Ovarian cancer is the second most prevalent gynecologic cancer in the United States, but accounts for 55% of deaths associated with a gynecologic cancer. The majority of time, ovarian cancer is diagnosed at an advanced stage. This is due to lack of good screening tests, vague presentation of symptoms and the aggressive nature of the cancer.

The American Cancer Society estimated 21,550 newly diagnosed cancers and 14,600 deaths related to the disease. Survival at early or Stage I is 93%. This number drops to 28-30% at Stage III-IV. This is the most common stage of presentation. Only 15% of all ovarian cancers present at Stage I. The vast majority of ovarian cancers present at Stage III, 79%.

Risk factors are age, family history, ethnicity and reproductive factors. The average age of diagnosis is 59 and the rate of ovarian cancer increases with age. One in 70 women will develop ovarian cancer.

Family history is a strong risk factor for ovarian cancer. Strong family history of ovarian and/or breast cancer should prompt a full evaluation. Hereditary ovarian cancers account for approximately 10% of all ovarian cancers. Patients with a strong family history should undergo genetic testing. If the BRCA 1 or BRCA 2 mutation is identified, prophylactic surgery is recommended. Women with this genetic mutation have a higher probability of developing ovarian and/or breast cancer and at an earlier age.

The incidence is higher in white women and in North American and northern Europe. Mutations of the BRCA1 and BRCA2 genes are more common in Ashkenazi descent.

There is also an increased risk seen in women who have not had children or women who have had their first child after age 35. Treatment with infertility drugs may increase the chances of developing ovarian cancer. Use of oral contraceptives (birth control pill) for 5-10 years may decrease your risk of developing ovarian cancer.

Symptoms of ovarian cancer include pelvic pain, abdominal or pelvic bloating and feeling “full” all the time. These symptoms are vague and many times ignored. Ovarian cancer is aggressive and metastasis rapidly. Presentation of symptoms and diagnosis are often at a more advanced stage.

The most common question is: What kind of screening test can I do? Presently we do not have an effective screening test. A pelvic and transvaginal ultrasound may be ordered but it is not a very specific test. A blood test called CA-125 can be ordered as well. The combination of these two tests is often done to attempt to diagnose an early ovarian cancer. However, this does not work in the same manner as mammograms. Mammograms have reduced the number of deaths related to breast cancer because it is caught earlier. Transvaginal ultrasounds and CA-125 blood levels have not reduced the number of ovarian cancers. In addition, CA-125 levels may be elevated in benign conditions such as fibroids, endometriosis, infection and pancreatitis. It is more valuable in post menopausal women.

This combination of tests is recommended for women with BRCA1 or BRCA 2 mutation to begin at age 35, or 10 years earlier from when their closest relative was diagnosed with ovarian cancer. For women who have the genetic mutation, prophylactic surgery is recommended. This includes removal of ovaries and/or uterus. There are a vast number of minimally invasive surgical techniques that can be used. These include robotic surgery, traditional laparoscopy or single incision (scarless) laparoscopic surgery.

Although the incidence and survival of ovarian cancer has not changed over the years, we can identify patients who are at higher risk for developing this disease. Knowing one’s family history is extremely important and must be conveyed to your physician. Awareness is key to your health. Please take an active role in knowing your body, family history and make others aware of this disease and it’s better to be safe, if you think you have symptoms, don’t ignore them, go ask a professional!