What Causes Ovarian Cancer?
Ovarian cancer is a stealth enemy, but you can outsmart it
by Alynn Kingsbury Published: Feb 29, 2012
When 37-year-old TV host Giuliana Rancic's breast cancer was caught after a mammogram ordered by her fertility doctor, a storm of speculation ensued. Were her in vitro fertilization (IVF) treatments to blame? Experts said no, and scientists have found no solid IVF connection to breast cancer. Soon after, though, another study reported that the fertility treatments might increase the risk for an often-deadlier disease: ovarian cancer.
Upon closer inspection, the correlation turned out to be less alarming than it seemed (see "Is IVF Dangerous?"). But some good did come of the research: It pointed a spotlight on the so-called silent killer. Ovarian cancer is less common than breast cancer, but it's faster-growing and astonishingly lethal, killing nearly three out of four late-stage patients within five years (approximately one in eight patients is under age 45).
"The ovaries are hooked up to a great blood supply and are inundated with hormones—two things that create an ideal cancer breeding ground" explains Barbara Goff, M.D., director of gynecologic oncology at the University of Washington. And because screening is difficult and symptoms are often vague and misinterpreted, early detection rates are poor. Your greatest defense against the disease is understanding your vulnerability, caring for your body, and knowing how to spot the danger signs.
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The Quiet Threat
First, a little sixth-grade sex ed: Your ovaries, two almond-size organs that hover on each side of your uterus, have a couple of big jobs. One is to churn out the female sex hormones estrogen and progesterone. The other is to produce eggs. Every month, an ovary releases an egg, and, well, you know what happens next.
Most women's ovaries hum along just fine, but sometimes, due to a host of unclear reasons, ovarian cells can malfunction and become malignant. Even then, the ovaries don't scream and shout. The cancer's main symptoms—bloating, abdominal aches, heartburn, feeling full quickly, pelvic pain, and the frequent need to urinate—are subtle and easily mistaken (by patients and their doctors) for benign maladies such as indigestion or irritable bowel syndrome. The result: Tumors often aren't discovered until they've grown and spread.
When found at an early stage, breast and ovarian cancers both have survival rates of more than 90 percent. But while 60 percent of breast cancer cases are caught early, about 60 percent of ovarian cancer cases are not diagnosed until the disease has distantly metastasized (most commonly into the abdomen).
Another problematic issue: screening. For starters, because the ovaries lie deep inside your body, it's difficult for your doctor to examine them. And there's no Pap smear or mammogram equivalent for testing for ovarian cancer. A current test—a painless transvaginal ultrasound coupled with a CA125 blood test that measures a cancer-indicating protein—isn't sensitive enough to catch most cases early, even if done regularly. In fact, a 2011 study in the Journal of the American Medical Association found that annual screening among average-risk women did nothing to reduce the number of deaths from ovarian cancer; instead, it yielded many false positives. "A false positive on a mammogram may require a biopsy, which, although inconvenient, does not lead to loss of a breast," says Martee L. Hensley, M.D., an associate attending physician at Memorial Sloan-Kettering Cancer Center in New York. "In contrast, a false positive on an ovarian cancer screening test might lead to surgery."
Hope on the Horizon
It's hard to gild the current picture of ovarian cancer, but potential breakthroughs are in the works, including better screening strategies, says Karen Lu, M.D., a professor of gynecologic oncology at the MD Anderson Cancer Center in Houston. And researchers are hard at work developing a number of vaccines designed to prevent the recurrence of ovarian cancer in diagnosed patients. Research also shows that high-risk women might be better off than was initially thought.
Researchers are also looking at the fallopian tubes for answers. Some scientists propose that the majority of aggressive ovarian tumors may actually begin in the tube, then spread to the ovary. That's potentially good news for younger patients, since ovarian removal in premenopausal women cuts off a hefty estrogen supply, which can lead to increased long-term risk for heart disease and osteoporosis. While studies have yet to confirm it, "we're intrigued by this possibility, because we could theoretically remove the tubes but leave the ovaries, preserving fertility," says Michael Seiden, M.D., Ph.D., president and CEO of the Fox Chase Cancer Center in Philadelphia.
