Ovarian cancer is the third most common gynecologic cancer worldwide. Throughout the world
nearly 314,000 women were diagnosed with ovarian cancer in 2020
and over 207,000 women died from this disease.
This important disease will affect 1.3 percent of women in the United States during their life.
This video will provide information about ovarian cancer, including treatment.
What is ovarian cancer?
Ovarian cancer develops when cells in the ovary grow in an abnormal way. We also know today
that some ovarian cancers start in the fallopian tube, which is located right next to the ovary.
The normal ovary is about the size of a walnut, but can grow much larger when ovarian cancers develop.
There are a rather large number of different ovarian cancers. The most
common type is called epithelial ovarian cancer and has its origin at the surface of the ovary.
Other ovarian cancers are different and are called stroma tumors or germ cell tumors. These two
categories of ovarian cancers grow from the cells inside the ovary and are less common.
Who is at risk?
The risk of developing ovarian cancer increases with age. In addition women who experience periods early or menopause late in life have an increased risk. Some women are born with
mutations in their genes that can significantly increase the risk. The most important genes
are called BRCA1 and BRCA2 which can increase the lifetime risk to as high as 45 percent.
Up to one quarter of ovarian cancer cases are due to inherent mutations in these genes.
Genetic testing is very important for any patient with ovarian cancer since it allows
the identification of gene mutations in families. Women who are found to have a gene mutation
like in the BRCA genes can undergo prophylactic surgery to remove the ovaries and fallopian tubes
before they develop into an ovarian cancer. This procedure greatly reduces the risk of
ovarian cancer. We also know about factors that can reduce the risk of developing ovarian cancer
including, hormonal contraception like oil contraceptive pills or IUDs.
In addition, women who had multiple pregnancies develop ovarian cancer less often.
How do we screen for ovarian cancer?
Screening women for certain cancers like breast cancer with mammograms,
can detect the disease at an early stage and therefore treatment can result in better outcomes.
Unfortunately there is no screening strategy for ovarian cancer. Blood tests, ultrasounds of the ovaries,
or pelvic exams are not able to detect ovarian cancer at early stages.
That is why over two-thirds of ovarian cancers are diagnosed at late stages when the disease has
already extended beyond the pelvis and has spread to lymph nodes in the upper abdomen.
Early detection of ovarian cancer however is crucial to reduce mortality. The five-year survival
rate for patients who are diagnosed at stage 1 when the disease is still confined to the ovary is
over 90 percent. However, the survival rate drops to about 20 to 30 percent in patients with advanced
disease. The most effective strategy to reduce ovarian cancer mortality in certain individuals
is the identification of women at high risk particularly those with genetic mutations.
So, it is important to know if anyone in your family has a history of breast, ovarian,
prostate, or pancreatic cancer because these cancers might be caused by the same genes that
cause ovarian cancer. If any of your family members is diagnosed with these cancers
you would likely benefit from genetic counseling and genetic testing.
How is ovarian cancer treated?
When women are diagnosed with ovarian cancer they undergo a surgery. The surgery is called the debulking surgery that removes all the tumor.
The tumor in ovarian cancer is located on the ovaries, fallopian tube, uterus but can also spread to the lymph nodes
and other locations inside the abdomen, Following surgery women are treated with chemotherapy.
The two most common drugs used for this chemotherapy are called carboplatine
and taxol which are very effective to treat this cancer. If the cancer recurs at some point in time,
women are treated again with chemotherapy or other drugs including part inhibitors and immunotherapy.
What's on the horizon?
We have fortunately made significant progress in the treatment of ovarian cancer. Pop inhibitors are pills that are taken either alone or in combination with other
drugs including immunotherapy. Pop inhibitors are particularly effective in ovarian cancers that are
unable to repair DNA damage in the cancer cells. Genetic testing of the tumor itself can detect
these defects and hence patients that will likely respond to this treatment can be appropriately selected.
Immunotherapy works well in many cancers including, melanoma and lung cancer, but has so far
not shown significant effects in ovarian cancer patients. A new type of therapy is the use of
antibodies that carry molecules into the cancer cells and these molecules are toxic to the cells.
These are called antibody drug conjugates and have shown very good under tumor effects
in clinical trials in many patients. There are other new therapies including cell therapies in
clinical trials in ovarian cancer that are very exciting and will hopefully show better effects
on the tumor. Please reach out to your doctor if you have more questions about ovarian cancer.