Women's Health, Oncology

Ovarian Cancer

BY: PHYSICIANS COMMITTEE FOR RESPONSIBLE MEDICINE

Ovarian Cancer: Symptoms and Risk Factors

Ovarian cancer is the second most common gynecologic cancer (after cervical cancer) and the leading cause of death from gynecologic cancer. It generally affects women 40 to 65 years of age.

Several types of cancer can occur in the ovaries. The most common types occur when cells within the ovaries become cancerous, which may be related to excessive estrogen stimulation. In addition, advanced cancers of the breast and abdomen commonly spread to the ovaries.

In the early stages of ovarian cancer, the symptoms are subtle and may be overlooked. Indeed, most women will not seek medical attention, and may attribute symptoms to their menstrual cycle. As a result, most cases are advanced, and may be incurable, by the time of diagnosis.

Symptoms

  • Fatigue
  • Poor appetite or poor digestion
  • Lower abdominal discomfort (e.g., pressure, swelling, cramps, bloating, gas)
  • Low–back pain
  • Nausea
  • Diarrhea or constipation
  • Frequent urination
  • Weight gain or loss
  • Irregular or abnormal vaginal bleeding
  • Painful sexual intercourse
  • Swelling (edema) of the lower extremities

Risk Factors

  • Age: Most ovarian cancers occur in women over 50 years, with the highest risk in those over 60.
  • Family history: Women who have relatives with ovarian cancer have a three times increased risk. Having many affected relatives raises the risk further.
  • BRCA gene mutation: Women with a mutation of the breast cancer susceptibility genes (BRCA1 or BRCA2) have a 25 percent to 45 percent risk of ovarian cancer during their lifetimes.
  • Race: White women are affected more often than black women.
  • Previous cancer: Women with a history of breast or colon cancer may have an increased risk.
  • Absence of pregnancies or infertility
  • Endometriosis
  • Diet: See Nutritional Considerations below.
  • Other: Estrogen replacement therapy, smoking, and obesity may be risk factors, though further study is necessary.
  • Factors that reduce the risk include breast–feeding, previous pregnancy (and especially multiple pregnancies), use of birth control pills, tubal ligation surgery, and hysterectomy.

Diagnosis

  • A careful history and physical examination may reveal symptoms that may suggest the possibility of ovarian cancer. However, because the symptoms can be vague, the clinical exam may miss the diagnosis in the early stages of disease.

    As the cancer advances and the tumor enlarges, the physical examination may reveal a lower abdominal mass and the pelvic examination may reveal a pelvic mass, which should prompt further evaluation.
  • Blood testing will measure molecules in the blood (CA–125, alpha–fetoprotein, lactate dehydrogenase, human chorionic gonadotropin) that may suggest ovarian cancer. Blood testing is also used to monitor the recurrence of cancer after treatment.
  • Ultrasound is often used to visualize ovarian tumors, and may distinguish cancer from a benign tumor.
  • If blood tests and ultrasound raise suspicion for ovarian cancer, most women will then require exploratory surgery to evaluate the tumor more closely and perform a biopsy.

    If cancer is found, the surgeon will try to remove as much of the tumor as possible during the exploratory surgery.
  • CT scan and MRI may be necessary to determine if the cancer has spread beyond the ovaries.

Treatment

  • The primary treatment is surgery to remove the tumor. In most cases, both ovaries, the uterus, the fallopian tubes, nearby lymph nodes, and other affected structures are also removed. In advanced disease, chemotherapy is also indicated.

    In young women who want to be able to become pregnant, a modified surgical procedure may be possible in which one ovary, one fallopian tube, and the uterus is left in place.

Ovarian Cancer: Nutritional Considerations

The role of nutrition in ovarian cancer is not yet firmly established. However, the following nutritional steps are under investigation for a possible role in preventing ovarian cancer:

  • Avoiding or reducing meat consumption: A high intake of fat may increase the risk of ovarian cancer, perhaps by as much as 25 percent. Most of this risk is attributed to saturated fat intake. Various food sources of saturated fat have been implicated, including meat, eggs, and whole milk.

    Animal fat and meat are thought to increase risk by influencing estrogen activity and blood concentrations of insulin–like growth factor–1 (IGF–1), a hormone that has been implicated in several cancers, including ovarian cancer.
  • Avoiding milk: Saturated fat aside, even women who drink skim or low–fat milk in small amounts (one or more servings per day) have a greater risk for ovarian cancer. This may be due to the hormones and growth factors present in milk.
  • A diet with plenty of fruits and vegetables: Women whose diets are rich in fruits and vegetables appear to have a reduced risk of developing ovarian cancer. This may be due to their high levels of carotenoids, such as beta–carotene and lutein, and folate (especially in green leafy vegetables).
  • A diet rich in vitamin E: Higher intake of food sources of vitamin E (including whole grains, wheat germ, and nuts) is associated with a 40 percent lower risk for ovarian cancer.

    It is not yet known if taking vitamin E supplements results in the same protective effect. Some evidence indicates that taking at least 75 mg per day of vitamin E pills is associated with lower risk. Other studies indicate this benefit is evident only with long–term (longer than 10 years) supplementation.
  • Maintaining a healthy body weight: Obesity in adolescence or early adulthood may double the risk for ovarian cancer. The same low–fat, plant–based diet that lowers cancer risk generally also helps trim excess body weight.
  • Moderate alcohol intake: Alcohol–containing beverages do not appear to increase the risk for ovarian cancer. Studies suggest that alcohol intake may even be protective against this cancer in patients who have a high intake of folate. However, given the health risks of alcohol consumption, including increased breast cancer risk, alcohol use cannot be recommended as a prevention strategy.
  • Green tea consumption: Drinking at least one cup of green tea per day may lower the risk for developing ovarian cancer.
  • Consider a consultation with a registered dietician to help make the appropriate dietary changes.

Nutrition for survival

Women with established ovarian cancer who consume vegetable–rich diets may have improved survival. In one study, women who consumed the most vegetables had a 25 percent lower death rate, compared with women who ate the fewest vegetables.

Of note, some studies suggest that a benefit only occurs in women who eat at least three servings of vegetables daily. Other studies suggest that the benefit primarily occurs when women increase their intake during adolescence.

Green tea has been associated with a lower mortality risk in women with established ovarian cancer.

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