Ovarian Cancer Support Group

Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). It is the fifth leading cause of cancer death in women, the leading cause of death from gynecologic malignancies and the second most commonly diagnosed gynecologic malignancy [1]. It is idiopathic, meaning that the exact cause is unknown. The disease is more common in industrialized nations, with the exception of Japan. In the United States, females have a 1.4 % to 2.5 % (1 out of 40-60 women) lifelong chance of developing ovarian cancer.

Older women are at highest risk. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age and approximately one quarter of ovarian cancer deaths occur in women between 35 and 54 years of age.

The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy, older ages of final pregnancy, and the use of some oral contraceptive pills have also been shown to have a protective effect. Ovarian cancer is reduced in women after tubal ligation.

The link to the use of fertility medication has been controversial. An analysis in 1991 raised the possibility that use of drugs may increase the risk for ovarian cancer. Several cohort studies and case-control studies have been conducted since then without providing conclusive evidence for such a link with the possible exception that prolonged use (> 1 year) of clomiphene citrate should be avoided.1 It will remain a complex topic to study as the infertile population differs in parity from the "normal" population.

There is good evidence that in some women genetic factors are important. Carriers of certain mutations of the BRCA1 or the BRCA2 gene (especially Ashkenazi Jewish women) are at a higher risk of both breast cancer and ovarian cancer, often at an earlier age than the general population. Patients with a personal history of breast cancer, or a family history of breast and/or ovarian cancer, may have an elevated risk. A strong family history of uterine cancer, colon cancer, or other gastrointestinal cancers may indicate the presence of a syndrome known as hereditary non-polyposis colon cancer (HNPCC), which confers a higher risk for developing ovarian cancer. Patients with strong genetic risk for ovarian cancer may consider the use of prophylactic oophorectomy after completion of child-bearing.

A recent Swedish study, which followed more than 61,000 women for 13 years, has found a significant link between milk consumption and ovarian cancer. According to the BBC, "[Researchers] found that milk had the strongest link with ovarian cancer - those women who drank two or more glasses a day were at double the risk of those who did not consume it at all, or only in small amounts."

Other factors that have been investigated, such as talc use, asbestos exposure, high dietary fat content, and childhood mumps infection, are controversial and have not been definitively proven.

A study funded by American Cancer Society conducted at the H. Lee Moffitt Cancer Center & Research Institute has found a correlation between high levels of lysophospholipids (a type of fatty acid) with ovarian cancer patients and low levels of lysophospholipids with healthy women. This potential biomarker can be detected by a simple blood test. The blood test was 93 % accurate as predictor of ovarian cancer with less than 4 % false positives of the 117 women studied. Other indicators of ovarian cancer could be used to increase accuracy to 100 %.

Surgery is the preferred treatment and is frequently necessary for diagnosis. Studies have shown that surgery performed by a specialist in gynecologic oncology usually result in a higher rate of cure. Chemotherapy is used as after surgery to treat any residual disease. Until recently, intravenous chemotherapy was used in treating patients with advanced ovarian cancer. A recent study has shown that women with advanced ovarian cancer live longer if chemotherapy is given into the abdomen. Now doctors are recommending chemotherapy delivered to the abdomen as a preferred method of treating advanced ovarian cancer. This treatment is referred to as intraperitoneal chemoperfusion. Chemotherapy can also be used to treat women who have a recurrence. Radiation therapy is rarely used in ovarian cancer in the United States.

Chemosensitivity testing is being done by a few labs in the USA. These labs use a variety of methods to attempt to identify chemotherapy agents that will work with an individual's cancer. However, response to chemotherapy can be much different when a tumor is removed from an individual, and many forms of purported chemosensitivity testing have not yet been shown to predict actual response. The procedure often requires that the patient contact a lab offering this service, which then ships containers ahead of surgery, so that the surgeon can send tumor samples in for testing. Costs are often not covered by insurance.

Surgery is usually the first treatment for ovarian cancer. The type of surgery depends upon how widespread the cancer is when diagnosed (the cancer stage), as well as the type and grade of cancer. The surgeon may remove one (unilateral) or both ovaries (bilateral), the fallopian tubes (salpingectomy), and the uterus (hysterectomy). For some very early tumors (stage 1, low grade or low-risk disease), only the involved ovary and fallopian tube will be removed (called a "unilateral salpingo-oophorectomy," USO), especially in young females who wish to preserve their fertility and have children.