Ovarian Cancer Awareness Month 2021: Surveying the Situation

For a woman of any age, a diagnosis of ovarian cancer can be the beginning of an anxiety-ridden journey into the unknown. This cancer can sneak up on women — due to its lack of obvious or differentiated symptoms — and often proves to be lethal. It is the fifth leading cause of cancer death among women,1 and its mortality rates are higher than that of any other cancer of the reproductive system.1

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Ovarian Cancer Awareness Month 2021:
Surveying the Situation

September 21, 2021

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For a woman of any age, a diagnosis of ovarian cancer can be the beginning of an anxiety-ridden journey into the unknown. This cancer can sneak up on women — due to its lack of obvious or differentiated symptoms — and often proves to be lethal. It is the fifth leading cause of cancer death among women,1 and its mortality rates are higher than that of any other cancer of the reproductive system.1


However, the situation is not hopeless! When caught early, the prospects for ovarian cancer patients can be very good. When diagnosed with Stage 1 epithelial ovarian cancer, 5-year survival rates have been shown to exceed 90%.2 As September is ovarian cancer awareness month, it is a good time to review the fundamentals of this serious disease, discuss a primary care physician’s role in patient care, and look toward new developments that could give hope to women and the physicians who are treating them.

5 women holding each others' hands walking in a park

Risk – A Cloudy Calculation

The uncertainty around risk factors associated with ovarian cancer continues to be a source of concern. While the presence of risk factors does not always spell doom, physicians and women should be aware of elements that can raise the risk of developing the disease:

 

    • Genetic syndromes: Approximately 10% to 12% of cases are associated with genetic syndromes. In particular, the presence of the BRCA mutation can be relevant.2
    • Age: More than 75% of women are diagnosed starting from their 40s to 60s. Often, they are diagnosed with advanced stages of cancer.2, 3
    • Family history of cancer and/or previous diagnosis of cancer (ovarian, breast, colon, other)2, 4
    • Never having children3
    • Obesity2, 4
    • Hormone replacement therapy (risk may increase with length of use)2
    • History of endometriosis3

 

Physicians should take note of risk factors when conducting periodic physicals and take advantage of opportunities to educate patients on the types of risk that could contribute to the occurrence of ovarian cancer.

 

Symptoms – Ambiguity Abounds

At this time there is no widely accepted screening test for ovarian cancer. This gap is troubling as symptoms can be nonspecific or nonapparent in the early to mid stages. Consequently, ovarian cancer is often detected only when it has reached an advanced stage.

 

Patients will often present with symptoms including:2, 3, 4

    • Atypical vaginal bleeding
    • Back pain
    • Fatigue
    • Abdominal bloating or pain
    • Constipation/urinary issues
    • Upset stomach or a feeling of fullness
    • Unexplained change in weight

 

Physicians can encourage patients to be attuned to their bodies and aware of changes that last for more than a few weeks. The presence of multiple symptoms or a combination of risk factors and symptoms may merit further investigation.

 

Papillary serous ovarian adenocarcinoma, cancer of ovary, light micrograph, photo under microscope

Diagnosis — A Multipronged Approach

When ovarian cancer is a possibility, multiple diagnostic strategies are often needed to make the best assessment and determine the next steps. In addition to a thorough evaluation of patient history, a physician will perform a thorough physical exam. This generally includes a pelvic and abdominal exam to search for a cyst, tumor or other mass.

 

In some cases, imaging might also be considered if a physician detects a mass, if a physical examination cannot be completed properly, or if some other circumstance raises suspicion. Imaging sheds more light on the situation, giving physicians a better view of internal anatomy and increasing the chances of detecting an abnormality, should one exist. A variety of imaging tests are available, with transvaginal ultrasound being common in the early stages of evaluation.

