September is Ovarian Cancer Awareness Month, and while ovarian cancer is fairly uncommon, accounting for only 3 percent of all cancers in women, it is often deadly. This is because ovarian cancer is frequently not diagnosed in its earliest stages. In the U.S., about 20,000 cases of ovarian cancer are diagnosed each year and it leads to 15,000 deaths, making it the 8th most common cancer in women, but the fifth cause of cancer-related deaths.
Risk factors for the development of ovarian cancer include early puberty or late menopause; having a personal history of breast, uterine or colon cancer; having a family history of ovarian cancer in a close relative like mother, grandmother, sister or daughter; and having a genetic mutation such as BRCA 1 or 2, or Lynch syndrome. Most women with ovarian cancer are over 40, with the majority over age 60.
Ovarian cancer has often been described as “silent,” meaning there are no symptoms until it is well advanced. That is not quite true — there are symptoms, but they are vague and frequently associated with other common, benign conditions. Some of the symptoms include abdominal or pelvic pain, low back pain, bloating, getting full easily after eating and urinary frequency or urgency. What woman, especially after menopause, hasn’t experienced at least one of those symptoms? What is important is the combination of those symptoms, especially if they occur for two or more weeks each month. If, for example, you begin to notice vague lower abdominal pain and bloating and back pain and you are urinating more often and this has been happening for a couple of weeks, then you should see your doctor.
If you do experience these symptoms, your doctor will obtain a complete history and do a thorough pelvic exam and rectal exam. Ultrasound will most likely be ordered. Blood tests may be helpful as well, specifically a CA-125 and perhaps the newer HE-4 test. If ovarian cancer is suspected, treatment consists of surgery, usually a complete hysterectomy with removal of tubes and ovaries.
While we have pap smears to screen for cervical cancer, and mammograms to screen for breast cancer, we do not have a good mechanism to screen for ovarian cancer in the general population of women without symptoms. Studies have shown that screening asymptomatic women does not significantly decrease deaths from ovarian cancer, and that almost 10 percent of women screened will have a false positive result, with many of them undergoing surgery for what turns out to be something other than cancer.
There are ways to reduce the risk of ovarian cancer, mainly using birth control pills; women who have used the pill for more than 5 years halve their risk of ovarian cancer. Women with BRCA 1 or 2 mutations should have their tubes and ovaries removed as soon as they finish having children.
— Dr. Kelly Shanahan is a board-certified gynecologist and owner of Emerald Bay Center for Women’s Health. For more information, call 530-542-4961 or 775-782-7300.