Frequently asked questions about ovarian cancer

FAQs

I had my ovaries removed – could I still get ovarian cancer?
Technically, no; women who have their ovaries removed cannot get ovarian cancer. There is a rare type of cancer called primary peritoneal carcinoma – a close relative to ovarian cancer that can develop without the ovaries. The treatment for primary peritoneal cancer is the same as that for ovarian cancer.
Does ovarian cancer have symptoms in its early stages?
While the symptoms for ovarian cancer tend to be nonspecific and can mimic other conditions, a large national study shows that an overwhelming majority of women diagnosed with ovarian cancer did have symptoms, sometimes even in the early stages. The most common symptoms reported include: abdominal bloating or discomfort; increased or urgent need to urinate; difficulty eating or feeling full quickly and pelvic pain.
Source: A. Goff, M.D., Lynn Mandel, Ph.D., Howard G. Muntz, M.D., Cindy H. Melancon, R.N., M.N. 2000. Ovarian carcinoma diagnosis. Cancer 89, No. 10: 1097-0142
Does promoting ovarian cancer information increase anxiety among women?
A recent scientific study in Britain dispelled this idea; promoting cancer information really reassures the public (British Medical Journal 1999).
It is important to empower women with the knowledge to take charge of their health and be good advocates for themselves.

Is there an association between hormone replacement therapy and ovarian cancer?
The latest interpretation of data resulting from the Women’s Health Initiative study suggests that postmenopausal women who take combined hormone replacement therapy (HRT) continuously may face a higher risk of ovarian cancer.
While researchers say the findings shouldn’t affect most women’s decisions to take HRT to relieve moderate to severe menopausal symptoms, such as hot flashes, the possibility of an increased ovarian cancer risk support recently revised guidelines that call for the conservative use of hormone therapy.
Source: Anderson, G. The Journal of the American Medical Association (Vol 290:1739-1748).
Does the use of talc (talcum powder) as a feminine powder increases the risk of ovarian cancer?
A number of past studies found an increased risk of ovarian cancer from talcum powder use, but these studies were considered inconclusive because of limitations in the way data were collected and analyzed.
More recent studies, such as one using data from Harvard University’s Nurses’ Health Study in 2000, find no overall risk of ovarian cancer from talc use and only a modest increase in one type of the disease – invasive serous ovarian cancer.
Source: Journal of the National Cancer Institute (Vol. 92, No. 3).
If a family member has ovarian cancer, can genetic screening determine if other family members will get the disease?
Approximately one out of every ten ovarian cancer cases is hereditary.
Most hereditary ovarian cancer can be attributed to two mutations in two genes, BRCA 1 (breast cancer gene 1) and BRCA2 (breast cancer gene 2).
Women who inherit a mutation in these genes are at greater risk of developing epithelial ovarian cancer. Lynch syndrome, which refers to a cluster of cancers that are related to a specific gene mutation, is also associated with increased risk of colorectal, uterine and ovarian cancer.
A thorough evaluation of family history (i.e., a history of breast, colorectal or ovarian cancer) can identify women most likely to have a hereditary cancer risk, and genetic testing can determine if these mutations exist. Although having these mutations increases risk, it does not mean a woman will definitely get the disease.
Furthermore, while genetic testing can indicate where there is increased risk and help determine appropriate monitoring, women should consider the psychological and possible insurance ramifications before proceeding with testing.
Genetic counseling can help women determine whether they should be tested for genetic mutations linked with ovarian cancer.
Source: Cancer Control, July, 1999; Genet Test, 2000.
Is there any way to prevent ovarian cancer?
Currently there is no way of preventing ovarian cancer. However, several measures have been found to reduce a woman’s risk of developing the disease. Oral contraceptives can reduce the risk of ovarian cancer by fifty percent if taken for at least five years.
Research has also shown that pregnancy and breast-feeding significantly reduce ovarian cancer risk (Br. J. Cancer, March, 2001).
Tubal ligation and hysterectomy reduce risk, though researchers are unclear exactly how. Finally, prophylactic oophorectomy (removal of the ovaries) is the most effective way of reducing risk (Gynecologic Cancer Foundation Slide Presentation, 2000).
Health professionals recommend that all options be discussed thoroughly with a physician.
What are ovarian cysts?
Ovarian cysts are fluid-filled sacs on the surface of the ovary that are quite common in women during their childbearing years. Most cysts result from the changes in hormone levels that occur during the menstrual cycle and the production and release of eggs from the ovaries. Most are harmless and go away on their own.
What is endometriosis? Can it cause ovarian cancer?
Endometriosis is a chronic and often progressive disease that develops when endometrial tissue, which normally lines the inner surface of the uterus, grows outside of the uterus. These implants occur most frequently in the pelvic region and on the reproductive organs but can appear in other areas, such as the bladder.
In spite of the high prevalence of endometriosis in women the world over, researchers have been unable to determine its cause.
Endometriosis can cause pain and scarring, and it is believed that 20 percent to 40 percent of women diagnosed with this chronic disease are infertile (National Cancer Institute).
Researchers have hypothesized that the most likely link between endometriosis and ovarian cancer is the association between endometriosis and infertility.
It is well established that ovarian cancer risk is reduced with each pregnancy. Consequently, women who do not bear children, whether by choice or due to infertility issues, are believed to be at greater risk for ovarian cancer (The Gynecologic Sourcebook, Third Edition).
Do fertility drugs increase your risk of developing ovarian cancer?
Use of fertility drugs does not increase a woman’s risk of getting ovarian cancer. On the other hand, scientists have found an association between ovarian cancer and certain causes of infertility itself, such as endometriosis.
“Some women who receive fertility treatments develop ovarian cancer because of underlying conditions that cause infertility, not because of the treatments themselves,” said Roberta Ness, MD, MPH, of the University of Pittsburgh’s School of Public Health.
Source: American Journal of Epidemiology (Vol. 155, No. 3: 217-224, 2002).
Is there a link between breast cancer and ovarian cancer?
Both breast and ovarian cancer can be caused by mutations in the BRCA1 (breast cancer gene 1) and BRCA2 (breast cancer gene 2) genes.
Women with a family history of breast and ovarian cancer, or a personal history for either, particularly if diagnosed before age 50, should be aware of increased risk for the other. Women who have had breast cancer before the age of 50 are twice as likely to develop ovarian cancer, as are women who have not (National Cancer Institute – What You Need To Know About Ovarian Cancer, 1998).  Additionally, ovarian cancer has also been linked to colorectal cancer and uterine cancer (via different genes).

