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Ovarian Cancer Risks and Prevention

Ovarian cancer is the second most common gynecologic cancer in the United States. Ovarian cancer causes more deaths than any other cancer of the female reproductive system because there are not good screenings for this type of cancer like there is for Breast cancer (mammograms) and cervical cancer (Pap smears).

Many women think that they are being tested for ovarian cancer when they go to their gynecologist for their routine well women and have a pap smear.

Your Pap smear is a test that is only testing for abnormal cells of the Cervix, there currently is no screening for ovarian cancer, which is why ovarian cancer causes more deaths than any other female reproductive organ.

Ovarian cancer can be in or around the ovaries, meaning that it cannot only originate in the ovaries, it may also come from the fallopian tubes and the peritoneum. What is interesting about ovarian cancer is that it likely originates in the fallopian tubes and not the ovaries themselves. A 2022 retrospective study in Canada followed nearly 26,000 women over an average of seven years after having their fallopian tubes removed during hysterectomy. None of the women developed high-grade ovarian cancer, an aggressive form of the disease. Rates of ovarian cancer were lower than expected rates, which were based on rates in a control group of individuals who underwent hysterectomy alone or tubal ligation.

This has been rapidly adopted by many gynecologists. Salpingectomy (surgical removal of the fallopian tubes) in the U.S, between 2010-2015 increased from 5 to 60%. The potential benefits of the preventive surgery

Signs and symptoms of ovarian cancer can be subtle and something that you may dismiss so it is important to pay attention to your body and know what is normal for you.

  • Vaginal bleeding (particularly if you are past menopause), or discharge from your vagina that is not normal for you.

  • Pain or pressure in the pelvic area.

  • Abdominal or back pain

  • Bloating

  • Feeling full too quickly, or difficulty eating

  • A change or new onset in your bathroom habits, like frequent or urgent need to urinate and/or a change in bowel habits.

Some of these symptoms may not seem concerning to you but if it is a change for you and your body it should be evaluated.

There are those that are at increased risk for Ovarian cancer, it does not mean you will get cancer but if one or more of the below factors applies to you, it is worth discussing with your health care provider.

· Those of us 40 and over

· Have close family members (such as your mother, sister, aunt, or grandmother) who have had ovarian cancer

· Having a genetic mutation BRCA1 or BRCA2, or one associated with Lynch syndrome.

· Personal history of breast, uterine, or colorectal (colon) cancer.

· Have endometriosis (a condition where tissue from the lining of the uterus grows elsewhere in the body)

  • Have never given birth or have had trouble getting pregnant

Where to start

If you have concerns about ovarian cancer, be it symptoms or your history the first place to start is with your provider. A simple pelvic ultrasound and blood work can help rule out pathology. The ultrasound will visualize your ovaries for their appearance to determine if anything looks abnormal and there is a blood test called a CA-125. This is a Cancer Antigen, which is a protein that may be found in high amounts in the blood of patients with ovarian cancer. CA-125 is produced on the surface of cells and is released in the blood stream.

CA 125 levels are high in about 1% of healthy women and are not always a sign of ovarian cancer. Women who are pregnant, have endometriosis, uterine fibroids, pancreatitis, are currently menstruating, have pelvic inflammatory disease, liver disease and simple ovarian cysts can also have abnormal CA-125 levels, so it is important to not only do the blood testing but also the pelvic Ultrasound to get a good clear picture of what is going on.

At the end of the day, if you are concerned then it is important for you to find a provider that will listen to you, review your health history and symptomology. Requesting an ultrasound and lab work is not out of the ordinary. The big thing is to not put things off, do not ignore your own concerns or think they will just go away (as many of us do). Be an advocate for yourself and know your body, ask questions and be sure that you are being heard.

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