What experts say you should know about ovarian cancer
Electively removing your fallopian tubes can help reduce your risk for the disease
Ovarian cancer is considered to be the most serious of women's cancers. Experts say that's because symptoms are generic, there isn't a specific test for it — like mammograms for breast cancer — and when detected, the cancer is usually in a later stage.
"It's definitely something I don't think that a lot of women really necessarily know about," Paige Gibbings, a registered nurse and the clinical co-ordinator for the ovarian tumours surgical program at Toronto's Princess Margaret Cancer Centre, told CBC's The Dose host Dr. Brian Goldman.
That's why it's important for those with female reproductive organs to know the risks, experts say.
Roughly 3,000 women were expected to be diagnosed with ovarian cancer last year. An estimated 1,950 will die from it, according to the Canadian Cancer Society.
Those who have a genetic mutation or family history are at higher risk of ovarian cancer.
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Early research has shown an opportunistic salpingectomy — the removal of the fallopian tubes as an elective procedure — can help reduce the risk of ovarian cancer.
Last week, the global nonprofit Ovarian Cancer Research Alliance released a statement encouraging women of average risk to have their fallopian tubes removed after they are done with childbirth and when they have a pelvic surgery for another health issue planned.
"We've got great prevention for the people who have known genetic mutations that increase their risk, but we didn't have anything for the general population, and opportunistic salpingectomy has really filled that void," said Dr. Gillian Hanley, an assistant professor in the University of British Columbia's obstetrics and gynecology department.
It's important women know if they are at risk of ovarian cancer and the broad symptoms, researchers and health-care professionals say.
Cancer types
Ovarian cancer isn't a single disease, but is five distinct types that "present very different clinically," said Hanley.
The most common is a subtype of epithelial ovarian carcinoma called high-grade serous. It represents about 70 per cent of ovarian cases and about 90 per cent of the deaths, says Hanley.
"That is the cancer that we now understand originates primarily on the fallopian tube and not on the ovarian surface, which is what we believed to be true 20 years ago," she added.
Symptoms
Symptoms like bloating, swelling, full bladder and bowel changes are common as the tumour grows, says the Canadian Cancer Society, which has the full list of symptoms on its website.
About 45 per cent of the women diagnosed with ovarian cancer will survive for at least five years, according to the Canadian Cancer Society.
Part of the reason ovarian cancer can be lethal is because it often goes undetected until it's in later stages, said Gibbings.
There are no screening tests done for ovarian cancer, unlike Pap tests for cervical cancer or mammograms for breast cancer, she said.
"Also, symptoms are very vague and nonspecific and can be caused by a plethora of other things," she added.
Who is at risk?
Ovarian cancer is generally diagnosed among women age 55 and older, and is found in women who have gone through menopause, experts say.
However, there are several factors that raise a woman's risk of ovarian cancer, according to the Canadian Cancer Society. Some of them are:
- Family history of certain cancers
- BRCA gene mutations
- Endometriosis
Alicia Tone, scientific advisor for Ovarian Cancer Canada, says those with a family history of ovarian cancer should speak to a health-care provider about genetic testing.
Genetic testing may be covered by provincial, territorial or personal health insurance plans as long as you meet certain criteria, she added.
About 20 per cent of ovarian cancers are linked to inherited genetic mutations. The majority of cases are in individuals with no known genetic mutation, Hanley emphasized.
Why opportunistic salpingectomy?
Researchers know now that most ovarian cancers — despite the name — originate in the fallopian tubes.
The fallopian tubes play no known role post-childbearing, so "we don't need to keep that tissue that's potentially going to transform into a malignancy around if you're finished having children," said Hanley.
That's why opportunistic salpingectomies have been happening in Canada for over a decade. The procedure removes the fallopian tubes in an average-risk woman who is done having children and is already undergoing a gynecological surgery, such as a C-section or surgery for endometriosis.
It currently isn't offered as a standalone surgery in Canada. Research in that area is just starting, Hanley said. She and colleagues are trying to increase the opportunities for opportunistic salpingectomy and are currently working with colorectal surgeons.
The laparoscopic procedure has no known pitfalls, she said, and only adds about 10 minutes of surgery.
Last week, the Ovarian Cancer Research Alliance and Society of Gynecologic Oncology released a joint statement encouraging women undergoing pelvic surgeries to have their fallopian tubes removed.
Canadian organizations had already released statements recommending opportunistic salpingectomy several years ago. The procedure has been reviewed for its safety "six ways from Sunday and there is no increased risk for complications," Hanley emphasized.
Does it work?
But does it actually work to lower the number of ovarian cancers? It does, according to early research from Hanley and colleagues' published in the peer-reviewed Journal of the American Medical Association last year.
What they found was the nearly 26,000 individuals who underwent opportunistic salpingectomy had significantly fewer serous and epithelial ovarian cancers than were expected compared to the rate among the control group who had either only a hysterectomy or tubal ligation.
When they looked at high-grade serous cancers in particular, there wasn't a single case found among those who had their fallopian tubes removed.
"You don't get better than zero," Hanley said.
So if you're at average risk for ovarian cancer — which would be most women — it's recommended that you speak with your health-care provider about removing your fallopian tubes if you're already planning gynecological surgery and are done with having kids, said Tone.
The ovaries are generally not removed for average-risk women because it would trigger early menopause, which would put women at greater risk of stroke, cardiovascular disease, cognitive issues, and decreased bone health.
If you're at a higher risk, it's strongly recommended you remove both the ovaries and fallopian tubes, Tone added. Hanley says doing so "dramatically improves their survival."
"Knowing your risk and taking the appropriate preventive action is really the most effective way that we can stop women from dying from ovarian cancer," Tone said.
On top of the recommendation to consider removing your fallopian tubes during a gynecological surgery, Hanley says research has shown life events that stop or decrease ovulations can help protect against ovarian cancer. Those are:
- Long-term use (five years or more) of hormonal birth control pills
- Giving birth
- Pregnancies of any length
- Breastfeeding
"But these are things that we decide about in our lives for very complicated reasons and not necessarily things that are going to be decisions that we make just based around our ovarian cancer risk," said Hanley.
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When to talk to a health-care provider
If you have a family history of ovarian or breast cancer, you should speak to your health-care provider as soon as possible to get genetic testing started, experts say.
For average-risk women, experts say to watch for any of the generic symptoms.
If you don't have a family doctor, a walk-in clinic is a good alternative. But if symptoms are "really worrisome and really severe," go to the emergency department, Gibbings said.
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