Ovarian Cancer

Background
There is a 1 in 70 lifetime risk of developing ovarian cancer. It ranks behind lung, breast, colorectal, and pancreatic as the leading causes of cancer deaths in U.S. women.

Recent advancements in the management of ovarian malignancies have significantly improved the prognosis for this cancer. Today, ovarian cancer is often characterized as a chronic disease due to the fact that more women are living with this cancer for a longer period of time than ever before.

Risk Factors
Only approximately 10% of women who develop ovarian cancer have a germ line mutation, which is an abnormal gene that is inherited from either her mother or father that greatly increases the lifetime risk of developing breast and/or ovarian cancer. The majority of women with ovarian cancer have sporadic mutations that occur within their own lifetime.

Deoxyribonucleic acid (DNA) encodes genetic information. A gene is a discrete sequence of DNA nucleotides that code for certain proteins. Many of these proteins play a key role in causing or preventing a cancer. It is estimated that there are 30,000 genes in the human genome of which only 5,000 code for critical targets.

For those 10% who have a gene abnormality, a positive family history is usually most helpful in signaling that an inherited defect is present. A positive family history is defined when there are two or more first- or second-degree relatives with breast and/or ovarian cancer and the breast cancer is diagnosed prior to age 50. Candidates for genetic counseling usually have a family history that includes several relatives who have had cancer, with at least some affected at an early age, or with bilateral tumors or multiple primary cancers. Genetic counseling and a carefully conducted family history can help identify an individual's risk of being a gene carrier. The American Society of Clinical Oncology has recommended that mutation testing be offered to individuals where the probability of identifying a BRCA1/2 mutation is 10% or greater based on the family history. Both genetic counseling and genetic testing services are readily available through the Division of Gynecologic Oncology at Columbia University.

Those women who are found to carry an abnormal cancer gene have a number of surgical and non-surgical options available to them that greatly decrease their chances of eventually developing breast and/or ovarian cancer.

Symptoms and Diagnosis
When ovarian cancer is diagnosed at an early stage such that the disease is confined to the ovaries, surgery can result in well over a 90% cure rate. Unfortunately, ovarian cancer is most often diagnosed at advanced stages when the cancer has spread into the upper abdomen. This late diagnosis that can occur in up to 75% of cases is due to the vague signs and symptoms of early stage disease that may go undetected.

Common symptoms include bloating, increased abdominal size, indigestion, nausea, decreased appetite, and vague abdominal pain. Occasionally vaginal bleeding, pelvic pressure, back pain, urinary symptoms, and constipation may be observed.

Early diagnosis is an area of active investigation and research. At this time physicians do not have an effective screening test for diagnosing early ovarian cancer. Pelvic ultrasound, physical exam and a tumor marker known as Ca-125 are currently available diagnostic tools, but their sensitivity and specificity are not high enough to be accurate for screening in the general population. The future is promising as a number of techniques are under development including proteomics in which key proteins are measured in the blood to determine early ovarian cancer. Available protocols should be discussed with your physician especially if you have an increased risk due to positive family history of breast or ovarian cancer.

Treatment Methods
Because the ovary is comprised of a variety of different cells -- all of which can develop a cancer -- there are many types of ovarian cancer. These different types of cells can also give rise to different tissue types. However, most of the types of cancers are evaluated and treated similarly. Additionally, cancer of the Fallopian tube and cancer of the lining of the abdominal cavity, known as primary peritoneal carcinoma, act so similar to ovarian cancers that they are treated in the same way as ovarian cancers.

Initial treatment of ovarian cancer is usually surgical. The cancer is staged, meaning that the amount of spread is determined. Staging often includes removal of lymph nodes in the abdomen and pelvis. The second goal of surgery is to remove as much of the tumor as possible when tumor has spread beyond the ovaries. This technique is known as debulking. Sometimes portions of the bowels or other organs are removed in addition to the reproductive organs.

These procedures may be performed using minimally invasive techniques. Such options should be discussed with your surgeon.

Subsequent treatment depends upon you medical condition, your cancer's stage, the type of cancer, and the residual amount of cancer left after the first operation. The treatment program may include chemotherapy medications, radiation, imunnotherapy, and sometimes added surgery. The treatment plan is individualized to minimize complications while maximizing quality and length of life.

Research and Vision
Clinical trials are the only way new drugs and treatments can be evaluated in a systematic manner to prove or disprove efficacy. Ovarian cancer patients are often asked if they wish to participate is a clinical trial because much new research is directed toward finding a cure for ovarian cancer. These trials may offer you the opportunity to receive the most advanced treatment. You should discuss with your doctor what clinical trials are available and if you might benefit from participating in one.

Ovarian cancer is still a devastating disease; however, new treatments are giving hope to these patients for longer and a better life.

For more information and detailed explanations of the stages and treatment of ovarian cancer, please refer to the National Cancer Institute website at www.nci.nih.gov/cancertopics then click on women's cancers, next click on ovarian.