Knowing These Ovarian Cancer Facts Could Save Your Life

There are known risk factors for ovarian cancer

Despite decades of research, we still don't know very much about the origins of ovarian cancer or the mechanisms by which it develops. But there are known risk factors. Women with a parent or sibling who has developed ovarian cancer are at an increased risk of developing it themselves (5% versus 1.4% for the general population, according to the Ovarian Cancer National Coalition).

As women get older, their risk also rises because the more menstrual cycles a woman has, the more likely she is to develop ovarian cancer, research suggests. Ovarian cancer rates are highest in women between the ages of 55 and 64.

There are other factors besides age that can cause a woman to have more periods, and therefore increasing the risk of ovarian cancer: experiencing menopause after age 50, menstruating before age 12, never having children, or giving birth for the first time after age 30. Fertility issues—regardless of whether a woman treated them with drugs—also increase the risk of ovarian cancer.

Some good news if you've ever been on the pill: taking oral contraceptives is linked to a lower risk of ovarian cancer because it prevents ovulation (more on this later).

Signs and symptoms of early-stage ovarian cancer are hard to catch

"Ovarian cancer used to be called the 'silent killer' because symptoms in early stage are often vague, and go unnoticed," says June Y. Hou, MD, an assistant clinical professor of gynecologic oncology at Columbia University Medical Center in New York City. "The majority of ovarian cancer is diagnosed at late stage, when symptoms are much more severe."

Those early symptoms can include bloating, pelvic/abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms, according to the American Cancer Society. These symptoms can also be caused by non-cancerous diseases, or even other types of cancer, which is why so many women ignore them.

Ovarian cancer symptoms tend to stick around

What tends to differentiate early symptoms of ovarian cancer from signs of other conditions is their persistence. If you experience, for example, particularly severe abdominal pain more than 12 times in one month, the American Cancer Society recommends a visit to the gynecologist. These potentially benign symptoms are also a red flag if they don't go away: fatigue, upset stomach, back pain, painful sex, constipation, menstrual changes, and abdominal swelling.

A Pap smear can't detect ovarian cancer (and a pelvic exam often won't, either)

Pap tests can be invaluable when it comes to the detection of cervical abnormalities and irregular cells that could develop into cervical cancer, but they're of no use when it comes to ovarian cancer. During a pelvic exam your doctor might notice that your ovaries are enlarged, but the MD won't necessarily be able to detect early-stage ovarian tumors.

There is no standard and reliable way to screen for ovarian cancer

"Unlike mammograms to screen for breast cancer, there are no screening tests for ovarian cancer," Dr. Hou says. "Routine ultrasounds and CA125, a blood test that can be abnormally high in women with ovarian cancer, have not been effective at catching ovarian cancer early." In fact, the FDA has warned women that they should not use ovarian cancer screening tests to make decisions about their health, and urged doctors not to use them since they have no proven benefit. "For women with average risk, screening with these tests may lead to unnecessary surgeries and unwarranted complications."

Transvaginal ultrasounds can find masses that could be ovarian cancer

In a 2014 article in the International Journal of Women's Health, researchers observed that ultrasounds can accurately detect changes in the size and shape of ovaries. That said, the article also revealed ultrasounds are unreliable when it comes to determining whether or not a tumor is malignant or benign. Still, "although transvaginal ultrasounds [have] known limitations as a screening method for ovarian cancer, [they] remain an integral part of all screening trials."

Ovarian cancer has four stages

In Stage I ovarian cancer, the disease remains within the ovaries and fallopian tube, and has yet to spread to other organs and tissues. In Stage II, the cancer has spread to other pelvic organs, such as the uterus, the bladder, and the colon. Stage III ovarian cancer has gone beyond the pelvis to the lining of the abdomen, the lymph nodes in the back of the abdomen, or both. In Stage IV, the cancer has spread to the spleen or liver, to additional lymph nodes, and to other tissues outside the peritoneal cavity (which separates the abdomen from the rest of the body).

There are more than 30 types of ovarian cancer

There are more than 30 types of ovarian cancer, and they're categorized by the type of ovarian cells from which they developed.

Epithelial tumors develop from surface epithelium cells (the cells that line the outside of the ovary). This is the most common type of ovarian tumor, accounting for up to 90% of all ovarian cancers. Sadly, this type of cancer tends not to be diagnosed until later stages of the disease.

Germ cell tumors arise from the type of cells that form eggs. Most of these tumors are benign, but they can be cancerous.

