According to the National Cancer Institute, approximately 10 percent of the women in Minnesota have been diagnosed with ovarian cancer. For Ovarian Cancer Awareness Month in September, University of Minnesota Medical School expert Colleen Rivard, MD, talks about the subtle signs and risk factors of ovarian cancer.
Q: What is ovarian cancer?
Dr. Rivard: Ovarian cancer is the second-most common and most deadly gynecologic malignancy in the United States. It is a malignant tumor which arises from the ovary or fallopian tube. There are three main types of ovarian cancer:
Germ cell tumors arise from the cells which give rise to the oocytes of the ovary,
Stromal tumors arise from the support cells of the ovary surrounding the oocytes, and
Epithelial tumors are by far the most common and most deadly so that is where we will focus today. Of these epithelial tumors, the most common are serous carcinomas of which we divide them further into low-grade and high-grade.
Q: What are the subtle symptoms of ovarian cancer and what other health conditions are they familiar with?
Dr. Rivard: One of the biggest problems with ovarian cancer, and why it is so deadly, is that there often are not symptoms at the early stages, and by the time women develop subtle symptoms, the cancer has already spread. The majority of ovarian cancers are diagnosed at stages three and four — at which point it is very challenging to cure.
The most common symptoms are abdominal symptoms, including pain, bloating or distension, changes in their appetite or early satiety, changes in bowel or bladder habits. These symptoms are often nonspecific and can mimic other health conditions, such as digestive conditions, esophageal reflux or urinary issues. We also sometimes have patients who present with more acute issues — such as pleural effusion, venous thromboembolism, bowel obstruction or significant ascites — that lead to diagnosis.
Q: What are the risk factors of having ovarian cancer and the current treatment options available?
Dr. Rivard: In general, the biggest risk factor for ovarian cancer is age with the vast majority of epithelial tumors arising in women age 60 and older. Other risk factors include infertility, endometriosis, polycystic ovary syndrome, nulliparity, early menarche or late menopause.
There are also several genetic mutations and syndromes that are associated with a significant increase in the risk of developing ovarian cancer. These include Hereditary Breast and Ovarian Cancer syndrome and Lynch syndrome. There are also a number of other genetic mutations that we know lead to an increased risk of ovarian cancer. In fact, these genetic mutations lead to up to 25% of ovarian cancer diagnosis, and thus, it is recommended that all women with a diagnosis of ovarian cancer receive genetic counseling and testing. These mutations can also have an impact on the treatment that a patient receives.
The mainstay of upfront treatment for ovarian cancer is currently a combination of surgery and chemotherapy. Unfortunately, in 85% of patients, their cancers will recur and in these situations, the mainstay of treatment is chemotherapy or enrollment into a clinical trial.
Q: If someone is diagnosed with ovarian cancer, what should they know about the diagnosis?
Dr. Rivard: A diagnosis of ovarian cancer can be very overwhelming for a patient, and I think it can be helpful to take the diagnosis and treatment one step at a time. I think it is also very important for a patient to have an advocate who is either a family member or friend who can attend visits with them to help them to remember and understand all the information that is discussed. We also have a great resource here in Minnesota in the Minnesota Ovarian Cancer Alliance (MOCA), which has great resources for patients, families and providers. September is also National Ovarian Cancer Awareness Month, and we just had the MOCA run/walk to raise money for research into early detection and treatment of ovarian cancer.
Q: What are you doing in your research and practice to further our understanding of ovarian cancer and patient relations?
Dr. Rivard: We have made many important discoveries in the treatment of ovarian cancer in the past 10 years, including PARP-inhibitors and immunotherapy. We, as a division of gynecologic oncology, are committed to having access to and enrolling patients into clinical trials, as that is the best way to improve the outcomes for patients with ovarian cancer.
Colleen Rivard, MD, a gynecologic oncologist at the U of M Medical School and M Health Fairview, is deeply committed to the care of women with cancer and believes in involving patients and their families throughout the treatment process. She strives to use minimally invasive approaches to surgical interventions, whenever possible, in order to promote reduced recovery times and minimization of complications. Dr. Rivard also has a strong commitment to outcomes-based clinical research, encouraging patient involvement in clinical trials when feasible, to improve the care provided to all women. She is also a member of the Masonic Cancer Center.