Ovarian Cancer - Risks and Symptoms

by Jane Ashley

When we think of ovarian cancer, many of us immediately think of Gilda Radner, the Saturday Night Live actress and comedian, who died of ovarian cancer in 1989. While the treatment for ovarian cancer has greatly improved in the last 30 years, ovarian cancer’s onset is characterized by vague symptoms. Sadly, even in 2020, only 15% of ovarian cancer is diagnosed in the early stages.

Gilda Radner

An estimated 21,750 women will be diagnosed with ovarian cancer this year. In the last 10 years, new cases have dropped by 1.6% annually — most probably due to the decrease in the use of hormone-replacement therapy. 

What is ovarian cancer?

Ovarian cancer is cancer that begins in the ovary or fallopian tubes. Rarely, ovarian cancer begins in the peritoneum — the serous membrane lining the cavity of the abdomen and covering the abdominal organs. 

Research now suggests that most ovarian and fallopian tube cancers are high-grade serous cancers (HGSC) that begin in the outer end of the fallopian tube and spread to the outer surface of the ovaries.

Since ovarian cancer in its early stages only produces vague symptoms, it’s important to know if we have risk factors so we can be extra vigilant. 

Ovary Image National Cancer Institute

Risk factors include:
• Family history – a strong family history of breast and/or ovarian cancer puts women at increased risk. Sometimes, family history is linked to specific genetics.
• Genetic mutations – at least 10-20% of ovarian cancer is linked to genetic mutations. The American Society of Clinical Oncology (ASCO) recommends that women diagnosed with epithelial carcinoma (high-grade serous cancers) have genetic testing for several cancer risk genes, including BRCA1 and BRCA2, RAD51, and PALB. This testing should be done regardless of whether there is a family history or not. Women without these inherited mutations should also be tested for BRCA mutations in the tumor cells. There are specific treatments for ovarian cancer that work, regardless of whether this mutation is inherited or not.
• Rare genetic conditions – several rare genetic syndromes increase the risk of ovarian cancer, including Lynch syndrome, Peutz-Jeghers syndrome, Nevoid basal cell carcinoma syndrome, and Li-Fraumeni syndrome and ataxia-telangiectasia.
• Age. Women over 50 are more likely to develop ovarian cancer. About half of all women diagnosed with ovarian cancer are over 63.
• Weight. Women who were obese in early adulthood are more likely to develop ovarian cancer.
• Ethnicity. North American, Northern European, or Ashkenazi Jewish heritage are linked to an increased risk of ovarian cancer.
• Reproductive history. Mensural periods before the age of 12 and menopause after the age of 51 put women at an increased risk for ovarian cancer. Not having children and unexplained infertility also put women at increased risk. Not ever having taken birth control pills also puts a woman at increased risk.
• Hormone replacement therapy. Women who took estrogen-only hormone replacement therapy after menopause are at increased risk.

Most experts recommend that women with the BRCA1 and BRCA2 mutations, along with women with Lynch syndrome, have their fallopian tubes and ovaries removed after they have had all the children they’ve planned. High-risk women should talk to a genetic counselor to fully understand their personal risks.

What are the symptoms of ovarian cancer?

Symptoms of ovarian cancer are vague and aren’t just symptomatic for ovarian cancer — non-cancerous medical conditions can cause these symptoms. The best advice is for any woman who experiences any of the symptoms every day for several weeks to see their gynecologist.
• Abdominal bloating
• Back pain
• Constipation
• Difficulty eating or feeling full almost immediately
• Fatigue
• Indigestion or upset stomach
• Irregular menstrual cycles
• Pain or swelling in the pelvic or abdominal area
• Painful intercourse
• Urinary urgency or frequency
• Vaginal discharge may be clear, white, or blood-tinged

Ovarian Cancer Symptoms Are Vague

Unfortunately, there is no screening test for ovarian cancer. The Pap smear is not for ovarian cancer. Nor is the CA-125 specific for ovarian cancer — the CA-125 level can be elevated for a variety of reasons that are non-cancerous in women of childbearing age. The CA-125 level is more reliable for post-menopausal women.

September is Ovarian Cancer Awareness Month. The most important takeaway about ovarian cancer is to know if you are at higher risk for ovarian cancer and to see a gynecologist if you experience any of these symptoms daily for several weeks. Early detection saves lives.

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