Maggie McKay (Host): Welcome to Check-up Chat with EvergreenHealth. I'm your host, Maggie McKay. Today, Dr. Zainab Alnoor, OB-GYN, joins us to discuss ovarian cancer. Thank you so much for making the time to be here. This is such an important topic.

Zainab Daghir-Alnoor, MD: Thank you so much for having me.

Host: Let's just start with what is ovarian cancer?

Zainab Daghir-Alnoor, MD: So, ovarian cancer is a cancer that arises from the ovaries, fallopian tubes or the peritoneum. It's the second most common type of female reproductive cancer. And more women die from ovarian cancer than cervical and uterine cancer combined. It has the highest mortality rate of all women cancers, and it's the fifth leading cause of cancer death among women. Unfortunately, it's poor prognosis is because most patients are diagnosed at a advanced stage. While if they're diagnosed at an earlier stage, it's potentially curable. most of them are diagnosed at an advanced stage about 65% of the time. And when they're diagnosed at that advanced stage, which we usually call stage III or IV, the cure rate is only 18%. But if it's diagnosed at an early stage, which is stage I, when the disease is localized, the cure rate could be 88%.

Host: How do you screen for ovarian cancer?

Zainab Daghir-Alnoor, MD: So unfortunately, currently, there's no good screening tests for ovarian cancer. They did research on pelvic ultrasound and something called CA-125, which is like a tumor marker. But these have not been successful and the false positive rates for them were high, that caused unnecessary surgery and surgical complications. There's currently research going to help aid early detection based on symptoms. So currently, there is actually no recommendation for screening average-aged women for ovarian cancer.

Host: Is that one of the reasons a lot of times it's found at a late stage?

Zainab Daghir-Alnoor, MD: Exactly.

Host: Who is most at risk?

Zainab Daghir-Alnoor, MD: Most women that are at risk, older women, so in the menopause age, so after 50. Women that have gone through early menarche and late menopause; so basically, longer number of years of ovulation. Genetic mutation is a strong risk factor. Women might have heard of BRCA1 and BRCA2 genes associated with breast cancer. These women also have a higher chance of getting ovarian cancer. And another genetic mutation called Lynch syndrome is also associated with ovarian cancer. Also, family history of ovarian, breast, or colon cancer can increase women's risk. Women that have never been pregnant, history of radiation in the pelvic area. And there are some associations with endometriosis, but the risk is very low. And also, some studies show some links to obesity, but those have not been conclusive.

Host: That's a broad group. What are the symptoms of ovarian cancer?

Zainab Daghir-Alnoor, MD: Like I mentioned earlier, unfortunately, ovarian cancer get diagnosed when it's in late stages. But some of the symptoms that women might notice. And maybe go to the doctor or ask them to do some more investigation if they start to have some abdominal bloating or swelling more than their normal for extended period of time, pelvic pain or discomfort, feeling full quickly when eating, frequent urination, fatigue, back pain, which again, are very common symptoms, but sometimes the combination of these symptoms; changes in bowel habits like constipation when women never had constipation before, unexplained weight loss.

Host: And how is it diagnosed?

Zainab Daghir-Alnoor, MD: So again, currently, there's no reliable screening tests. But usually, it's diagnosed based on a pelvic exam, imaging like pelvic ultrasounds, CT scans, or MRIs. Blood tests like a cancer antigen called CA-125, and sometimes it's actually diagnosed during surgery when somebody's undergoing surgery for pelvic surgery or other kinds of surgery, and they do note masses or abnormalities in their pelvis.

Host: Wow. And so, do they take care of it then or they have to wait

Zainab Daghir-Alnoor, MD: It depends. I mean, if they've done surgery for different reasons, they remove it and then diagnosis comes back cancer, obviously. Sometimes they go in and they see something that look more like cancer than what they expected on the imaging that was done before the surgery.

Host: So, let's say you go to the doctor, they find an ovarian cyst, when should you be concerned?

Zainab Daghir-Alnoor, MD: So definitely, size of the cyst is it getting larger or bigger? So, sometimes we follow these cysts over time to see if they're getting increasing in size. Bilaterality, so we have two ovaries. So if they're both sides, that's more concerning than one-sided. There's this thing called solid components. So, most benign ovarian cyst are fluid-filled. But if they look more solid, that's more of a concern. Having some fluid in the abdomen called ascites, which is really fluid outside the pelvic organs. Again, if people have ovarian cysts, but they also have a family history or genetic history, those are all kind of triggers more investigation to see if this is a concerning cyst versus a benign one.

And finally, that tumor marker I talked about called CA-125. Sometimes we get that blood test. When we see a ovarian cyst to see if it's elevated, that is usually more concerning than if it's normal.

Host: Are there any ways to protect yourself from ovarian cancer?

Zainab Daghir-Alnoor, MD: There are some, not something like you physically can do. But when I talked earlier about how many years of ovulation you've had, so early menarche and late menopause. Anytime during those years, if you're not ovulating, you're actually decreasing your chance of ovarian cancer. So, one is having children, so the more children you have when you're pregnant, you're not ovulating. So, your ovaries are not working, that's protective actually. Breastfeeding is really protective. So again, you're not ovulating during that time. Some women get surgery on their uterus or fallopian tubes, so removing your uterus and/or fallopian tubeS decreases the risk because some ovarian cancers come from the fallopian tubes.

So, one of the most common surgeries that women get is a tubal ligation or tubal removal. It's a form of birth control, like permanent sterilization. Removing those fallopian tubes decrease women's lifetime risk of ovarian cancer because some ovarian cancers arise from the fallopian tubes. So, when women choose that form of birth control, we do talk about that. Using actually birth control pills or birth control options that inhibit ovulation, that also decreases chance of ovarian cancer, because you're not ovulating.

Host: Do people who have it in their family choose to get rid of their fallopian tubes as kind of a measure to maybe stave it off?

Definitely women that have genetic mutations like the BRCA genes or Lynch syndrome do get counseled by genetic counselors and other physicians about removing their ovaries and fallopian tubes as a protective thing. So, that's something that some women choose to do, versus getting just regular ultrasounds and testing.

You may have mentioned this earlier. But when you have your annual checkup with your OB-GYN, are there any things like, I don't know, blood tests that might show that you have a cyst?

Zainab Daghir-Alnoor, MD: So as a routine screening, no. But again, we always encourage women to go get your annual checkup once a year because the goal of a checkup is for the doctor to ask you questions about your symptoms to see if they should be concerned about doing more investigation like an ultrasound or a blood test. They definitely ask you about your family history. So if you have a strong family history of breast and ovarian cancer, they offer you genetic testing, or if you have that genetic mutation, seeing then a specialist that tells you what kind of screening test you can do.

But otherwise, if you're low risk or average risk woman, then really a routine pelvic exam is one way we use as a screening. Obviously, it's not great. But when you're low risk, that's the only thing we can do is as a pelvic exam and your symptoms and family history.

Host: Thank you so much for sharing your expertise. This has been very informative and educational.

Zainab Daghir-Alnoor, MD: Thank you so much for having me. I hope this information helps women seek care. You know, go to the doctor if you have any concerning symptoms. And thank you for having me again.

Host: Absolutely. Again, that's Dr. Zainab Alnoor. To learn more, please visit evergreenhealth.com/healthservices/gynecology. And that wraps up this episode of Check-up Chat with EvergreenHealth. Head on over to our website at evergreenhealth.com for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth Podcasts. For more health tips and updates, follow us on your social channels.