Stormal tumors develop from the cells that produce estrogen and progesterone and make up structural and connective tissue. This type of tumor is very rare, and most cases are detected in Stage I.

Women who inherit BRCA1 or BRCA2 mutations are at greatly increased risk of developing ovarian cancer

According to the National Cancer Institute at the National Institutes of Health, an estimated 39% of women who inherit the BRCA1 mutation and between 11 and 17% of women who inherit the BRCA2 mutation will develop ovarian cancer by the time they're 70 years old. Based on current data, those genetic factors appear to be the characteristics most likely to influence an individual woman's risk.

Most women don't need routine testing for BRCA1 and BRCA2

Because the BRCA1 and BRCA2 are relatively rare, most experts believe it's unnecessary to test for it in women without cancer or family histories that suggest the mutations. The NIH recommends that women who do have that history (or who experience early-onset breast or ovarian cancer) meet with a genetic counselor before undergoing genetic testing.

Taking birth control pills decreases your risk of ovarian cancer

A research review published in Obstetrics and Gynecology examined the results of 55 studies and found "significant reduction in ovarian cancer incidence" in oral contraceptive 'ever-users' compared to 'never-users'—and the duration of use increased the protective effect. "For women with average risk, using oral contraceptives can reduce lifetime risk of ovarian cancer by 40 to 50%, and that effect can last for 15 years after discontinued use," Dr. Hou says. "This protection can be seen with low-dose pills as well as pills with higher estrogen used in the past."

Removing your fallopian tubes can also decrease your risk

The fallopian tubes are important for child-bearing—they carry the egg or embryo from the ovary to the uterus. But they don't produce hormones like the ovaries. So if a woman is not interested in having a child (or more children) the fallopian tubes can be removed to reduce cancer risk, without causing menopause (which is what happens if you remove the ovaries.)

"We now know that the origin for the most aggressive types of ovarian cancer stems from the tips of fallopian tubes," Dr. Hou explains. "Salpingectomy, or removal of the entire fallopian tube, can decrease the risk of high-grade, serious ovarian cancer by as much as 65%, and should be considered as a preventative strategy in women who are done with childbearing and who want to preserve hormonal function of the ovaries." Women who have a high risk of ovarian cancer should discuss the potential benefits of this procedure with their gynecologists.

Removing your ovaries could do more harm than good

There is mounting scientific evidence that many types of ovarian cancer don't originate in the ovaries at all, says Dr. Hou. A review of the Nurses' Health Study involving more than 29,000 women who had either hysterectomies (uterus removal) with oophorectomy (ovary removal) or hysterectomies alone found that over the next 24 years, patients who had their ovaries removed had a decreased risk of developing breast cancer or ovarian cancer—and an increased risk of heart disease, lung cancer, and death by any cause. "In no analysis or age-group," the authors wrote, "was oophorectomy associated with increased survival."

Most patients with ovarian cancer are treated initially with surgery

Surgery is usually the first step in treating and staging most ovarian cancers, according to the American Cancer Society. In a 2010 article in Reviews in Obstetrics & Gynecology, researchers observed that "a single maximal surgical debulking effort"—that is, the removal of as much of a tumor as possible to complement radiation and chemotherapy treatment, depending on the cancer's stage—can make a "clinically important difference" for newly-diagnosed patients.

Working with a specialist is crucial

A review in the Journal of the American Cancer Institute which found that ovarian cancer patients who received treatment from gynecologic oncologists or gynecologists (as opposed to general surgeons) had "clearly superior outcomes," and noted that all potential surgical patients should meet with a gynecological oncologist, if possible. The Society of Gynecologic Oncology has a tool on its website where you can search for an gynecologic oncologist in your area.

Infertility is associated with increased risk of ovarian cancer

An observational study involving more than 12,000 female patients evaluated for infertility between 1965 and 1988 found that they had a higher risk for ovarian cancer than other women did; subjects with endometriosis and primary infertility (that is, infertility without any previous pregnancy) had the highest risk. The researchers weren't able to determine the basis of the association, but they noted that additional findings about endometriosis could shed light on how ovarian cancer develops.

Working dogs might help us detect ovarian cancer

In partnership with the Penn Ovarian Cancer Research Center, dogs at the Penn Vet Working Dog Center in Philadelphia are learning to sniff out the volatile organic compounds (VOCs) present in ovarian cancer patients' blood plasma samples. If the dogs are able to respond to the VOCs specific to cancer cells, scientists might one day be able to develop an electronic sensor that could revolutionize the detection process.