If there are no reliable screening tools, how is ovarian cancer diagnosed?
An exploratory surgical procedure called laparotomy is generally required for the definitive diagnosis of ovarian cancer.
During this procedure, cysts or other suspicious areas must be removed and biopsied. After the incision is made, the surgeon assesses the fluid and cells in the abdominal cavity.
If the lesion is cancerous, the surgeon continues with a process called surgical staging to ascertain how far the cancer has spread. In select cases aspiration of ascites because of metastatic lesion or laparoscopy is used to confirm the diagnosis.
Does an elevated CA-125 level always indicate that ovarian cancer is present?
Not always. Although a CA-125 blood test can be a useful tool for the diagnosis of ovarian cancer, it is not uncommon for a CA-125 count to be elevated in premenopausal women due to benign conditions unrelated to ovarian cancer. Uterine fibroids, liver disease, inflammation of the fallopian tubes and other types of cancer can elevate a woman’s CA-125 level (ACOG Patient Education – 1996).
The CA-125 test is more accurate in postmenopausal women with a pelvic mass. It is also important to note that in about 20 percent of cases of advanced stage disease, and 50 percent of cases of early stage disease, the CA-125 is NOT elevated, even though there is ovarian cancer present. As a result, the CA-125 is generally only one of several tools used to diagnose ovarian cancer in a patient with a pelvic mass or other suspicious clinical findings.
One of the most important uses of the CA-125 test, however, is to evaluate progressive disease and tumor response in patients undergoing treatment, and to monitor the levels of women in remission for evidence of disease recurrence.
Why don’t doctors give women a CA-125 test and transvaginal ultrasound each year? Isn’t an imperfect screening tool better than nothing?
A study published in 2011 found that screening women at average risk of ovarian cancer did not improve the women’s odds of surviving ovarian cancer – and actually put them at greater risk due to complications from unnecessary surgeries.
More than 78,000 women were randomized between normal care and screening arms. The screening protocol involved annual CA-125 testing for six years and a transvaginal ultrasound for four years. The study was designed to show the effect of screening on overall survival by following patients for 13 years. The study showed that more women were diagnosed in the screening arm, but more women died of ovarian cancer in the screening arm.
Additionally, more than 3,000 women had surgery based on false positive results, leading to more than 160 women with serious complications. This study showed that screening with this protocol did not reduce ovarian cancer mortality.
What is a clinical trial?
Clinical trials are carefully designed research studies that involve people. Some clinical trials are conducted to find ways to improve the medical care and treatment that is available to women with ovarian cancer. Some trials test ways to detect and prevent ovarian cancer or its recurrence.
There are also clinical trials that study how to improve an ovarian cancer patient’s quality of life during and after treatment. To read more about clinical trials, click here.
Is the blood marker LPA (lysophosphatidic acid) an effective screening tool for ovarian cancer?
LPA or lysophosphatidic acid is a substance that stimulates the growth of ovarian tumors. One small study found that levels of LPA in blood plasma are elevated in about 90 percent of women with early ovarian cancer. There are clinical trials going on presently to determine the effectiveness of LPA in detecting ovarian cancer (JAMA, August 26, 1998). However, it is still too early to know if this test will be a good screening tool.
Who is best trained to treat ovarian cancer?
Gynecologic oncologists are the best qualified to treat ovarian cancer. A gynecologic oncologist is an obstetrician gynecologist who is further trained in oncology and advanced abdominal pelvic surgery to specialize in the diagnosis and treatment of women with gynecologic cancers.
Research has shown that women survive longer when their initial surgeries are performed by a gynecologic oncologist. The initial surgery and staging of ovarian cancer is critical to determining the appropriate course of treatment, and ultimately survival outcomes.
To find a gynecologic oncologist in your area, visit the Foundation for Women’s Cancer website.