 

Because a mass may not always be detected even when ovarian cancer is present, physicians may also use laboratory tests. One biomarker that is commonly evaluated is CA 125. Research has shown this to be a useful tool, although its utility can vary based on the disease risk and stage.2 Patients with a strong family history of ovarian cancer may also benefit from further genetic testing.

 

Detection of suspicious masses and other results outside the norms dictated by current guidelines are often good reasons for referral to a gynecological oncologist. This specialist can use additional evaluations and tests to make a definitive determination as to whether a patient has ovarian cancer.

Doctor telling to patient woman the results of her medical tests. Doctor showing medical records to cancer patient in hospital ward. Senior doctor explaint the side effects of the intervention.

Treatment – Hope Is On the Horizon

The good news in regard to ovarian cancer is that treatment strategies do exist. When caught early, ovarian cancer can sometimes be cured. Surgery is usually the first-line treatment, although new therapies are emerging. While surgery may sound scary to patients, it enables the physician to remove the offending cancerous tissue and is also useful for staging. “Fertility-sparing” surgical techniques exist, which can benefit women of childbearing ages.

 

Post-surgery, chemotherapy is often used when cancer is determined to be at an advanced stage. Depending on the type of chemotherapy used, it may be administered via a pill or intravenously, and could be used alone or in combination with other drugs.

 

Targeted therapy is a newer type of cancer treatment that uses drugs to identify and attack cancer cells while doing little damage to normal cells.5 These therapies attack the cancer cells’ inner workings — the programming that makes them different from normal, healthy cells. Examples of targeted therapies include PARP inhibitors and Bevacizumab.5 While PARP inhibitors have been used under certain circumstances for recurrent cancer and maintenance therapy, research will evaluate their utility at various points within the treatment life cycle.6

Primary Care and Cancer

A woman’s primary care physician can play several roles during her journey through ovarian cancer. First and foremost, she will need to stay as healthy as possible. While the treatment of cancer is of utmost importance, other health issues may be present, such as hypertension, diabetes, or heart disease. Physicians should also ensure that patients stay current on important tests (e.g., mammograms) and vaccines.

 

Primary care physicians will also want to examine drug interactions and side effects associated with chemotherapy and other drugs. Treatment is known to impact immune systems, and certain chemotherapies have also been associated with loss of kidney function, hypertension, low platelet counts, and anemia.4

 

Targeted therapies are known to have side effects as well. These include, but are not limited to, bleeding, sores, nausea, fatigue, blood clots, anemia, structural changes to the bowel, and slow wound healing.4, 5

 

Providing primary care for women who are undergoing treatment or who have survived ovarian cancer may also entail consultation regarding emotional health and assistance coordinating care when multiple providers are involved. Maintaining good lines of communication with patients and other providers can create a supportive environment for the patient and reduce the risk of oversights.

Footnotes:
1 Cancer Facts and Figures 2021. American Cancer Society, 2021, https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf.
2 Doubeni, Chyke A, et al. “Diagnosis and Management of Ovarian Cancer.” Am Fam Physician, vol. 93, no. 11, 1 Jun. 2016, pp. 937-944.
3 “Ovarian Cancer Basic Information.” Centers for Disease Control, reviewed 15 Mar. 2021, https://www.cdc.gov/cancer/ovarian/index.htm.
4 Tedesco, Alaina. “Ovarian Cancer: What PCPs Need to Know.” Healio Internal Medicine, 12 Sep. 2018, https://www.healio.com/news/primary-care/20170926/ovarian-cancer-care-what-pcps-need-to-know.
5 “Targeted Therapy for Ovarian Cancer.” American Cancer Society, 11 Apr. 2018, https://www.cancer.org/content/dam/CRC/PDF/Public/8776.00.pdf.
6 ASCO Releases New Guidelines on PARP Inhibitor. ASCO press release, 20 Sep. 2020, https://www.cancernetwork.com/view/asco-releases-new-guidelines-on-parp-inhibitor-use-for-management-of-ovarian-cancer.

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