SURVIVORS TEACHING STUDENTS: SAVING WOMEN’S LIVES®

OBJECTIVES Through the stories we will share with you today, we hope to increase your understanding of ovarian cancer symptoms and risk factors so you will be able to diagnose the disease when it is in its earlier, most treatable stages.

Ovarian Cancer: The Facts It is the tenth most common cancer in women. It is the deadliest of all gynecologic cancers and the fifth leading cause of cancer deaths among American women. More than 22,000 American women will be diagnosed with ovarian cancer in About 14,400 women will die from ovarian cancer in the United States each year. Source: Statistical information from the American Cancer Society: Cancer Facts and Figures 2012

EARLY DETECTION GREATLY INCREASES SURVIVAL Ovarian cancer is difficult to diagnose because the symptoms are often subtle and easily confused with other conditions. When ovarian cancer is detected before it has spread beyond the ovaries, nine out of 10 women will survive for more than five years. However, only 15 percent of ovarian cancer cases in the United States are diagnosed at this early stage. Source: National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program 90% of women DO report symptoms, even at early stages. Source: Journal of American Medical Association, May 2004

EVERY WOMAN IS AT RISK A woman’s lifetime risk of developing invasive ovarian cancer is 1 in 72. A woman’s lifetime risk of dying from invasive ovarian cancer is 1 in 95. Source: Statistical information from the American Cancer Society: Cancer Facts and Figures 2011

HEREDITY HEREDITY – Although heredity is the strongest risk factor, it accounts for only 10% of cases. Family history of any of the following cancers may indicate an increased risk: Breast cancer Ovarian cancer Colon cancer Uterine cancer Genetic counseling should be suggested if there is a family history. Both maternal and paternal family history should be considered when assessing for increased risk.

GENETIC MUTATIONS RELATED TO INCREASED RISK Mutations in the breast cancer genes, BRCA1 or BRCA2. HNPCC (hereditary nonpolyposis colorectal cancer) or Lynch syndrome is associated with mutations in MLH1, MSH2, and MSH6 genes. HNPCC is primarily associated with increased risk of colon cancer but has also been found to be associated with increased risk of uterine/endometrial cancer and ovarian cancer. Source: Women’s Cancer Network, Gynecologic Cancer Foundation, 2012

RISK FACTORS THAT MAY INCREASE A WOMAN’S RISK OF DEVELOPING OVARIAN CANCER: Increased age Family and/or personal history of breast/ovarian cancer More menstrual cycles/early onset of menarche Never pregnant Hormone replacement

AGE AT DIAGNOSIS Under age 20 years1.3% Between 20 and 34 years3.6% Between 35 and 44 years7.2% Between 45 and % Between 55 and % Between 65 and 74 years20.4% Between 75 and 84 years17.2% 85+ years8.2% Source: National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program

FACTORS THAT MAY DECREASE A WOMAN’S RISK OF DEVELOPING OVARIAN CANCER: Oral contraceptive use Childbearing Breastfeeding Tubal ligation Removal of ovaries and fallopian tubes

REMOVAL OF OVARIES DOES NOT ELIMINATE RISK Women who have had their ovaries removed are at risk of developing PRIMARY PERITONEAL CANCER (PPC) which is closely related to epithelial ovarian cancer. The clinical presentation and treatment of PPC are similar to that of ovarian cancer.

SYMPTOMS The following four symptoms are more commonly reported by women with ovarian cancer than by women in the general public: BLOATING ABDOMINAL OR PELVIC PAIN DIFFICULTY EATING OR FEELING FULL QUICKLY URINARY SYMPTOMS – FREQUENCY/URGENCY Source: Goff, Mandel, Drescher, Urban, Schurman, Patras, Mahony, Anderson, Development of an ovarian cancer symptom index. Cancer 2007; 109:221-7.

OTHER SYMPTOMS Additional symptoms may include fatigue, indigestion, back pain, pain with intercourse, constipation/diarrhea and menstrual irregularities.

CONSIDER OVARIAN CANCER Consider ovarian cancer in the differential diagnosis if the symptoms:  Often occur frequently, approximately 12 times in a month  Are persistent over the course of 2 or more weeks  Are unusual for her and are unexplained by other causes

IF OVARIAN CANCER IS SUSPECTED The following should be performed: Pelvic and rectal examination Transvaginal or pelvic ultrasound CA-125 blood test if an irregularity is found on the above exams or if the patient is symptomatic Please see the Management Algorithm for Average-Risk Women with Symptoms Suggestive of Ovarian Cancer on the handout provided for further information.

Gynecologic Oncologist Studies have shown that women diagnosed with ovarian cancer generally have a better likelihood of prolonged survival if treated by a gynecologic oncologist.

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