How common is ovarian cancer?

It is estimated that 1 in 3 women could get some type of cancer in their lifetime. Ovarian cancer, although it receives much press is a rare cancer. To put this into perspective, the risk that a woman could get breast cancer is 1 in 8. The risk that a woman could get ovarian cancer is 1 in 55 to 70.

Are there risk factors that increase or decrease one's risk of getting this disease?

Yes. Women who have never had children, infertile women, and women with a family history of breast and ovarian cancer are at increased risk. Having children, breast feeding, and/or a history of hysterectomy decreases a women's risk.

How common is inheriting ovarian cancer?

The good news is that only about 5-10% of ovarian cancers are hereditary. The vast majority of cases come once to a family member and never to be seen again. Hereditary ovarian and breast cancers do exist. These cancers can be transmitted from the father's as well as from the mother's side of the family. It is important that you keep a written and thorough family medical history.

Copies of medical records are also a good thing to have. There is new genetic knowledge about this disease and in some cases genetic testing can be done for some of these families at risk. It is best to discuss these issues with your doctor.

As a Jewish woman, are my risks increased or decreased. Does it make a difference if I am from Ashkenazi or Sefardi descent?

Generally speaking, when it comes to genetic disease, the risk is amongst Jewish women of Ashkenazi descent as opposed to Sefardi. However, when we speak of ovarian cancer, just as it is rare for it to be hereditary, so too, the risk to a Jewish woman is no more prevalent because of her genetic disposition. Yet, a woman who is aware that she carries the genetic mutation that is found in breast cancer, would be at an increased risk for ovarian cancer as well. Furthermore, a woman who is found to have ovarian cancer, would be encouraged to do genetic testing to determine her risk for breast cancer.

Why is ovarian cancer so difficult to cure?

The major reason is that most cases of ovarian cancer present in advanced stages when cure is less likely.

Is the Pap smear a good screening test for this cancer?

No. The pap smears is a good screening test to find precancer and cancer cells of the cervix. The pap smear does not detect ovarian cancer cells.

Is there a good screening test for this cancer, I've heard about ultrasound and CA125?

Unfortunately today we do not have a screening test for ovarian cancer. Ultrasound examinations cannot tell with enough accuracy which enlargements of the ovary are benign or malignant. The CA125 may be elevated because of many benign conditions such as endometriosis, and uterine fibroids. One study showed that only 50% of early cases of ovarian cancer have elevated CA125 levels. Currently much research is being done in this area to develop an accurate screening test.

What are the symptoms of ovarian cancer?

The most common symptoms are an enlargement of the ovary or fluid build up (ascites) in the abdomen. The symptoms of bloating, swelling, pain in the abdomen or lower back that persists should be a signal to go to your doctor for a thorough examination which should include a pelvic examination.

What is the usual treatment for this disease?

Most women undergo surgery to remove as much tumor as possible (debulking surgery) followed by approximately 6 months of chemotherapy.

Are there any new developments in the surgical and medical management of this disease?

Yes. On the surgical front there are new surgical tools such as the CUSA (an expensive vacuum cleaner type of device), which help surgeons remove as much of the tumor as possible. This valuable tool is now available at many hospitals in the region. On the chemotherapy front we have many new effective agents such as Taxotere, Doxil, Gemcitabine and Topotecan to help in the treatment of this disease.

We also have many new drugs to help combat the side effects of chemotherapy so that most patients get through the treatments with little toxicity. Many patients continue to work and enjoy life while going through treatment. Outpatient chemotherapy has made treatment much more convenient for the patient.

What is a gynecologic oncologist and how can one help me?

A Gynecologic Oncologist is a physician who has taken special fellowship training in the treatment of female pelvic cancers. They are trained in all surgical as well as medical aspects involved in the treatment of the patient with gynecologic cancer.

The input of a gynecologic oncologist can be a very important addition to your medical team. They are also available for advice and second opinions.

Are their any dumb questions that I shouldn't ask my doctor?

No. The only dumb questions are those that you did not ask. It is easy to forget an important question while you are in the doctor's office, so I encourage patients and family to try to write down questions ahead of time and ask them as they pop in to your mind. Don't ever be afraid to ask.