Frequently Asked Questions

Ovarian Cancer Myths

Q. Is it true that there are no symptoms in the early stages of ovarian cancer?

No. Many people and many medical texts still hold the incorrect belief that there are no symptoms in the early stages of ovarian cancer. Yet, while the symptoms for early stage ovarian cancer tend to be non-specific and can mimic non-gynecologic conditions, a large national study shows that an overwhelming majority of women diagnosed with ovarian cancer did have symptoms. The most common symptoms reported include: Abdominal pressure, bloating or discomfort; Nausea, indigestion, or gas; Urinary frequency, constipation, or diarrhea; Abnormal bleeding; Unusual fatigue; Shortness of breath. (Goff Survey)

Q. Is it true that a woman who has had her ovaries removed cannot get ovarian cancer?

Technically, women who have their ovaries removed can't get ovarian cancer, but there is a type of cancer called primary peritoneal carcinoma - a close relative to ovarian cancer. Although it is rare, it can develop without the ovaries. Primary peritoneal carcinoma is cancer of the abdominal lining. It looks the same as epithelial ovarian cancer under a microscope, it has the same symptoms, it spreads in a similar pattern, and it is treated the same way as ovarian cancer. (ACS)

Q. Doesn't promoting ovarian cancer information increase anxiety among women one more disease to worry about?

A recent scientific study in Britain dispelled this idea; promoting cancer information really reassures the public. (BMJ 1999) It is important to empower women with the knowledge to take charge of their health and be good advocates.

Prevention, Risk, and Hereditary Factors

Q. Is there any way to prevent ovarian cancer?

Currently, there is no method of preventing ovarian cancer. However, there are several measures things that have been found to reduce a woman's risk of developing the disease. Oral contraceptives can reduce the risk of ovarian cancer by fifty percent if taken for at least 5 years. Research has also shown that pregnancy and breast-feeding significantly reduce ovarian cancer risk. (Br. J. Cancer, March, 2001) Tubal ligation and hysterectomy reduce risk, though researchers are unclear exactly how. Finally, prophylactic oophorectomy (removal of the ovaries) also reduces the risk. (Gynecologic Cancer Foundation Slide Presentation, 2000) Health professionals recommend that all options be discussed thoroughly with a physician.

Q. Are fertility drugs safe?

Since the 1980s, an increasing number of American women have battled infertility with drugs. The possible correlation between fertility drugs and an increased risk of ovarian cancer has led researchers to conduct numerous studies in an attempt to establish the extended effects of such treatments. The results of these studies have been conflicting. Several studies in the early 1990s identified certain fertility drugs as increasing a woman's risk for ovarian cancer. However, a study published in February 2002 reported that ovarian cancer risk was not increased by use of fertility drugs but rather by infertility itself. Researchers compared 5,207 women with ovarian cancer and 7,705 women without the disease and found that women with endometriosis or unexplained fertility problems were 73 percent and 19 percent more likely to get the disease.(American Journal of Epidemiology, Feb, 2002)While this study was significantly larger that previous studies, more research is needed to definitively rule out a connection between ovarian cancer and fertility drugs.

Q. Does the use of talc (talcum powder) as a feminine powder increases the risk of ovarian cancer?

Some research has shown a potential association between talc exposure in the genital area with a slightly increased risk of ovarian cancer. Talcum powder is produced from talc, which in its natural form may contain asbestos, a known carcinogen. Because of this association with asbestos, all talc products marketed for use in the home have been required to be asbestos free since 1973 (i.e. baby powders, body powders, facial powders). Studies suggest that talcum powder (including "asbestos-free" talc) may affect the outer layer of the ovaries when applied to the genital area, sanitary napkins, diaphragms, or condoms. Although several studies have examined the relationship between talcum powder and ovarian cancer, findings are mixed (Women's Cancer Network). Some experts recommend that until more conclusive research is available, women should consider avoiding talc products.

Q. Is there a connection between hormone replacement therapy and ovarian cancer?

Nearly 40% of postmenopausal American women use hormone replacement therapy to relieve the symptoms of menopause. However, in a study released in May of 2002, researchers concluded that taking a combination therapy of estrogen plus progestin showed little benefit in reducing cardiovascular disease, as once believed. In fact, findings demonstrated an increased risk of cardiovascular disease, as well as stroke and invasive breast cancer. The studies have been inconclusive for ovarian cancer (JAMA).As a result, millions of women are reconsidering whether to start or continue HRT. It is important to note that these findings do not apply to women who have had hysterectomies or to those who have used unopposed estrogen (JAMA). While estrogen replacement therapy has been proven to increase ovarian cancer risk in some studies, more research is needed to determine if there is a link between combination HRT and the disease. In the meantime, women should discuss these finding with their health care providers.

