Gilda Radner. Madeline Kahn. Dinah Shore. Coretta Scott King. Loretta Young.
Besides their fame, what all these women had in common was death from ovarian cancer.
According to the American Cancer Society, ovarian cancer ranks fifth in cancer deaths among women; it is the most deadly of the cancers of the female reproductive system.
A woman’s risk of developing ovarian cancer during her lifetime is about 1 in 75. Ovarian cancer mainly strikes older women — about half of those diagnosed are 63 years or older — and is more common in white women than African-American women.
There are three main types of ovarian cancer. The most common is epithelial, from cells that cover the outside of the ovary. Less common are germ cell cancers, from cells that manufacture the eggs, and stromal cancers, from cells that bind the ovary together.
As with many cancers, the exact causes of ovarian cancer are not known. Scientists have discovered some things, however, that seem to reduce a woman’s risk, such as having a full-term pregnancy before age 26 and taking birth control pills. Both of these factors reduce the number of times the ovary releases an egg and some researchers believe there is a relationship between ovulation and ovarian cancer risk.
The surgical procedures of tubal ligation and hysterectomy also appear to lower the risk of ovarian cancer. Some scientists believe that cancer-causing substances may enter the body through the vagina and pass through the uterus and fallopian tubes to reach the ovaries, so removing the uterus or blocking the fallopian tubes would lower the risk.
While full-term pregnancies, birth control, hysterectomy and tubal ligation seem to lower the risk of developing ovarian cancer, the most common type, epithelial ovarian cancer, has a few known risks.
Age. Epithelial ovarian cancer is rare in women younger than 40. Most ovarian cancers develop after menopause.
Obesity. Researchers have studied the relationship between obesity and ovarian cancer; it appears that women with a body mass index higher than 30 are at higher risk.
Family history. Women who have a mother, sister or daughter with ovarian cancer are at higher risk. Also, a family history of colorectal and breast cancer is associated with increased ovarian cancer risk.
There are other potential risk factors as well, such as taking some fertility drugs and hormones.
Unfortunately, the symptoms of ovarian cancer are the same as many other common problems — bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, needing to urinate urgently or often.
The key to symptoms that might signal ovarian cancer is their persistence, so it’s very important to see your physician or clinician if your symptoms don’t go away after normal treatment such as a change in diet or laxatives.
Because the symptoms are so vague and so common, fewer than 20 percent of ovarian cancers are diagnosed in the early stages.
Unlike Pap tests for cervical cancer or mammograms for breast cancer, there currently is no standard screening procedure for detecting ovarian cancer. If signs point to the possibility of ovarian cancer, however, additional testing can be done. Transvaginal sonography, a type of ultrasound, makes a picture of the ovaries on a video screen. CT scans also take clear pictures of the ovaries. Blood work may be done to check for high levels of some proteins. An ovarian biopsy is the only way to tell for certain whether cancer is present.
Surgery is usually the main form of treatment for ovarian cancer. Many women also receive chemotherapy and radiation therapy. Other treatments include targeted therapy, which uses drugs to find and kill only the cancer cells and not normal cells. Hormone therapy, used more often in treating ovarian stomal cancers, uses hormones or hormone-blocking drugs.
Although scientists have identified protective factors and risk factors, what is known does not translate into practical tips for preventing ovarian cancer. Yet there are still some things women can do.
See your physician, clinician, or gynecologist promptly if you have any symptoms that persist for longer than a few weeks and cannot be explained by other common conditions.
Talk with your physician or clinician about having an annual pelvic exam. In a pelvic exam, the physician or clinician manually feels for abnormal swelling and can detect any tenderness.
Women with a high-risk family history might consider genetic counseling and testing. Genetic testing can help determine if certain gene mutations that increase the risk for ovarian cancer are present.
While there is currently no recommended screening program for ovarian cancer, the best approach to its prevention is to seek regular care from your health care provider and to familiarize yourself with your family medical history. There is ongoing research to assist providers in developing effective screenings. Until then, become your own health care advocate and follow recommendations by your provider.
Dr. Tucker Kueny is an obstetrician/gynecologist forCooley Dickinson Medical Group Women’s Health. Women’s Health is written by health care professionals affiliated with Cooley Dickinson Hospital in Northampton. It appears here monthly.