Caitlin Whyte (Host): Welcome back to BayCare HealthChat. I'm your host, Caitlin Whyte. And in this episode, we are going to be discussing ovarian cancer, what it is, signs and symptoms to watch out for, and how to treat it. Joining us for this conversation is Dr. Jessica Kennard, a gynecologic oncologist.

 Well, to start out our episode today, doctor, what is ovarian cancer?

Dr. Jessica Kennard: It is an overgrowth of cells on the ovaries, can be one or both ovaries involved. It happens as a result of some sort of insult where the cells are damaged and their DNA is affected in a way that the cells start to rapidly divide uncontrollably. And then, the cells will grow and divide and multiply and will eventually evolve into a mass. And that is what ovarian cancer becomes.

Host: Okay. So, just how common is ovarian cancer?

Dr. Jessica Kennard: Ovarian cancer is much more common than most people realize. A woman's risk of getting ovarian cancer in her lifetime is about 1 in 78 according to the most recent American Cancer Society statistics for 2023. One in 78, that's pretty significant. It mainly develops in older women. The average age is usually 63 years old, but we'll go into it a little bit further. There's many different types of ovarian cancer too. And depending on which type we're talking about, it can affect different age groups.

Host: Well, what are some signs or symptoms that people can look out for when it comes to ovarian cancer?

Dr. Jessica Kennard: That's a good question, and one that I often get. The ovarian cancer, we identify as a masquerader. And what I  mean by that is the symptoms are often very vague and nondescriptive, not isolated to the pelvis. Most people would think that you would have significant pain or pain in the pelvis or changes in your menstrual cycles with ovarian cancer, but that may not be true. It's a gradual onset. Most people will describe abdominal bloating or swelling, starting to feel more full and a lack of appetite. They may start to have changes in their bowels where they become more constipated. They may notice that they're going to the bathroom urinating more frequently. All of this kind of ties together, might lead to unexplained weight loss. All of a sudden you're dropping pounds and you're not even really trying to through diet and exercise. And oftentimes, the way that patients eventually come to me is usually not direct. They will actually go through a gastroenterology type of workup first, a colonoscopy or an EGD for these nonspecific GI symptoms of bloating and distention. And lo and behold, it's not until maybe they eventually get a CT or CAT scan and find what exactly is going on.

Host: Wow. So, that kind of leads me into my next question here. You know, talking about these signs and symptoms getting easily missed. Are there any other reasons that that could be happening?

Dr. Jessica Kennard: Ovarian cancer in general, there's no good screening guidelines, which can be frightening for women to hear about. You know, we have mammograms for breast cancer. We have colonoscopies for colon cancer. But there is no good test for ovarian cancer. Women often think that just because they get their pap smears that this can't happen to them, and it's not true.

But there is great benefit in having an annual well-woman exam, where you're getting a pelvic exam, maybe not necessarily a pap smear because a pap smear is only intended to be for cervical cancer screening. But during that pelvic exam, you get what's called a bimanual exam, where with your hands you feel in the pelvis and often times that's the way to detect anything that's going on that's abnormal with your ovaries or your uterus. But there's no blood test. There's no regular imaging or anything, unfortunately, that we currently have as a guideline for screening for ovarian cancer. It may be something that happens down the road. There's a lot of new research and technology trying to be developed to become a regular screening protocol. But currently, we don't have anything like that.

The one caveat with that, though, is if you have a genetic mutation. People might recognize the BRCA mutations, BRCA 1 and 2. There's actually a long cascade of genetic mutations that we now know are associated with increased risk of ovarian cancer in your lifetime. The National Cancer Societies have defined certain screening guidelines that we can do for those patients that are at elevated risk, and those could include transvaginal ultrasounds and some blood testing, lab work, specifically looking for tumor markers like CA-125 levels. But that's the only thing that we have right now in terms of guidelines.

Host: Gotcha. So in terms of risk factors, of course genetics is one, but what are some other things that people can keep in mind?

Dr. Jessica Kennard: Yes, that's a great question. Ovarian cancer in the classic form that most people think of is called high-grade serous ovarian cancer. That is the most common type. This type usually affects women of older age, as I said before, in their 60s to 70s. Family history certainly plays a role and the genes that I previously mentioned. Obesity is a risk factor for ovarian cancer as well as a use of hormone replacement therapy, using excess estrogen can be a risk factor. Women that have a history of endometriosis can be at risk for developing ovarian cancer because of the chronic inflammation in the ovaries that endometriosis can cause can eventually cause damage to the cells and the errors in DNA that can trigger a cancer to develop. Never having been pregnant or breastfeeding and having a really early onset of menstruation, being very young when you start your period or very late when you end having your period or menopause. The more number of years you have of your menstruation in your lifetime, the higher the risk of developing ovarian cancer. And again, it kind of follows the same theory. The cells are always turning over and they're dividing as long as you're menstruating and ovulating and any one of those divisions has a chance to develop an error.

Host: Well, we've talked now a lot about signs and symptoms, risk factors. How is ovarian cancer treated if someone is diagnosed?

Dr. Jessica Kennard: The mainstay of treatment for ovarian cancer remains surgery. Surgery should be performed by a gynecologic oncologist, such as myself. Depending on the clinical scenario, there's a lot of variation in how we can do surgery. If you get ovarian cancer young in life and you're not done having children, there may be possibilities of preserving your fertility options by just taking one of the ovaries out and doing biopsies of the lymph nodes and the lining of the abdomen and everything. But if you're older in life or the cancer has spread or metastasized, then typically surgery treatment is a total hysterectomy, removal of both of your tubes and ovaries as well as the biopsies I mentioned about the lymph nodes and the omentum and other areas in your abdomen to see if there's been any spread. And if there has been spread, and it's obvious when we get in there, you may have to have bowel resection, or resection of any other tumor-involved organs in your abdomen.

Typically, for the most common high-grade serous type that we talked about before, women will typically require chemotherapy as an adjuvant treatment in order to give them the best chance of never having to deal with recurrence in the future. There's lots of new technologies coming out, lots of clinical trials. Right now, we have standard of care chemotherapy regimens, but there's a lot of movement in this area about targeted agents, immunotherapies. We have PARP inhibitors now. Some of the different types of ovarian cancer can be treated with hormonal therapies as well. So, it would be a very individualized conversation with your doctor about what would be the best treatment regimen for you and your cancer.

Host: Of course. Well, wrapping up here, doctor, what are some things that I can do to hopefully prevent ovarian cancer?

Dr. Jessica Kennard: Through clinical research we have found a couple things that we can do to prevent ovarian cancer. First and foremost is always maintain a healthy relationship with your primary care provider or your OB-GYN. So, you're getting those regular pelvic exams. Consider taking an oral contraceptive medication or birth control pill. The longer that you're on a birth control pill in your life actually directly correlates with a risk reduction of ovarian cancer in your lifetime. If when you're done having children you decide that you want to "get your tubes tied", instead ask your doctor about complete removal of the fallopian tube instead. There's been new clinical research that has shown that some of our cases of ovarian cancer are actually starting in the fallopian tubes and not the ovaries themselves. So, complete removal of the fallopian tube when you're done having children can reduce that risk of ovarian cancer. Those are the main ones. If you have a strong family history, talk to your primary care provider about any options you may have to qualify for genetic testing.

Host: Just some vital information. Thank you, doctor, for joining us today. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to also subscribe, rate, and review this podcast and all of the other BayCare  podcasts.

For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media. And be sure to check out all of the other interesting podcasts in our library. I'm Caitlin Whyte.