation - or a hysterectomy to remove the uterus may lower the risk of ovarian cancer.

"People should keep in mind that these 'risk factors' merely show some sort of association with ovarian cancer, they do not prove the cause," he emphasizes. "We really don't know what causes the disease."


Symptoms and Diagnostic Screenings

In the early stages, ovarian cancer produces few symptoms, and those symptoms tend to be vague and resemble symptoms of other more-common conditions such as bladder problems and digestive disorders:

* Abdominal swelling or bloating
* Pelvic pressure or pain
* Frequent urination or urinary urgency
* Loss of appetite
* Low back pain
* Abnormal menstrual cycles

"Most of these symptoms can be caused by problems other than cancer," Dr. Lilja says. "Ovarian cancer simply is very hard to detect early."

Blood tests to detect ovarian cancer are inadequate, according to Dr. Sharma. "There is a blood test for a protein in the blood called CA-125 that may be higher than normal in some women with ovarian cancer," she says. "The CA-125 test really is not a good screening test, however, because a number of other conditions also cause elevated CA-125 levels, and many women with early ovarian cancer have normal CA-125 levels. The best advice is still to get an annual physical, including a pelvic exam."

Diagnostic imaging tests such as ultrasound, CT scans and MRIs are not recommended for routine ovarian cancer screenings unless the patient is in a high-risk category, preferably confirmed by genetic testing.

"Diagnostic imaging is a two-edged sword, because it can be harmful," Dr. Lilja explains. "For example, if a 'shadow' shows up on an ovary in an ultrasound, you would still have to do surgery to take a biopsy sample. Diagnosing ovarian cancer actually rests on getting a surgical biopsy. You don't know what that shadow is until you get in there. Multiple studies have shown that you'd need to do hundreds of biopsy surgeries to find one case of cancer."


Treatment Options

Generally, when a woman undergoes a biopsy procedure to detect ovarian cancer, the surgeon will stay with her while the pathology testing is completed.

"That way, if we get a positive diagnosis of cancer, we would immediately proceed to remove the ovaries, fallopian tubes, uterus and other adjacent tissues as well as nearby lymph nodes," Dr. Lilja says. "We would do everything we can to leave no residual disease."

Surgery would be followed by chemotherapy, delivered either throughout the body by intravenous (IV) infusion or directly to the abdomen, to eradicate any small microscopic traces of cancer. "Radiation therapy is seldom used, because chemotherapy works better," Dr. Lilja notes.

A new class of drugs called PARP (poly ADP-ripose polymerase) inhibitors also is showing promise in treating some ovarian cancers.

"PARP is an enzyme that helps repair the DNA of cancer cells," Dr. Sharma explains. "By blocking the action of this enzyme, PARP inhibitors reduce the ability of tumor cells to repair themselves, making them more vulnerable to being destroyed by chemotherapy. This is a hopeful development because we now have good data regarding the effectiveness of PARP inhibitors in women with ovarian cancer. PARP inhibitors seem to be more effective in women with BRCA gene mutations, but we've also seen positive results in other cases."

Dr. Lilja also is conducting clinical trials of another treatment that holds some promise of extending the survival period for patients with ovarian cancer. The treatment, called Hyperthermic Intraperitoneal Chemotherapy, involves exposing the cancerous tissues to high heat. The procedure is designed to kill any cancer cells remaining in the patient's abdomen after surgery. It also may improve the absorption of chemotherapy drugs with minimal exposure to the rest of the body.


Learn More About Ovarian Cancer

Please note: This class was originally advertised to take place on Wednesday, September 7 but has been rescheduled to take place on Thursday, September 29. To register for this class, visit www.whhs.com or call (510) 608-1301 for more information. You can also learn more about the Washington Women's Center at www.whhs.com/womenscenter

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