May is Ovarian Cancer Awareness Month
By Gina M. DiVenuti, MD

The ovaries are a pair of organs in the female reproductive system located on either side of the uterus. Their normal function is to produce eggs and female hormones. The most common type of ovarian cancer is ovarian epithelial cancer. In this type of ovarian cancer, malignant (cancer) cells form in the tissue covering the ovary.

Risk Factors

This type of cancer usually occurs in women more than 50 years old. A family history of either ovarian and/or breast cancer, especially at a young age, is the most important risk factor for this disease. Never having had children also increases risk. A lower risk is associated with a history of pregnancies, oral contraceptive use, or breastfeeding.

The genes that are in cells carry the hereditary information that is received from a person’s parents. Approximately 5 to 10 percent of all cases of ovarian cancer are hereditary; that is, they are due to abnormal genes inherited from a person’s parents.

Three hereditary patterns have been identified – families with ovarian cancer alone, ovarian and breast cancers, or ovarian and colon cancers. Inidividuals in these families may want to consider genetic testing.  If they are found to have mutations in the BRCA-1 or BRCA-2 genes, intensive screening with CA-125 blood levels and transvaginal ultrasounds may be considered, though as yet there is no proof that such screening improves the chances of catching ovarian cancer at a curable stage.

Other maneuvers to reduce risk in these patients are oral contraceptive use and removal of the ovaries when childbearing is complete. 

Symptoms

In 30 percent of cases, ovarian cancer is detected early when a mass is detected on pelvic exam, or occasionally when a patient develops pelvic pain from twisting of the ovary. However, disease often presents at a more advanced stage when the disease has traveled from the ovary to the upper part of the abdomen. Under such circumstances, patients can have symptoms such as abdominal pain, bloating, or loss of appetite.

The most common way that ovarian cancer can spread outside the abdomen is as fluid surrounding the lung. Occasionally patients with ovarian cancer can have an increased predisposition to blood clots. 

Diagnosis

The initial diagnostic test for ovarian cancer is often transvaginal ultrasound. The next step is usually a surgery called an exploratory laparotomy.  Reasons for this surgery include obtaining tissue for a definite diagnosis and determining the stage of the disease (how much cancer there is and its location). In addition, patients who are able to have most of their tumor removed tend to have better survival than those with larger amounts of tumor left behind after surgery.

Patients who are too sick for exploratory laparotomy may have diagnosis obtained by removing fluid from the abdomen with a needle to search for malignant cells.  

Treatment

Patients with very early disease, which has not spread outside the ovaries and does not otherwise appear aggressive when reviewed by pathologists, may be treated with surgery alone. Otherwise, it is recommended that patients receive chemotherapy after surgery with two drugs called paclitaxel and carboplatin.

These drugs are given every three weeks, usually for six doses (cycles).  Side effects can include a drop in blood counts, allergic reactions, some nausea, muscle aches, hair loss and numbness of the digits, which can occasionally be painful.

Patients with disease that has spread outside the abdomen often are also treated with paclitaxel and carboplatin. Drugs that may be administered to patients who are resistant to paclitaxel and carboplatin include liposomal doxorubicin or topotecan. 

Current Areas of Research

There is ongoing research in some areas of ovarian cancer that should help provide further weapons against this serious illness. Investigators at the Beth Israel Deaconess Medical Center have identified an Ovarian Cancer Prognostic Profile, with results reported in a December 2004 issue of the Journal of Clinical Oncology, which they believe will help in predicting prognosis in patients with advanced ovarian cancer. This profile examines the expression levels of certain genes in an individual patient and linked these levels to prognosis.

Another area of research is targeted toward a non-chemotherapy drug, called oreguvomab, which is an antibody against the tumor-associated protein CA-125 and may be useful in patients with ovarian adenocarcinomas expressing this protein. This drug may be of benefit in some patients with advanced ovarian cancer and has begun to be tested in clinical trials.

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