September is 

Ovarian Cancer Awareness Month

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Ovarian cancer is cancer that begins in the cells that constitute the ovaries, including surface epithelial cells, germ cells, and the sex cord-stromal cells. Cancer cells that metastasize from other organ sites to the ovary (most commonly breast or colon cancers) are not then considered ovarian cancer.

According to the American Cancer Society, ovarian cancer accounts for 4 percent of all cancers among women and ranks fifth as a cause of their deaths from cancer. The American Cancer Society statistics for ovarian cancer estimate that there will be 25,400 new cases and 14,300 deaths in 2003. The death rate for this disease has not changed much in the last 50 years.

Unfortunately, almost 70 percent of women with the common epithelial ovarian cancer are not diagnosed until the disease is advanced in stage—i.e., has spread to the upper abdomen (stage III) or beyond (stage IV). The 5-year survival rate for these women is only 15 to 20 percent, whereas the 5-year survival rate for stage I disease patients approaches 90 percent and for stage II disease patients approaches 70 percent.

There are many types of tumors that can start in the ovaries. Some are benign, or noncancerous, and the patient can be cured by surgically removing one ovary or the part of the ovary containing the tumor. Some are malignant or cancerous. The treatment options and the outcome for the patient depend on the type of ovarian cancer and how far it has spread before it is diagnosed. (More)

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Risk Factors

While the presence of one or more risk factors may increase a woman's chance of getting ovarian cancer, it does not necessarily mean she will get the disease. A woman should be extra vigilant in watching for early symptoms. Risk factors include:

• Personal or family history of breast, ovarian, endometrial, prostate or colon cancer;

• Heredetary nonpolyposis colorectal cancer or syndrome;

• Increasing age;

• Unexplained infertility, no pregnancies and no history of birth control pill usage;

• Use of high dose estrogen for long periods without progesterone may be a risk factor;

• North American or North European heritage and/or Ashkenazi Jewish population;

• Living in an industrialized country.

Current recommendations for management of women at high risk for ovarian cancer are summarized below: (1,2)

1. Women who appear to be at high risk for ovarian or breast cancer should undergo genetic counseling and, if the risk appears to be substantial, may be offered genetic testing for BRCA1 and BRCA2  
2. Women who wish to preserve their reproductive capacity can undergo screening by transvaginal ultrasonography every 6 months, although the efficacy of this approach is not clearly established.
3. Oral contraceptives should be recommended to young women before they embark on a planned family
4. Women who do not wish to maintain their fertility or who have completed their family may undergo prophylactic bilateral salpingooophorectomy. The risk should be clearly documented, preferably established by BRCA1 and BRCA2 testing, before oophorectomy. These women should be counseled that this operation does not offer absolute protection because peritoneal carcinomas occasionally can occur after bilateral oophorectomy.
5. In women who also have a strong family history of breast cancer, annual mammography screening should be performed beginning at age 30 years.
6. Women with a documented HNPCC syndrome should undergo periodic screening mammography, colonoscopy, and endometrial biopsy.  (More)

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• Surgery: Surgery to remove the cancerous growth is the primary method for diagnosis and therapy for ovarian cancer.  It is best performed by a qualified gynecologic oncologist. Call the Gynecologic Cancer Foundation at 1-800-444-4441 for a referral list.
• Chemotherapy: Chemotherapy relies on the use of drugs that travel through the bloodstream to kill cancerous cells both in and outside of the ovaries.  It is used in the majority of cases as a follow-up therapy to surgery.
• Radiation Therapy: Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors (only rarely used in the treatment of ovarian cancer in the United States). (More)

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