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Q&A: What should women know about ovarian cancer?

April 15, 2019

By Jennifer Lee and Dr. Michelle Jacobson

This article is part of a special series featuring The Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital - a collaboration with the Canadian Cancer Society. The centre draws together excellence in research, clinical care, innovation and education for women’s cancers.

Dr. Michelle Jacobson
Dr. Michelle Jacobson, co-director of the Familial Ovarian Cancer Clinic at Women’s College Hospital.

Dr. Michelle Jacobson specializes in obstetrics and gynecology, in particular for women during menopause and is co-director of the Familial Ovarian Cancer Clinic at Women’s College Hospital.

1. Are there early signs to watch out for?

In its early stages, ovarian cancer rarely causes noticeable symptoms. One of the challenges is that at present, there is also no reliable test to detect it. Once the disease has progressed to a later stage, symptoms can include:

  • bloating or swelling in the abdomen
  • unintended weight loss
  • feelings of discomfort in the pelvic area
  • changes in digestion, such as loss of appetite, indigestion or feeling full quickly after starting to eat a meal
  • a frequent need to pee and/or difficulties with constipation

2. What are the biggest misconceptions about ovarian cancer?

There can be some confusion that pap tests used to detect cervical cancer can also detect ovarian cancer. The fact of the matter is that there is no screening test that can be used to detect the early onset of ovarian cancer.

Similarly, many women believe that ultrasounds and MRIs or even a blood test called the “CA125” (or cancer antigen 125 test) can detect ovarian cancer in its early stages. Unfortunately though, this has not shown to be an effective method of screening.

3. Is there anything in particular that women should know about the disease during menopause?

Firstly, I think it’s important to note that ovarian cancer is less common than other women’s cancers such as breast, uterine and cervical cancer – although it does have a higher mortality rate. Since ovarian cancer is most commonly found in menopausal women, it’s important to be aware of any unexpected changes to your weight, abdominal girth, or digestion.

There is no value in doing regular screening ultrasounds for ovarian cancer detection in a woman who has an average risk of developing the disease. Any bleeding after menopause is considered abnormal and may be a sign of other gynaecologic cancers such as uterine or cervical cancer. It is important that women continue their recommended screening for cervical, breast and colon cancers.

4. What are the top risk factors?

One of the first things that is important to know is whether or not anyone in your family has been diagnosed with ovarian cancer or tested positive for the BRCA1 or BRCA2 genetic mutations that place women at greater risk. There are a few other genetic mutations linked with increased risk, which are less common such as Lynch Syndrome or mutations in the BRIP1 and RAD51C/D genes.  

A second thing to know is that while the disease can develop at any age, typically the most common age of onset is in the 50’s and 60’s. For women with genetic mutations, ovarian cancer develops on average 10-20 years earlier.

Risk factors include an early first period or late menopause, not having had a pregnancy and exposure to certain chemicals (like talc), earlier in life. Endometriosis can also predispose women to certain kinds of ovarian cancer. 

5. What can women do when it comes to prevention?

When we talk about prevention, what we’re really talking about is how can we reduce our risk? So for example, if you know you have had a history of breast or ovarian cancer in your family, you may want to also ask for genetic screening. If a test comes back positive for one of the known gene mutations, you may want to look at options for prophylactic surgery, such as removing the fallopian tubes ovaries (a salpingoophorectomy).

Research also suggests that certain types of contraception can reduce the risk for ovarian cancer. For example, taking birth control pills for more than three to five years, having your fallopian tubes tied, or having them removed altogether can all reduce risk. Your doctor can help determine the best method of contraception with you.

 

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