SCNM's Dr. Katrina Stage recently took some time to give us some valuable information about ovarian cancer. Read what she had to say below.
September is ovarian cancer awareness month. Unlike many types of cancer, ovarian cancer presents with vague symptoms, which are often ignored. Unfortunately, this can lead to a late diagnosis and less options for treatment. Awareness of the risks and common symptoms of ovarian cancer can empower women to take steps to reduce their risk, and to recognize when to follow up with their health care provider.
Ovarian cancer is relatively uncommon, but it causes more deaths than any other cancer of the reproductive system. There are approximately 22,000 new cases of ovarian cancer and 14,000 ovarian-cancer related deaths in the United States each year. The estimated lifetime risk is 1.3%. Women who are diagnosed early have excellent survival rates (>93%); however, when diagnosed after the cancer has spread to other areas of the body, the prognosis is much less promising.
Ovarian cancer typically presents with vague, general symptoms that can be easy to attribute to other causes. The most common symptoms of ovarian cancer include abdominal bloating, pelvic or abdominal pain, feeling full quickly, lack of appetite, and urinary urgency or frequency. Other symptoms may include nausea, indigestion, gas/bloating, constipation, reflux, fatigue, shortness of breath, backache, and fever/sweats. If you have experienced any of these symptoms for more than 2-3 weeks, please make an appointment to see your physician.
The cause of ovarian cancer is not well understood. It is more common in a woman’s midyears, with most cases diagnosed between 55-64 years of age, but women can be diagnosed as early as in their 20’s. Other risk factors include genetic factors and those related to hormone changes in a woman’s life. There are many types of ovarian tumors that are called ovarian cancer; the prognosis depends on the type of tumor and whether it has spread outside of the ovary or not.
Having a family history of ovarian cancer, breast ovarian cancer syndrome (disorders of BRCA 1 or BRCA genes), or Lynch II syndrome (also called hereditary nonpolyposis colorectal cancer) increases the risk of ovarian cancer. It is always a good idea to ask relatives about their health history, and if there is a strong family history, to be proactive about testing/evaluation of symptoms. Having a personal history of breast cancer also increases the risk of ovarian cancer.
Women who have never been pregnant have an increased risk of ovarian cancer compared to women who have been pregnant multiple times. Breastfeeding also decreases the risk of ovarian cancer. Women who start puberty early (first menstrual period before age 12) or menopause late (last menstrual period after age 52) have an increased risk of ovarian cancer.
Hormone replacement therapy (HRT) to address menopausal symptoms may slightly increase the risk of some types of ovarian cancer, but the risk declines the more years a woman is off of the HRT. In general, it is safest for women to start HRT within 10 years of menopause, to take the lowest dose that alleviates their symptoms, and to stop the HRT within 10 years of use, although severe symptoms may necessitate longer treatment in some women.
Taking oral contraceptives (“the pill”) decreases the risk of ovarian cancer. For women with increased risks of ovarian cancer and the desire for contraception, this may be a good solution.
Avoidance of talcum powder in the vulva or perineum reduces the risk of ovarian cancer. Smoking cessation decreases the risk of all cancers, including ovarian. Maintaining a healthy weight and regular physical activity also seem to decrease risk.
Some studies have shown an increased risk of ovarian cancer in women who consume high amounts of dairy. Alternating dairy products with some non-dairy, such as fortified almond or coconut milk, can provide adequate calcium and may decrease risks. Other research seems to indicate that women who eat more fish and less red meat may have a decreased risk of ovarian cancer. The healthiest types of fish include wild salmon, trout, anchovies, sardines, and scallops. Farmed or Atlantic salmon, tuna, shark, swordfish, sea bass, Gulf Coast oysters, halibut, marlin, kind mackerel, pike, and walleye are high in mercury and should be limited for general health reasons.
Eating more vegetables seems to lower the risk of ovarian cancer. Cruciferous vegetables (broccoli, cauliflower, kale, cabbage, and Brussels sprouts) and high anti-oxidant foods (carrots, beets, artichoke, walnuts, tomatoes, plums, and all types of berries) seem most beneficial. When in doubt, aim to have a rainbow of colored fruits and vegetables as the base of each meal.
While clinical data are lacking, there is some in vitro evidence that endocrine disrupting chemicals may contribute to ovarian cancer. Look for personal care and cleaning products that have ingredients you can recognize. The environmental working group (www.ewg.org) has several databases where you can access the safety of common personal care and cleaning ingredients.
Routine screening is not done for ovarian cancer, however, yearly gynecologic exams can detect masses and provide an excellent opportunity to discuss symptoms with a physician. If ovarian cancer is suspected, a physical exam, imaging (typically starting with an ultrasound), and a blood test for CA-125 will be done. Other tests may also be done, such as a colonoscopy or upper GI, to rule out gastrointestinal causes of the symptoms. Additional imaging and a biopsy confirm diagnosis of ovarian cancer. Women at very high risk, such as those with a genetic redisposition, may consider having their ovaries removed as a preventative measure. While relatively uncommon, Angelina Jolie’s choice to have this surgery has brought this option to light.
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