facts and myths about ovarian cancer

1. Ovarian cancer: diagnosisOvarian cancer: diagnosis
and risk assessmentand risk assessment
Noelle Gillette Cloven MDNoelle Gillette Cloven MD
Gynecologic OncologyGynecologic Oncology
Texas Oncology/ Fort WorthTexas Oncology/ Fort Worth

2. Female Cancer Cases by SiteFemale Cancer Cases by Site
Reprinted by permission of theReprinted by permission of the
American Cancer SocietyAmerican Cancer Society

3. Female Cancer Deaths by SiteFemale Cancer Deaths by Site
Reprinted by permission of theReprinted by permission of the
American Cancer SocietyAmerican Cancer Society

4. Ovarian CancerOvarian Cancer
• Most lethal gynecologic cancerMost lethal gynecologic cancer
• Second most common gynecologic cancer in theSecond most common gynecologic cancer in the
USUS
– Responsible for 25,000 cases annuallyResponsible for 25,000 cases annually
– 14,500 deaths annually14,500 deaths annually
• There are 188,000 women living with ovarianThere are 188,000 women living with ovarian
cancer in the United Statescancer in the United States
American Cancer Society

5. Ovarian cancer vs other femaleOvarian cancer vs other female
cancerscancers

6. Ovarian Cancer: Stage Distribution and SurvivalOvarian Cancer: Stage Distribution and Survival
StageStage PercentPercent SurvivalSurvival
II 2424 95%95%
IIII 66 65%65%
IIIIII 5555 30%30%
IVIV 1515 15%15%
OverallOverall 50%50%
American Cancer SocietyAmerican Cancer Society

7. Survival Rates: Ovarian & Breast CancersSurvival Rates: Ovarian & Breast Cancers
Five-Year Survival RatesFive-Year Survival Rates
by Stage at Diagnosisby Stage at Diagnosis
StageStage OvaryOvary BreastBreast
LocalLocal 93%93% 97%97%
RegionalRegional 55%55% 76%76%
DistantDistant 25%25% 21%21%
All StagesAll Stages 50%50% 84%84%
American Cancer Society

8. Ovarian Cancer: Risk FactorsOvarian Cancer: Risk Factors
Increased Risk Decreased Risk
Age Oral Contraceptive Use
Family history
Pregnancy and
Breastfeeding
Infertility/low parity Tubal ligation
Personal cancer
history
Hysterectomy/Removal
of Both Ovaries

9. 5 Things every woman should5 Things every woman should
know about ovarian cancerknow about ovarian cancer

10. 1) Your personal and family1) Your personal and family
history affect your riskhistory affect your risk
• if your mother,if your mother,
daughter or sister hasdaughter or sister has
ovarian, breast or colonovarian, breast or colon
cancercancer
• age is a strong riskage is a strong risk
factorfactor
• if you are at high risk,if you are at high risk,
there are actions tothere are actions to
take that reduce yourtake that reduce your
risksrisks

11. Ovarian Cancer: Hereditary RisksOvarian Cancer: Hereditary Risks
Family History of Ovarian Cancer
Lifetime
Risk
None 1.5%
1 first-degree relative 5%
2 first-degree relatives 7%
Hereditary ovarian cancer
syndrome
40%
Known BRCA1 or BRCA2 inherited
mutation
35-65%

12. Hereditary SyndromesHereditary Syndromes
• Account for 15% of Epithelial OvarianAccount for 15% of Epithelial Ovarian
Cancer ( BRCA, HNPCC)Cancer ( BRCA, HNPCC)
• new genes have been identifiednew genes have been identified
• Inherited from either parentInherited from either parent
• Associated with breast, colon, prostate,Associated with breast, colon, prostate,
pancreatic and endometrial cancerspancreatic and endometrial cancers

13. Ovarian Cancer: Risk Reduction & PreventionOvarian Cancer: Risk Reduction & Prevention
• Oral contraceptives reduce risk by 50% after 5 orOral contraceptives reduce risk by 50% after 5 or
more years of usemore years of use
• First full-term pregnancy < age 25; number ofFirst full-term pregnancy < age 25; number of
pregnanciespregnancies
• Breast-feedingBreast-feeding
• Hysterectomy/Tubal ligationHysterectomy/Tubal ligation
• Removal of the ovaries and/or fallopian tubesRemoval of the ovaries and/or fallopian tubes
(risk of primary peritoneal cancer remains)(risk of primary peritoneal cancer remains)

14. 2) If you are at high risk, you may2) If you are at high risk, you may
benefit from preventative surgerybenefit from preventative surgery
• removal of tubes andremoval of tubes and
ovariesovaries
• minimally invasiveminimally invasive
surgeriessurgeries
• weigh risks of earlyweigh risks of early
menopausemenopause
• option is screeningoption is screening
with blood tests andwith blood tests and
ultrasoundsultrasounds

16. 3) Ovarian cancer is one of the3) Ovarian cancer is one of the
most diverse kinds of cancermost diverse kinds of cancer
60-70%
15-20%
5-10%
Epithelial Germ Cell Sex Cord Stromal

17. 4) early diagnosis is key, don’t4) early diagnosis is key, don’t
ignore symptomsignore symptoms
• ovarian cancer hasovarian cancer has
been called “silentbeen called “silent
killer”killer”
• symptoms are vaguesymptoms are vague
and mimic moreand mimic more
common conditionscommon conditions
• having a normal PAPhaving a normal PAP
test does not rule outtest does not rule out
ovarian cancerovarian cancer

