September is Ovarian Cancer Awareness Month. This cancer is shrouded with mystery and is often called the silent killer among women. We are fortunate have two gynecologic oncologists at NCH: Diane Yamada, M.D. and Kathryn Mills, M.D., both of the University of Chicago Department of Obstetrics-gynecology in partnership with NCH Medical Group. Dr. Mills took some time to answer our questions about this cancer.
According to National Women’s Health Network, “Though it only accounts for three percent of all cancers in women, according to the CDC, ovarian cancer causes more deaths each year than any other cancer of the female reproductive system. In 2013 alone, there were an estimated 22,000 cases of ovarian cancer resulting in about 14,000 deaths (ourbodiesourselves.org). These shocking statistics make it clear that ovarian cancer awareness is of utmost importance.”
Q: At what age are women typically diagnosed with ovarian cancer?
A: Postmenopausal women, most commonly in their 60s to 70s, are generally affected by the most common types of ovarian, fallopian and peritoneal cancers. I will refer to these cancers as ovarian cancers. In the United States, it is the second most common gynecologic cancer after uterine cancer. The average lifetime risk of being diagnosed with ovarian cancer is about 1 to 2 percent. There are hereditary forms of ovarian cancer where women develop cancer at a younger age in their 40s to 50s.
Q: What are symptoms of ovarian cancer?
A: Many early stage ovarian cancers are asymptomatic. Once more advanced, it often presents with a constellation of nonspecific symptoms including pelvic or abdominal pain, fatigue, bloating, unintentional weight loss, early fullness with eating, bladder habit changes and constipation.
Q: Why aren’t most women diagnosed until they have advanced stage cancer? Won’t it be caught in my annual gynecological appointment, during the Pap smear?
A: Unfortunately, many of the symptoms of ovarian cancers are nonspecific and many women at an early stage are asymptomatic. Thus, often by the time women are diagnosed, they are already at an advanced stage. In addition, there is no good screening test to diagnose ovarian cancer at an early stage. A Pap smear is a good screening test to find early stage cervical cancers and pre-cancers, which is why we recommend this to patients. But pap smears do not reliably diagnose ovarian cancers because the Pap is sampling the cervix area, not the ovaries or fallopian tubes. A very large screening trial previously completed (called the PLCO Cancer Screening Trial) actually demonstrated harm to patients for unindicated surgical procedures related to false-positive findings from screening tests. Altogether, at this time there is no reliable method to screen for ovarian cancer, which includes the routine use of blood tests and transvaginal ultrasounds.
Q: What puts a woman at higher risk for ovarian cancer?
A: Increasing age, history of endometriosis, never having been pregnant, personal or family history of breast or ovarian cancers and certain genetic factors.
Q: What can women do to prevent ovarian cancer, especially if they have a family history?
A: The best known factors that can reduce the risk of ovarian type cancers include oral contraceptive use (especially for more than five years), having undergone tubal ligation, having had the fallopian tubes and/or ovaries removed, breast feeding and having increasing numbers of pregnancies.
If there is a strong family history of cancer, we usually recommend testing of the family member with cancer, or if they are no longer able to be tested, we may recommend the individual closest genetically to them be tested. If you carry an increased risk gene, such as BRCA1 or BRCA2, your doctor will usually discuss with you the timing of a surgery to remove the ovaries and fallopian tubes, usually around the completion of child bearing or between the ages of 40 and 50, depending on your situation. Even in high risk patients, using ultrasound and blood tests to check for ovarian cancer has not been conclusively able to find ovarian cancer at an early stage, when it is often curable.
Q: Is there any new research on ovarian cancer?
A: New research is being done all the time! Some of the most exciting new findings include oral medications that may be used in certain patients after initial chemotherapy to prevent the cancer from coming back (called PARP inhibitors), as well as new surgical approaches including the use of heated chemotherapy at the time of surgery to help prevent the cancer from coming back.
Q: There are women who believe their use of baby powder caused their ovarian cancer. Has there been scientific proof there is a connection? How would a woman (or her remaining family) prove that was the cause?
A: There is no conclusive data that supports talc as a major cause of ovarian type cancers. A 2018 meta-analysis that included 27 different studies was unable to conclusively associate routine talc use directly with increased ovarian cancer risk.
Q: My gynecologist does sonograms yearly to look at my ovaries and I get yearly Pap tests. What else can I do to make sure my ovaries are healthy?
A: Unfortunately, studies thus far have not conclusively suggested that screening with transvaginal ultrasound reduces ovarian cancer mortality. Even in patients who are high risk, the use of transvaginal ultrasound did not reduce ovarian cancer related mortality. As discussed above, unfortunately Pap smears are not an effective way to check for ovarian cancer, either. I generally recommend to my patients to eat a well-balanced diet, exercise regularly and maintain a healthy weight, to keep their bodies, including their ovaries, healthy.
Q: Why don’t they just remove ovaries of women who have completed their family?
A: In women, the ovaries play an important role in maintaining cardiac and bone health. The American College of Obstetrics and Gynecology recommends maintaining the ovaries in place until the mid-50s to 60, at which point if the patient is undergoing an indicated hysterectomy, for example, concurrent removal of the fallopian tubes and ovaries may be indicated. Since the incidence of ovarian cancer is quite rare, many sets of ovaries and fallopian tubes would need to be removed in order to prevent one case of cancer. In younger women undergoing hysterectomy, we often do recommend removal of the fallopian tubes alone at the time of surgery, as it may reduce the risk of ovarian type cancers by up to 40 percent without an increase in surgical risk for the patient. In an average risk woman, we generally do not recommend a separate surgery to remove the fallopian tubes and/or ovaries, as this carries surgical risk.
Q: Once diagnosed, what are the treatment options, and can women still work?
A: Once a diagnosis of ovarian cancer is made, treatment options generally include combinations of chemotherapy and surgery; however, this is tailored to individual patients and the stage of presentation. Many patients are able to work even if they are receiving these therapies; it all depends on the patient and the type of work they do.
Q: Is PCOS a pre-symptom or linked in any way?
A: PCOS, or polycystic ovarian syndrome, is a complex endocrine disorder that affects younger, reproductive aged women. Available data is mixed; it does seem to support that PCOS increases the risks of uterine cancers, but it is unclear how it may affect the risk of ovarian cancers. Because PCOS is often seen in the setting of infertility and obesity, there may be confounding data regarding the direct risk of PCOS on ovarian cancer development.
Q: Does ovarian cancer often metastasize in the lung?
A: Ovarian cancers often metastasize into the abdominal cavity first. Once the cells have escaped their primary site, they can and often will attach to the surfaces of the abdominal cavity, called the peritoneum and the omentum, which is a fatty layer attached to our large colon. It may also attach to bowel, bladder and diaphragm surfaces. At later stages, it can travel to the area around the lung, called the pleural space.
Drs. Yamada and Mills are both available for appointments at NCH Medical Group’s 880 West Central Road, Suite 5000 office in Arlington Heights. For appointments, call 847-618-3800.