Practical Practitioner

By: Pamela Egan, FNP-C CDE

One in every 55 women will be diagnosed with Ovarian Cancer

Dear Pam,

My sister was recently diagnosed with ovarian cancer. I have not had a pap smear in four to five years and have not had a hysterectomy. Where should I go from here?

Ovarian cancer is a disease in which malignant or cancerous cells are found in the ovary. An ovary is one of two small almond-shaped organs located on each side of the uterus that produce female hormones and store eggs. Ovarian cancer is the fifth leading cause of new cancer cases.

In women age 35-74, ovarian cancer is the fourth leading cause of cancer related deaths. An estimated one woman in 55 will develop ovarian cancer during her lifetime. The American Cancer Society estimates that each year approximately 23,400 new cases of ovarian cancer are diagnosed and 13,900 women die of ovarian cancer.

A woman can inherit an increased risk for ovarian cancer from either her mother or father’s side of her family, particularly if a “first degree” relative (mother, sister or daughter) has, or has had ovarian, breast or colon cancer.

Furthermore, women with a strong family history of ovarian cancer are more likely to develop the disease at an early age (younger than 50). Women of Jewish descent are also at greater risk if they have an affected family member.

Studies show that inheriting a defect in the BRCA1 or BRCA2 gene can also increase a woman’s risk of developing ovarian cancer by about 13 to 50 percent. Normally, these genes help to prevent cancer, but if a woman has inherited a mutated BRCA1 or BRCA2 gene her ovaries are more susceptible to the development of cancer.

What are some of the symptoms or potential signs of ovarian cancer?

While the symptoms of ovarian cancer are often not acute or intense, they are not always silent. In my mother’s case, the only symptom was right shoulder pain and gastritis.

Symptoms of ovarian cancer may include:

– Pelvic or abdominal pain or discomfort
– Vague, but persistent gastrointestinal upsets such as gas, nausea and indigestion
– Frequency and urgency of urination in absence of an infection
– Unexplained changes in bowel habits
– Unexplained weight gain or weight loss, particularly weight gain in the abdominal region
– Pelvic and/or abdominal swelling, bloating and/or feeling of fullness
– Pain during intercourse
– Chronic fatigue
– Abnormal postmenopausal bleeding

So what should you do? Since you haven’t had a pap smear in several years, get one with a vaginal and rectovaginal exam. Although no consistently reliable, accurate screening test to detect ovarian cancer exists. A pelvic ultrasound, blood test to determine if the level of a tumor marker called CA-125 has increased in the blood for women at high risk or with an abnormal examination. If any of these tests are positive, consultation with a gynecological oncologist should be considered. CT scans, X-rays and samples of fluid from the abdomen or tissue from the ovaries may be performed. I ultimately opted for genetic testing which was negative, giving me peace of mind.

Treatment options include surgery, chemotherapy and/or radiation. At present there is no known method to prevent ovarian cancer, but some things appear to reduce a woman’s risk of developing the disease.

They include: oral contraception, breast feeding and pregnancy, tubal ligation, hysterectomy and prophylactic oophorectomy (the removal of one or both ovaries). For more information please contact the National Ovarian Cancer Coalition. at 1-888-OVARIAN; www.ovarian.org.

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