Understanding Ovarian Cancer: Symptoms, Risks, and Prevention Strategies

The 11th most common cancer among women, ovarian cancer is not common. However, it  is the deadliest of gynecologic cancers.

This ‘deadliest distinction’ is largely due to two factors:

1: There is no screening for ovarian cancer

Unlike other cancers, including breast and colon cancer, there is no screening tool for ovarian cancer. Pap smears, common in annual gynecologic exams, only screen for cervical cancer, not ovarian cancer. 

2: The symptoms of ovarian cancer are often very subtle and easy to miss

In most of cases, symptoms of ovarian cancer don’t show up until the cancer has advanced (when the growth of the tumor triggers symptoms). 

Symptoms may include:

• Bloating

• Pelvic or abdominal pain

• Difficulty eating or feeling full quickly

• Urinary symptoms (urgency or frequency)

However, very often these symptoms are far more likely to be associated with common, benign problems than cancer. This is especially true for women at low risk of ovarian cancer and in instances where symptoms come and go or improve over time.

That said, all women who experience symptoms—especially persistent symptoms—should be evaluated by a gynecologist

As for who is at great risk of ovarian cancer, it’s important to note that it’s most often diagnosed in women aged 55-64 years with the median age being is 63. That means that at the time of diagnosis, half of women are younger than 63 and half are older.

Certain factors may put you at greater risk of developing ovarian cancer. These include:

• Age older than 55

• Family history of breast cancer, ovarian cancer, colon cancer, or endometrial cancer

• Personal history of breast cancer

• Mutations in BRCA1 and BRCA2 genes

• Never having had children

• Infertility

• Endometriosis

• Lynch syndrome

Women at high risk should speak to their doctor about ways to reduce their risk of developing and even prevent ovarian cancer. Options include:

Surgical Options:

Hysterectomy

Having a hysterectomy, or removal of the uterus while leaving the ovaries, may decrease the risk of ovarian cancer by 33 percent. 

Removal of fallopian tubes and ovaries

Referred to as a bilateral Salpingo-oophorectomy, this reduces ovarian cancer risk in women at average-risk but is not recommended unless there is a medical need other than prevention.

Removal of fallopian tubes

The surgical removal of both fallopian tubes, referred to as bilateral Salpingectomy, may prevent many cases of the most common ovarian cancer. The procedure leaves the ovaries intact, which means patients who undergo the procedure do not immediately enter menopause and preserves fertility by leaving the option for in-vitro fertilization in play.

Tubal Ligation

While not recommended to prevent ovarian cancer if there is no other medical need, tubal ligation, also known as “getting your tubes tied,” reduces ovarian cancer risk in women at average-risk. 

Non-Surgical Options:

Oral Contraceptive 

Research shows the use of oral contraceptives (birth control pills) for at least five years is associated with a 50 percent reduction in ovarian cancer risk when compared to women who have never used oral contraceptives. 

Breastfeeding

Breastfeeding is linked to a 24% reduced risk of ovarian cancer.

Pregnancy

A woman who carries a child, or multiple children, to term before age 26 has lower risk of ovarian cancer than women who have not. The risk goes down with each full-term pregnancy. 

If you’re at high risk for ovarian cancer or are simply concerned, talk to your gynecologist about prevention options.

Themarge Small, MD, FACOG, is an obstetrics & gynecology specialist at SVMC.