Ovarian Cancer: What All Women Need to Know

1. Ovarian Cancer: What All Women Need to Know

2. Presentation Objectives • Realize the impact of ovarian cancer • Recognize the early symptoms • Understand the risk factors • Know the proper steps to take if you or someone you know has persistent symptoms and where to go for more information

3. What is Ovarian Cancer? • A growth of abnormal malignant cells that begins in a woman’s ovaries • These ovarian cancer cells can metastasize or spread to other organs in the pelvis or abdomen

4. The Female Reproductive System Reprinted with permission from the American Cancer Society

5. What Causes Ovarian Cancer? • The causes of ovarian cancer remain unknown • Current theories: • Repeated “wear and tear” which occurs during monthly release of an egg may create a situation in which genetic errors can occur • Increased hormone levels before and during ovulation may stimulate the growth of abnormal cells

6. Impact of Ovarian Cancer • Strikes 1 in 69 women • Is the 2nd most common gynecologic cancer • Each year, approximately 20,000 women are diagnosed with the cancer • In 2007, it is estimated that 22,430 women will be diagnosed • Majority of women diagnosed have no family history of disease • Affects all women, regardless of race or ethnicity Sources: American Cancer Society. (2007). Cancer Facts and Figures 2007. Available at www.cancer.org. National Cancer Institute. (2006). SEER Cancer Statistics Review, 1975-2003. Available at http://seer.cancer.gov.

7. Impact of Ovarian Cancer • Is the deadliest gynecologic cancer • Ranks as the 5th leading cause of cancer death among American women • Kills about 15,000 women each year • In 2007, it is estimated that 15,280 women will die Sources: American Cancer Society. (2007). Cancer Facts and Figures 2007. Available at www.cancer.org. National Cancer Institute. (2006). SEER Cancer Statistics Review, 1975-2003. Available at http://seer.cancer.gov.

8. Impact of Ovarian Cancer • Overall 5-year survival rate is 45% • This rate is even lower for black women at 40% • Close to 75% of women are diagnosed at an advanced stage after the cancer has spread beyond the ovary • When detected early, survival rates greatly improve • 5-year survival rate is 93% for early-stage disease Source: National Cancer Institute. (2006). SEERCancer Statistics Review, 1975-2003. Available at http://seer.cancer.gov.

9. Compared to Breast Cancer Source: National Cancer Institute. (2006). SEER Cancer Statistics Review, 1975-2003. Available at http://seer.cancer.gov.

10. What Do the Numbers Tell Us? EARLY DETECTION CAN SAVE LIVES

11. The Challenge • Currently, there is no screening test for the early detection of ovarian cancer • The Pap test or smear does NOT screen for ovarian cancer • Most women are not aware of the symptoms or risk factors

12. What All Women Need to Know • Even in its early stages… • Research indicates that 95% of women with ovarian cancer had symptoms and even 90% of women with early-stage disease experience symptoms OVARIAN CANCER CAUSES SYMPTOMS Sources: Goff BA, et al. (2000). Ovarian carcinoma diagnosis. Cancer, 89: 2068-2075. Olson SH, et al. (2001). Symptoms of ovarian cancer. Obstet Gynecol, 98: 212-217.

13. Symptoms of Ovarian Cancer • Bloating • Pelvic and abdominal pain • Difficulty eating or feeling full quickly • Urinary symptoms (urgency or frequency). If a woman has a combination or many of these symptoms for more than a few weeks and they are persistent and unusual for her, she should see a health care professional, preferably a gynecologist.

14. Other Symptoms Commonly Reported • Fatigue • Indigestion • Back pain • Pain with intercourse • Constipation • Menstrual irregularities NOTE: These symptoms are not as useful in identifying ovarian cancer because they are found in equal frequency in women who do not have the disease.

