Melanie Cole, MS (Host): If you or one of your close relatives has been diagnosed with ovarian cancer, you may have concerns and questions about whether this type of cancer runs in your family. Today we’re talking about ovarian cancer with Amy Eddy. She’s a certified family nurse practitioner at Memorial Health System. Amy, I'm so glad to have you with us. As a woman in my 50s, I know that this is something that many women are scared of. We have our pap smears, but that’s cervical. We hear this is a silent killer. Tell us a little bit about ovarian cancer. How common it is and really what’s going on in the world?

Amy Eddy RN, MSN, CFNP (Guest): Ovarian cancer—and I'm going to primarily focus on epithelial ovarian cancer. That encompasses about 90% of all ovarian cancers. It is the leading cause of death for gynecologic cancer in the United States for women. It’s the fifth most common cause of cancer death in women in the United States. Approximately 22,000 new diagnoses will be made this year and approximately 14,000 deaths this year as well. As you said, it has been known as the silent killer. That is primarily because the presenting symptoms—or what they feel are consistent presenting symptoms—are also common symptoms with so many other gastrointestinal problems, urinary problems. I think often they are either diagnosed late or they're misdiagnosed, and that leads to the main problem of this cancer being diagnosed most of the time at an advanced state. So 80% of patients are diagnosed with an advanced disease.

Host: I would like to talk about diagnosis but before we do—because it’s so important—tell us who’s at risk. What role does inherited trait play in developing ovarian cancer because we’ve heard so much about the BRCA gene. We’ve heard about that mutation for breast cancer, and now they're saying for ovarian as well. Tell us about that.

Amy: The risk factors for ovarian cancer based on theories, based on research that we know. We know that decreased risk of ovarian cancer is related to pregnancy and taking birth control pills. So there can be up to a 60% reduction in ovarian cancer incidents with these two things. That’s felt to be because they reduce ovulation. So there’s felt to be some relationship between ovulation and the risk of developing ovarian cancer. So conversely nulliparity—or women who have never been pregnant and perhaps at an older age had their first pregnancy may be at increased risk.

Host: Okay. So along those lines then as someone who has ovarian cysts and fibroids. There's all kinds of things growing down there. Is there a link? If somebody is told that you have ovarian cysts, does that mean that they will turn into cancer like a polyp in the colon? What about that relationship?

Amy: That relationship has not been shown. There's some small studies that have suggested that polycystic ovarian syndrome may be associated with ovarian cancer, but the larger studies are not showing that. So no. Ovarian cysts are very common, and they are benign. They can be a problem for women, of course. If they grow, they can rupture and even result in surgery, but they are not linked to cancer.

Host: Well, thank you for clearing that up for women such as myself. So now, onto diagnosis. We have the screening test for cervical cancer. We have a mammogram for breast cancer. What's the deal for ovarian cancer? Is there any screening test or any warning signs, symptoms? How is it diagnosed?

Amy: For the general woman—and we’ll talk about the BRCA gene here shortly—but for the general average risk woman, screening is not recommended for ovarian cancer. That’s primarily because screening tests, for example transvaginal ultrasound. It has not been shown to—If you screen every woman, it’s not feasible. It’s not practical, and it’s not been shown to effect overall survival. The CA125 is a tumor marker that also—90% of women with advanced ovarian cancer will have an elevation in this marker, but 50% of women with ovarian cancer may not even have an elevated CA125. So it’s not a very specific or sensitive test to use as a screening measure.

The symptoms to watch for or be aware of bloating, pelvic abdominal pain, difficulty eating or feeling full quickly, or urinary symptoms. Again, those are kind of vague symptoms. We’re looking for women who these symptoms are new for them or they are significantly worse, and they occur almost daily for a few weeks to a few months. Those women when they see their primary care provider, those are the women that need to be possibly screened a little further considering an ultrasound of the pelvis.

Host: Well certainly, as you say, those are the symptoms of everything we women go through. Whether it’s GI or pelvic floor or any kinds of things we go through. Menopause, pre-menopause. So then what? If we do have those and you mentioned and internal ultrasound, a vaginal ultrasound. So there is a way to detect ovarian cancer.