18. Ovarian Cancer: SymptomsOvarian Cancer: Symptoms
• 95% of women DO report symptoms95% of women DO report symptoms
• Symptoms can be vague and not gynecologic:Symptoms can be vague and not gynecologic:
– Abdominal bloating, increased girth, pressureAbdominal bloating, increased girth, pressure
– Unusual fatigueUnusual fatigue
– Gastrointestinal disturbances such as nausea,Gastrointestinal disturbances such as nausea,
indigestion, gas, constipation or diarrheaindigestion, gas, constipation or diarrhea
– Urinary frequency or incontinenceUrinary frequency or incontinence
– Abdominal/pelvic painAbdominal/pelvic pain
– Unexplained weight loss or gainUnexplained weight loss or gain
– Shortness of breathShortness of breath

19. How is Ovarian Cancer Diagnosed?How is Ovarian Cancer Diagnosed?
• Vaginal - rectal examVaginal - rectal exam
• Transvaginal ultrasoundTransvaginal ultrasound
• CA 125 blood testCA 125 blood test
• If indicatedIf indicated, surgery and study of tumor tissue, surgery and study of tumor tissue

20. 5) The type of doctor that you see5) The type of doctor that you see
affects outcomeaffects outcome
• studies show betterstudies show better
survival in patientssurvival in patients
who receive care by awho receive care by a
gynecologic oncologistgynecologic oncologist
• ““high volumehigh volume
hospitals” also havehospitals” also have
better outcomesbetter outcomes

21. What is a GynecologicWhat is a Gynecologic
OncologistOncologist??
• Obstetrician/gynecologists who specialize inObstetrician/gynecologists who specialize in
treating women with reproductive tracttreating women with reproductive tract
cancerscancers
• Comprehensive management of gynecologicComprehensive management of gynecologic
cancers, including:cancers, including:
– Surgery, radiation therapy, chemotherapySurgery, radiation therapy, chemotherapy
and experimental treatmentsand experimental treatments

22. The Importance of Specialty CareThe Importance of Specialty Care
• Gynecologic oncologists are 5 times more likelyGynecologic oncologists are 5 times more likely
to completely remove ovarian tumorsto completely remove ovarian tumors
• 80% of ovarian cancer patients receive inadequate80% of ovarian cancer patients receive inadequate
surgical staging fromsurgical staging from
non-gynecologic oncologist surgeonsnon-gynecologic oncologist surgeons
• Survival outcomes vastly improved with gynecologicSurvival outcomes vastly improved with gynecologic
oncologistsoncologists

23. Ovarian Cancer: TheOvarian Cancer: The
Importance of StagingImportance of Staging
• Accurate staging is essential for physiciansAccurate staging is essential for physicians
to know what course of treatment will beto know what course of treatment will be
most effective.most effective.

24. Ovarian Cancer: How is OvarianOvarian Cancer: How is Ovarian
Cancer Treated?Cancer Treated?
Standard:Standard:
• Surgical staging (preferably by a gynecologicSurgical staging (preferably by a gynecologic
oncologist)oncologist)
• Chemotherapy for most patients (For example,Chemotherapy for most patients (For example,
platinum/Taxane chemotherapy)platinum/Taxane chemotherapy)
• Radiation therapy when appropriateRadiation therapy when appropriate
• Clinical trialsClinical trials

25. Ovarian Cancer: Take ActionOvarian Cancer: Take Action
• Define your riskDefine your risk
– Discuss regular monitoring with physicianDiscuss regular monitoring with physician
• If symptoms persist and are unusual for youIf symptoms persist and are unusual for you
– See a doctorSee a doctor
• If ovarian cancer is suspected or diagnosedIf ovarian cancer is suspected or diagnosed
– Insist on being referred to a gynecologicInsist on being referred to a gynecologic
oncologistoncologist
Share this information!Share this information!

26. Ovarian Cancer: Future DirectionsOvarian Cancer: Future Directions
• Effective screening testsEffective screening tests
• Early detectionEarly detection
• PreventionPrevention
• Overcoming chemoresistanceOvercoming chemoresistance
• Targeted therapy (angiogenesis, PARP)Targeted therapy (angiogenesis, PARP)
• Strengthening education effortsStrengthening education efforts

27. • Individualized confidential gynecologicIndividualized confidential gynecologic
(ovarian, endometrial, cervical) and breast cancer ris(ovarian, endometrial, cervical) and breast cancer ris
assessmentassessment
• SGO/GCF member directory by name/stateSGO/GCF member directory by name/state
• Daily newsfeedDaily newsfeed
• Links to otherLinks to other
sources of cancersources of cancer
informationinformation
• BookstoreBookstore
Women’s Cancer Network: www.wcn.orgWomen’s Cancer Network: www.wcn.org

29. All Women
HPV and Cervical CancerHPV and Cervical Cancer

30. About 80% of Women
will be infected with
HPV in their lifetime
HPV and Cervical CancerHPV and Cervical Cancer

31. About 7% of
Women will have
an abnormal
Pap test
HPV and Cervical CancerHPV and Cervical Cancer

32. 300,000 Women
(per year in the
United States) will
have a high grade
precancerous
lesions
HPV and Cervical CancerHPV and Cervical Cancer

33. About 10,000
Women (per year
in the United
States) will
develop cervical
cancer
HPV and Cervical CancerHPV and Cervical Cancer