When ovarian cancer is caught at stage one, survival rates are in the 90th percentile. However, most ovarian cancers are caught in late stages where the five-year survival rate goes down to 40%. The early signs of the fifth leading cause of death for women “have been difficult to tease out,” says CU Medicine provider and gynecologic oncologist Dr. Nicole Marjon.
So, why is ovarian cancer often caught in later stages and what can you do to reduce your risk? Dr. Marjon, who practices at CU Medicine Gynecologic Oncology – Colorado Springs, answers some of our most pressing questions and offers an expert opinion about what you can do if you’re at risk.
Why is ovarian cancer hard to detect early?
Ovarian cancer is traditionally hard to spot and often presents in late stages. What we’ve now found is that it’s likely most ovarian cancers start from the end of the fallopian tube. Abnormal cells start to form at the end of the fallopian tube before they could ever be detected by imaging or changes in bio markers. Those changes start to happen, the fallopian tube is open to the abdominal cavity and the cells slough off or shed off very early. By the time you have any mass that could be detected on imaging or symptoms, the cells have shed into the abdominal cavity. That’s why it’s very difficult to detect and why we don’t have great screening.
What are the signs of ovarian cancer? Are there any early signs?
Ovarian cancer is a term that includes any cancer that starts from the ovary, the fallopian tube or peritoneum, which is a lining of the abdominal cavity. There are many different types of ovarian cancer, but when most people hear the word ovarian cancer, they’re thinking of something called high grade serous ovarian cancer, which is the most common type.
The early signs of ovarian cancer have been difficult to identify because most people don’t present with early ovarian cancer. There was one study that looked at this and the most common signs of early ovarian cancer are bloating, changes in appetite, early satiety and pelvic cramping. The most common and most specific sign is feeling full fast and bloating. Pelvic pain, pelvic cramping, constipation and weight loss are also commonly reported.
Who is at risk of ovarian cancer?
Any patient with ovaries could be at risk for ovarian cancer, and the risk for those patients is in general one in 75. There’s an increased risk for anyone getting older. The most common age is between 50 and 60. It’s uncommon for anyone to have ovarian cancer before the age of 50 without a genetic reason. Other people at risk are those with a strong family history of ovarian or breast cancer and those with a genetic mutation. The most common genetic mutations are BRCA1 or BRCA2. We hear about those a lot in breast cancer, but it also puts people at risk for ovarian cancer. Understanding your family history and talking to your doctors about if there’s a genetic component could play a role in determining your risk factor.
What should you do if you have an increased risk for ovarian cancer?
If you have a strong family history of breast cancer or ovarian cancer, the first course of action should be to talk to your primary care doctor or gynecologist. They will most likely refer you to genetic counseling to have genetic testing done. If you are found to have a genetic mutation with a BRCA1 or BRCA2 mutation, the recommendation is, once you’ve completed childbearing, to undergo a risk-reducing surgery to remove your fallopian tubes and ovaries. The age differs slightly depending on the genetic mutation, but it’s usually by the age of 40 or 45 that we recommend that surgery.
Is there anything that can prevent or reduce the risk of ovarian cancer?
Being on oral contraceptive pills for more than 5 years actually reduces the risk of ovarian cancer by 50%. I know a lot of people are afraid of taking hormones when they are younger because of the risk of cancer, but we’ve seen a reduction in the risk of cancer.
We also think removing the fallopian tubes can prevent ovarian cancer. So, if somebody has completed childbearing and has decided they want a tubal ligation for permanent sterilization, we recommend having the entire fallopian tube taken out. We don’t do it unless you have a risk factor, but if you happen to be having surgery for something in the area, taking them out is a good idea.
What should you do if you think you have ovarian cancer?
If you have signs or symptom of ovarian cancer, you should go see your provider. Tell them your symptoms and that you’re concerned about ovarian cancer so they can do a workup.
Something I think is important to know is that we are coming up with new treatments all the time. Especially at the University of Colorado, where we have a large lab that’s really focused on finding new and more effective treatments for ovarian cancer. Things are starting to change, and we’re getting more targeted therapies that we hope can cure or at least give us longer term survival for cancers.
In addition to treating patients at CU Medicine Gynecologic Oncology – Colorado Springs, Dr. Marjon is a physician scientist where her clinical interests are focused on understanding and modifying the immune microenvironment in ovarian cancer with the goal of developing novel therapeutics. Dr. Marjon is also an assistant professor at the University of Colorado School of Medicine.