September is Ovarian Cancer Awareness Month.  UC Davis Comprehensive Cancer Center wants women to be equipped with the latest information about the devastating disease that is estimated to take the lives of more than 13,000 women in the U.S. this year.

There is hope. Ovarian cancer patients are living longer because they have more treatment options, but the cancer still frustrates doctors and their patients because it often is undetected until it has spread. The problem is that the symptoms are nonspecific and can often be discounted as gas, bloating or attributed to other causes.

Listen to your body

UC Davis gynecologic oncologist Rebecca Brooks said, “Women need to know what to watch for, trust their instincts, and see a doctor in order to give themselves the best chance of identifying and beating this tough cancer.”

Brooks and colleague Nancy Nguyen specialize in cancers of the female reproductive system.

“Treatment advancements are helping save lives, but we still need to improve the odds of finding the cancer earlier when treatment has the best chance of being successful,” Nguyen said.

Nguyen and Brooks are teaming up to help women advocate for themselves.

“Ovarian cancer awareness is gaining momentum but has been slower to gain attention because it is less common and also less publicized than the breast cancer movement,” Brooks said. “We want to make sure that cancers of the reproductive organs, such as ovarian cancer, are getting the attention they deserve.”

Few warning signs

Unlike mammograms that spot most breast cancer, no uniformly effective screening is available for ovarian cancer, and the symptoms are often silent in the early stages. As the cancer progresses, the following symptoms may emerge:

• Bloating or abdominal swelling
• Decreased appetite, getting full quickly, weight loss
• Pelvic pain
• Changes to bowel or bladder habits

“Women need to push for evaluation if they have symptoms that are suspicious,” Brooks said. “Ovarian cancer often lingers for months before diagnosis, if not years, which can be a big disadvantage for our patients.”

Risks of getting ovarian cancer include:

• Having children later in life or never having a full-term pregnancy
• Older age
• Family history of breast or ovarian cancer

Genetic Factors

Read one woman’s story

Ovarian cancer survivor Marie Kennedy wasn’t diagnosed until she was stage IV.

In my own words

The American Cancer Society reports that up to 25% of ovarian cancers are part of what are called family cancer syndromes resulting from inherited changes in certain genes.

Mutations in the BRCA1 or BRCA2 genes are responsible for most inherited ovarian cancers and are about 10 times more common in Ashkenazi Jewish people. A number of other genes may increase risk as well.

"If you do have a genetic mutation such as BRCA1 and BRCA2, you will be at higher risk and could get ovarian cancer at a much younger age," Brooks said. "That's why obtaining an accurate family history and screening appropriate candidates are crucial for identifying patients who can be saved from this disease."

Clinical trial is enrolling ovarian cancer patients

Ovarian cancer occurs in the layer of cells covering the ovary and many are thought to begin in a projection at the far end of the fallopian tubes called the fimbria, which sits adjacent to ovaries.

"We now know that the most common type of ovarian cancers likely develop from the ends of the fallopian tubes," Nguyen said.

UC Davis Comprehensive Cancer Center has opened a clinical trial for women who have a BRCA1 mutation and want to reduce their chances of getting ovarian cancer later in life. It is called the SOROCk clinical trial and it is being led by UC Davis clinical scientist Hui Amy Chen.

"We want to see if removing the fallopian tubes and waiting to remove ovaries until a later time is effective at reducing the risk of younger women getting ovarian cancer later in life," Chen said.

The standard approach of removing the ovaries first sends women into a surgically induced menopause, which is difficult for a lot of women.

The clinical trial is open to women with the BRCA1 mutation between the ages of 35 and 50. The study also surveys women before, during, and after their treatment to gauge their overall quality of life.

For more information on cancer center clinical trials, call 916 734-0565.

Ways to Reduce the Risk of Ovarian Cancer

The risk of ovarian cancer increases with age. Ovarian cancer is rare in women of childbearing age. The typical patient is in her 60s and past menopause. Women who have been pregnant and have breastfed their babies as well as women who have taken birth control are less at risk of ovarian cancer.

Ways to potentially decrease the risk of ovarian cancer include:

• Use birth control pills, typically for at least five years.
• Consider removal of fallopian tubes and ovaries in patients with high-risk genetic mutations, such as patients with BRCA1 or BRCA2 mutations.
• For those already planning a sterilization procedure, consider removing the entire fallopian tubes instead of a tubal ligation.
• For those already planning a hysterectomy (removal of uterus), consider removing the fallopian tubes at the same time. This could potentially decrease the lifetime risk of developing ovarian cancer.

Is the CA 125 blood test an effective screening tool?

Sometimes ovarian cancer can cause high levels of the protein CA 125 and there is a blood test available to check for its presence. Women who are worried about the potential of having ovarian cancer often ask their doctor for a CA 125 test.

"It is important to know that CA 125 is not an effective screening because the cancer antigen level isn't always elevated in ovarian cancer patients, especially if the cancer is limited to the ovary or hasn't spread yet," Brooks said. "It is an important tool, though, to monitor patients who have completed treatment to make sure it isn't coming back."

Brooks emphasized that CA 125 is not totally specific. An elevated CA 125 level in the blood can also indicate a wide range of other non-life-threatening conditions, such as ovarian cysts, fibroids, endometriosis, infection, ascites, or anything that causes inflammation of the lining of the abdominal cavity.

 "A positive CA 125 can cause a lot of anxiety and unnecessary procedures for women," Nguyen added. "The test is not something we feel can be solely relied on as a diagnostic tool."

Targeted Therapy

While chemotherapy is still a standard approach to treating ovarian cancer, targeted therapy is playing a larger role in the treatment of UC Davis ovarian cancer patients. This type of cancer treatment uses drugs to attack cancer cells.

"Every tumor has its own genetic makeup," Nguyen said. "When tumor cells are developing, there are different mechanisms that can turn on and off genetic mutations, so we are using the genetics of the cancer itself to guide treatment." 

Nguyen said PARP inhibitors are tremendously helpful with BRCA1 and BRCA2 mutations. PARP stands for poly adenosine diphosphate-ribose polymerase, which is a type of enzyme that repairs DNA in cells. PARP inhibitors work in ovarian cancer patients by blocking cancer cells from repairing or replicating, specifically capitalizing on what's genetically broken in cancer cells of patients with a BRCA mutation.

Treating the Whole Person

Whether it is chemotherapy, clinical trials, targeted therapy, or surgery, UC Davis uses an individualized and interdisciplinary approach to treating ovarian cancer patients. This is always accompanied by supportive services addressing their psychosocial needs.

"We are so honored to take care of these women during a time when they are vulnerable and facing a difficult situation," Nguyen said.

Brooks added that treating the whole person is important. This is one area in which oncology nurse navigators and social workers play such an important role on the care team.

"We want our patients and their caregivers to know that we are there for them, whether it is to provide emotional, nutritional, or even financial support," Brooks said.

Both Brooks and Nguyen said that the Supportive Oncology and Survivorship Program at UC Davis Comprehensive Cancer Center provides valuable resources that help their patients get through what can be a long and complex cancer journey.