High-Risk Ovarian Cancer
Ovarian cancer is a disease in which malignant cells are found in an ovary. There are three types of ovarian tumors, named for the tissue in which they are found:
- Epithelial cell refers to cells that cover the surface of the ovary. Most of these tumors are benign (noncancerous). However, epithelial ovarian cancer accounts for 85 to 90 percent of ovarian cancer cases.
- Germ cell refers to cells that form in the eggs in the ovary.
- Stromal cell refers to cells that form in the ovary and produce female hormones.
Although we still do not know what causes cancer, there are new and powerful options available today to successfully detect and fight ovarian cancer. The most important factor is catching cancer early, when it is most treatable — or closely monitoring women who may be at increased risk.
As the region's only NCI-designated cancer center, UVA brings you the region's most comprehensive cancer detection and treatment options, as well as personal support for you and your family.
These risk factors that can increase your chances of getting ovarian cancer:
- Family history of ovarian cancer
- Age (risk increases with age)
- No pregnancies
- Number of pregnancies, complete or incomplete
- Higher socioeconomic status
- Early menarche/late menopause
- Prior hysterectomy
What You Should Know About BRCA1 and BRCA2
The mutations that most often cause both breast and ovarian cancer are changes in the BRCA1 and BRCA2 genes ("Breast cancer 1 gene" and "Breast cancer 2 gene").
Women with inherited mutations in the BRCA1 or BRCA2 genes are three to seven times more likely to develop breast and ovarian cancer than those who do not have the mutations, and at an earlier age.
According to the National Cancer Institute (NCI), the women who are mostly likely to have BRCA1 or BRCA2 mutations are those of Eastern European (Ashkenazi) Jewish heritage and/or those with family members who have had:
- Multiple cases of breast cancer
- Cases of both breast and ovarian cancer, or
- One or more family members with two primary cancers (original tumors at different sites).
However, the NCI also notes that not every woman in such families carries an alteration in BRCA1 or BRCA2, and not every cancer in such families is linked to alterations in these genes.
For many women, a genetic evaluation performed by the genetic counselors at the UVA High-Risk Breast and Ovarian Cancer Program can provide valuable insight into inherited risk. For women who are at higher inherited risk for breast and ovarian cancers, the high-risk program offers many options for proactive, watchful management.
Hereditary versus Sporadic Cancer
We all have 20,000 to 25,000 genes in the cells of our body. These genes determine all of our characteristics — hair color, height, body type and so on. Cancer is caused by uncontrolled growth of cells as the result of mutations in genes.
Because the mutated genes that cause hereditary cancer are inherited from a person's parents, every cell in the body of a person with such a mutation contains the mutation.
It usually takes more than one mutation to cause cancer, but people who inherit a cancer-causing mutation are that much more likely to get cancer in their lifetimes.
About 90 percent of all cases of cancer are sporadic cancers. Unlike hereditary cancer, in which mutations are passed on from parents, in cases of sporadic cancer, the mutation occurs spontaneously — often from unknown origins and reasons.
Doctors believe that these mutations are caused through exposure to risk factors for cancer during a person's lifetime.
Ovarian cancer often does not cause many early signs until the cancer grows. The following are the most common symptoms of ovarian cancer. In women with cancer, they are more likely to occur more than 12 times in a month.
- Pelvic or abdominal pain
- Increasing abdominal size
- Difficulty eating
- Feeling full quickly when eating
- Constipation and pelvic pressure
There are several ways to detect ovarian cancer and all begin with a physical exam, including a pelvic exam to feel the vagina, rectum and lower abdomen for masses or growths. Your doctor may also order other tests, including:
- Transvaginal ultrasound – an imaging technique that uses an ultrasound probe inserted into the vagina to produce an image of the ovaries created by sound waves.
- Computed tomography (CT or CAT scan) – a noninvasive procedure that takes cross-sectional images of the brain or other internal organs to detect any abnormalities that may not show up on an ordinary x-ray.
- Blood test – to measure a substance in the blood called CA-125 (a tumor marker that is found to be elevated in the blood of women with ovarian cancer). This test is more often used to monitor the progress of treatment than as a screening test since non-cancer problems can cause it to be elevated.
Non-surgical options for ovarian cancer prevention and treatment may include:
- Personal risk assessment and close observation – doesn't involve drugs or any other kind of active treatment. Instead, your doctor will use regular check-up visits and advanced diagnostics to keep a close eye on your overall health and watch for any possible signs of disease.
- Chemoprevention – is the use of oral contraceptives, which decrease ovarian cancer by 50 percent if used for five years. Chemoprevention works in a couple of different ways. First, it can prevent the mutations than can cause cancer. It can also help stop the process that makes the mutated, damaged cells grow out of control.
- Chemotherapy – involves the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells.
Surgical options for ovarian cancer prevention and treatment may include:
- Prophylactic oophorectomy – a preventive surgery to remove the ovaries for patients with a very high risk of ovarian cancer.
- Salpingo-oophorectomy – surgery to remove the fallopian tubes and ovaries.
- Hysterectomy – surgical removal of the uterus.
- Lymph node dissection – removal of some lymph nodes from the pelvis and abdomen.
To reduce your risk of ovarian cancer, and to keep yourself healthy overall, you should eat a balanced diet, get regular exercise and try to keep yourself relaxed and stress free. You should also avoid risk factors that are under your control and known to cause cancer.
What is Chemoprevention?
Chemoprevention is the use of natural or synthetic substances to reduce the risk of getting cancer or of having cancer recur. Chemoprevention works in several different ways. First, it can prevent the mutations that can cause cancer. It can also help stop the process that makes the mutated, damaged cells grow out of control.
Chemoprevention is not the same as chemotherapy. Chemotherapy is used to kill cells that have already mutated and become cancerous. Chemoprevention is done to try to stop cells from becoming cancerous.
“It runs in the family.” How many times have we said it about a family member’s wavy hair or wide-open smile? We don’t like to think about cancer as a family trait but here’s why we should: Thanks to remarkable advances in our understanding of the role of genetics, a woman can learn if she’s at higher inherited risk, enabling her to take action to stay healthy.
Genetic mutations and other inherited risk factors are a factor in less than 10 percent of all breast and ovarian cancers. But if a woman does carry an inherited mutation, specifically the BRCA1 or BRCA2 gene, our genetic counselors can help you understand what it means to you. Because genetic risk is complex, our genetic counselors are an integral part of the high-risk program’s interdisciplinary team, whose primary purpose is helping you manage your risk of developing cancer.