15. Symptoms of Ovarian Cancer • Symptoms will vary from woman to woman • Associated with the location of the tumor and its impact on the surrounding organs • Mimic other conditions such as irritable bowel syndrome • Many of us experience these symptoms from time to time – do not be alarmed! • If they persist or worsen, see a medical professional

16. How is Ovarian Cancer Diagnosed? • Pelvic examination, including a complete rectovaginal examination • Transvaginal or pelvic ultrasound • CA-125 blood test

17. How is Ovarian Cancer Diagnosed? • If tests suggest the presence of ovarian cancer, insist on a referral to a gynecologic oncologist • Gynecologic oncologists are specialists in treating ovarian cancer • To find one in your area, use the “Find a Doctor” resource of the Women’s Cancer Network at www.wcn.org

18. Risk Factors • Most women with ovarian cancer do not have any known risk factors • However, there are several factors that may increase risk of ovarian cancer • Having one or more of these risk factors doesn’t mean that ovarian cancer will develop, but the risk may be higher compared to the average woman

19. Risk Factors • Inherited genetic mutations • Often exhibited by a family or personal history of breast, colorectal or ovarian cancer • Family history of ovarian cancer • Age • Reproductive history and infertility • Hormone replacement therapy • Obesity

20. What Puts Women at Risk? • Family history of ovarian and breast cancers • Infertility • Endometriosis • Talc use • Hormone replacement therapy

21. Inherited Genetic Mutations • Most significant risk factor is an inherited mutation in BRCA1 or BRCA2 genes • Women of Ashkenazi Jewish descent are at high risk of carrying BRCA1 and BRCA2 mutations; however risk for the mutations is not exclusive to this group of women • Lower risk with inherited disease called hereditary nonpolyposis colorectal cancer (HNPCC)

22. Family History of Ovarian Cancer • Ovarian cancer can occur in more than one family member but NOT as a the result of a known inherited gene mutation • Women who have one first-degree relative (mother, daughter or sister) with ovarian cancer, but no known genetic mutation, are still at increased risk of developing the disease

23. Increasing Age • Most ovarian cancers develop after menopause • About 69% of women diagnosed are age 55 or over • A woman’s risk of ovarian cancer increases with age through her late 70s • Although most cases of ovarian cancer are diagnosed in women over age 55, the disease can occur in younger women Source: National Cancer Institute. (2006). SEER Cancer Statistics Review, 1975-2003. Available at http://seer.cancer.gov.

24. Reproductive History and Infertility • Women at increased risk if: • Started menstruating at an early age (before age 12) • Had no children • Had first child after age 30 • Experienced menopause after age 50 • In addition, research indicates that infertility increases the risk of ovarian cancer, even without use of fertility drugs

25. Hormone Replacement Therapy (HRT) • Women who use menopausal hormone therapy are at an increased risk for ovarian cancer • Risks differ according to HRT taken and hysterectomy status • Women who have not had a hysterectomy and use estrogen plus progestin for five or more years are at an increased risk • Women who had a hysterectomy and use estrogen alone for 10 or more years are at an increased risk • HRT has other health risks so consult a doctor to evaluate the risks and decide what’s best Source: Lacey JV, et al. (2006). Menopausal hormone therapy and ovarian cancer risk in the NIH-AARP Diet and Health Study Cohort. Journal of the National Cancer Institute, (98)19: 1397-1405.

26. Obesity • The research in this area has not been totally conclusive • Recent studies suggest: • Overweight/obesity in early adulthood is associated with an increased risk of ovarian cancer • A higher rate of death from ovarian cancer in obese women • Maintain a healthy weight and active lifestyle to ensure overall health Sources: Olsen, CM, et al. (2007). Obesity and the risk of epithelial ovarian cancer: A systematic review and meta- analysis. Eur J Cancer, 43(4):690-709. Pavelka, JC, et al. (2006). Effect of obesity on survival in epithelial ovarian cancer. Cancer, 107(7):1520-4.

27. Risk Reduction • Oral contraceptives or birth control pills • Tubal ligation or hysterectomy • Pregnancy and breast feeding • Removal of the ovaries or prophylactic oophrectomy

28. Risk Reduction • If you or someone you know is concerned about risk of ovarian cancer, talk with a health care professional • A health care professional can help identify ways to reduce risk as well as decide if consultation with a genetic counselor would be appropriate • Women who are at high risk should develop a plan for regular monitoring with their provider

29. Remember… • There are early symptoms of ovarian cancer • The main symptoms are: • Bloating • Pelvic or abdominal pain • Difficulty eating or feeling full quickly • Urinary symptoms (urgency or frequency) If a woman has a combination or many of these symptoms for more than a few weeks and they are persistent and unusual for her, she should see a health care professional, preferably a gynecologist.