In the meantime, there are things you can do to slash your risk, starting right now.
Alter your ovarian function. Though experts aren't totally sure why, giving birth and breastfeeding at least one baby are known risk reducers, possibly because they both suppress ovarian activity. But you don't have to become a mom: Being on the Pill yields the same result. Taking oral contraceptives for just five years can cut your ovarian cancer risk for the next 10 years by roughly 30 percent.
Snack on brussels sprouts, cabbage, and cauliflower. These foods are full of a phytochemical called sulforaphane, which can help reduce the risk for cancer. And new research from the National Institutes of Health indicates that limiting intake of fat—especially animal fat—may also help drop your chances of developing the disease.
Maintain a healthy weight. Women with a higher body mass index (BMI) may be at increased risk for ovarian cancer.
Climb into the stirrups once a year. "There's no evidence that pelvic exams will catch ovarian cancer early, but it's a great time to discuss any new symptoms with your doctor," says Lu. Be on the lookout for the most common signs—particularly if they seem to appear out of nowhere—and never be embarrassed to speak up about down-there discomforts. "Most of the time, it won't be ovarian cancer," says Goff, "but if you have symptoms that persist or get worse after two to three weeks, it's worth a trip to the gynecologist to investigate."
ASSESS YOUR RISK
As usual, genetics plays apart. Learn what other factors matter.
Endometriosis, infertility, and early menstruation can all increase a woman's chances of developing ovarian cancer, as can a family history of breast or ovarian cancer. But the best high-risk assessment lies in your DNA: some 10 percent of cases are hereditary.
Women who inherit mutations on their BRCA1 and BRCA2 genes—both of which are normally involved in DNA repair—are at a much higher risk for ovarian cancer. The BRCA2 mutation points to a 15 to 27 percent lifetime risk; the BRCA1 mutation skyrockets that number as high as 40 percent. In both cases, carriers typically fall ill around or after age 40 (the average patient has a 1.4 percent lifetime risk and is diagnosed after age 60).
"When a woman has one of these mutations, we'll monitor her every six months with the CA125 test and a transvaginal ultrasound," says Colleen Feltmate, M.D. "we'll wait for her to finish having kids, then suggest removing the ovaries and fallopian tubes, which cuts her risk for ovarian cancer by nearly 96 percent."
Research indicates the surgery should happen ASAP after a patient turns 35, but science suggests there might be ways to fine-tune your risk assessment—and possibly put off the surgery. For example, doctors now know that the BRCA1 and BRCA2 genes are very large, and that the mutations can occur anywhere along them. Pinpointing the exact spots could help further define your risk and aid your M.D. in coming up with a personalized prevention plan.
What's more, promising new research in the Journal of the American Medical Association shows that carriers of the BRCA mutations might actually have better survival rates after treatment than noncarriers.
If you have a strong family history of ovarian cancer (i.e., two or more first-or second-degree relatives have had it), consider seeing a genetic counselor for a BRCA blood test. You can also ask her about a separate genetic condition called Lynch syndrome, which has been linked to ovarian cancer. If you test positive for either, find a gynecological oncologist that you feel comfortable with and study all of your options before making any prophylactic decisions.
One bright note for high-risk women: You don't need to rush into motherhood. Even if you have the surgery early, scientific advances have made it possible to freeze eggs, remove the ovaries and fallopian tubes, and implant fertilized eggs into the uterus. Yep—you don't necessarily need your ovaries to be pregnant or deliver a baby.
Another Ovarian Intruder
For reasons that aren't quite clear, women in their child-bearing years are particularly at risk for a form of ovarian cancer called germ cell carcinoma, which grows in the egg-making cells of the ovary rather than on the surface of the ovary itself. The tumors, which make up about 5 percent of all ovarian cancer cases, are usually limited to one ovary and are easier to spot by an ob-gyn during a pelvic exam or ultrasound (exterior symptoms can include abdominal swelling). "While surgery and chemo are needed, this type of cancer is very curable," says Barbara Goff, M.D. "The vast majority of diagnosed patients can keep their uterus and other ovary, preserving their fertility."
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