Amy: For these women that you’ve ruled out other causes. They have these symptoms, they are felt to have risk factors, then those women perhaps should go on to get an ultrasound, even a CAT scan if necessary. If abnormalities are found on those studies then further evaluation with bloodwork, pelvic exam. Even though, as you mentioned earlier, pap smear is a cervical cancer screen, but on the pelvic exam—the by manual examination—the doctor can at times palpate the ovaries. So, again, this isn’t a common way of detecting ovarian cancer, but it’s part of the workup. So these women are put through this type of workup in trying to determine if there’s an ovarian abnormality. If there is then referral to gynecologists or perhaps an oncologic gynecologist to have the appropriate biopsy or surgical procedure done.

Host: Really great information. Before we wrap up, just tell us generally what you’ve seen if a woman is diagnosed with ovarian cancer. Treatments available. Kind of tell us what's going on in the field.

Amy: The most common treatment is surgery. So most patients with ovarian cancer will have some level of surgery. Early stage cancers will be treated perhaps with surgery alone. The ovarian cancer, there’s different stages. The stage of the cancer, which perhaps may be known prior to surgery. Sometimes you don’t know the full extent until surgery is done because surgery needs to be done in a specific way. That’s why it’s important for an oncologic surgeon to do these procedures. These cancers have to be staged very carefully and done in a very step by step manner. Again, surgery alone may be adequate for stage 1A or early cancers. Those with regionally advanced cancers and more advanced cancers spread to other organs will most likely require chemotherapy of some degree. That would be decided by medical oncologists. There are new targeted therapies, immunotherapies, that are showing some promising statistics. Those treatments also would be discussed for the appropriate patient.

Then, of course, we touched before a little bit about the BRCA genes. I want to just touch on that. About 15% of ovarian cancers come from women with inherited mutations. So we all have BRCA1 and BRCA2 genes. We all have those genes. But what happens when those genes undergo a harmful mutation, they can no longer do their job. Their job is to repair DNA in cells. When they become mutated, they cannot repair that damage properly. They can lead to harmful mutations that can lead to cancer. We get these mutations from your father or your mother and they are linked to increased risk of several types of cancer, mostly breast and ovarian. For a patient that is diagnosed with a BRCA mutation—and that is through genetic testing. There are genetic specialists that offer this testing. If you are felt to have certain risk factors then you may be a candidate for this testing. If you test positive, your family members also it is important to consider testing.

Host: That was a great explanation. Thank you so much, Amy. So wrap it up for us. What would you like the listeners to know that are like me that wonder, “Is this appointment going to be the one?” Or, “Are there any symptoms that I would notice?” What can we do and what is the importance of early detection?

Amy: Early detection is very important, but the challenge with ovarian cancer it is a cancer that is very difficult to detect early. Because often when some things present, the cancer has already advanced. It’s already at an advanced stage. So the symptoms that we talked about early, although vague, if someone develops these symptoms with the bloating, the pelvic pain, eating and getting full quickly, urinary symptoms that are otherwise unexplained, then they need to be proactive and talk to the doctors, perhaps, about the concerns. Possible ovarian etiology, and have additional testing done if the doctor feels that is indicated. Of course, if you have a family member with ovarian cancer, genetic testing does need to be considered. All women who are diagnosed with ovarian cancer, it’s recommended that they have genetic testing done. Having that information, although it carries anxiety for family members when they find out that they have BRCA positive because the implications of the positive genetic test may result in a lot of difficult decisions for them in terms of risk reduction surgeries or how it may impact their families, other relationships.

Host: So important and such great information for us to hear and to reiterate the importance of hearing your own best health advocate and knowing your body. When symptoms like that pop up and they're different and they scare you, get in touch with your doctor. That’s really great advice. Thank you so much Amy for coming on. That wraps up this episode of Memorial Health Radio with Memorial Health System. Head on over to our website at mhsytem.org for more information and to get connected with one of our providers. If you found this podcast informative, as I did, if you are a woman, please share with other women because we all need to hear this information and we all need to learn from the experts together. So please, share on your social media, tell your friends and family to listen to this podcast, and be sure not to miss all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.