Q. What are ovarian cysts?

Ovarian cysts are fluid filled sacs on the surface of the ovary that are quite common in women during their childbearing years. Most cysts result from the changes in hormone levels that occur during the menstrual cycle and the production and release of eggs from the ovaries. Most are harmless and go away on their own. Your doctor will want to keep track of any cyst to be sure that it does not grow and become cancerous. (ACOG Patient Education: Ovarian Cysts, 1996)

Q. What is endometriosis? Can it cause ovarian cancer?

Endometriosis is a chronic and often progressive disease that develops when endometrial tissue, which normally lines the inner surface of the uterus, grows outside of the uterus. These implants occur most frequently in the pelvic region and on the reproductive organs but can appear in other areas, such as the bladder, as well. In spite of the high prevalence of endometriosis in women all over the world, researchers have been unable to determine its cause. Endometriosis can cause pain and scarring and it is believed that 20% to 40% of women diagnosed with this chronic disease are infertile. (NCI)Researchers hypothesized that the most likely link between endometriosis and ovarian cancer is the association between endometriosis and infertility. It is well established that ovarian cancer risk is reduced with each pregnancy. Consequently, women who do not bear children, whether by choice or due to infertility issues, are believed to be at greater risk for ovarian cancer. (The Gynecologic Sourcebook, Third Edition)

Q. If someone in my family has had ovarian cancer, can genetic screening tell me if I am going to get the disease?

Approximately one out of every ten ovarian cancer cases is hereditary. Most hereditary ovarian cancer can be attributed to two genes, BRCA 1 and BRCA2. Women who inherit a mutation in these genes are at greater risk of developing epithelial ovarian cancer. A thorough evaluation of family history (i.e. a history of breast, colon, or ovarian cancer) can identify women most likely to have a hereditary cancer risk, and genetic testing can determine if these mutations exist. Although having these mutations increases risk for the disease, it doesn't mean a woman will definitely get it. Furthermore, it is important to keep in mind that while genetic testing can indicate where there is increased risk and help determine appropriate monitoring, women should consider the psychological and possible insurance ramifications before proceeding with testing. Experts suggest that all genetic testing be done in conjunction with genetic counseling. (Cancer Control, July, 1999; Genet Test, 2000)

Q. Is there a link between breast cancer and ovarian cancer?

Both breast and ovarian cancer can be caused by mutations in the BRCA1 and BRCA2 genes. Women with a family history of breast and ovarian cancer, or a personal history for either, particularly if diagnosed before age 50, should be aware of increased risk for the other. Women who have had breast cancer before the age of 50 are twice as likely to develop ovarian cancer, as are women who have not. (NCI - What You Need To Know About Ovarian Cancer, 1998) Additionally, ovarian cancer has also been linked to colon cancer (via different genes).

Screening Tools, Detection and Treatment

Q. Does an elevated CA 125 level always indicate that ovarian cancer is present?

Not always. Although a CA 125 blood test can be a useful tool for the diagnosis of ovarian cancer, in premenopausal women, it is not uncommon for a CA 125 count to be elevated due to benign conditions unrelated to ovarian cancer. Uterine fibroids, liver disease, inflammation of the fallopian tubes and other types of cancer can elevate a woman's CA 125 level. (ACOG Patient Education - 1996) The CA 125 test is more accurate in postmenopausal women. It is also important to note that in about 20% of cases of advanced stage disease, and 50% of cases of early stage disease, the CA 125 is NOT elevated, even though there is ovarian cancer present. As a result, the CA 125 is generally one of several tools used to diagnose ovarian cancer. One of the most important uses of the CA 125 test, however, is to evaluate progressive disease and tumor response in patients undergoing treatment, and to monitor the levels of women in remission for evidence of disease recurrence.

Q. Is the blood marker LPA (lysophosphatidic acid) an effective screening tool for ovarian cancer?

LPA or lysophosphatidic acid is a substance that stimulates the growth of ovarian tumors. One small study found that levels of LPA in blood plasma are elevated in about 90% of women with early ovarian cancer. There are clinical trials going on presently to determine the effectiveness of LPA in detecting ovarian cancer. (JAMA, August 26, 1998) However, it is still to early to know if this test will be a good screening tool. This test is not yet available to the public.

Q. Who is best trained to treat ovarian cancer?

Gynecologic oncologists. Research has shown that the five-year survival rate is greater when the initial surgery is performed by a gynecologic oncologist. (NCI) The initial surgery and staging of ovarian cancer is critical to determining the appropriate course of treatment, and ultimately survival outcomes. A gynecologic oncologist is an ob/gyn who is further trained in oncology to specialize in the diagnosis and treatment of women with gynecologic cancers. To find a gynecologic oncologist in your area, visit the Women's Cancer Network website at www.wcn.org and select "Find a Doc," or call 1-800-444-4441.

Q. If there are no accurate screening tools, how is ovarian cancer diagnosed?

An exploratory surgical procedure called laparotomy is generally required for the definitive diagnosis of ovarian cancer. During this procedure, cysts or other suspicious areas must be removed and biopsied. After the incision is made, the surgeon assesses the fluid and cells in the abdominal cavity. If the lesion is cancerous, the surgeon continues with a process called surgical staging to ascertain how far the cancer has spread.

Q. What is a clinical trial?

Clinical trials, also called clinical research studies, are research studies involving people. Clinical trials try to answer specific scientific questions to find better ways to prevent, detect, or treat diseases or to improve care for people with diseases either by evaluating the effectiveness of a new treatment or a new way of using an old treatment. (NCI)

Research and Funding

Q. How much is being spent currently on ovarian cancer research?

The Federal Government's research money for ovarian cancer is at an all time high, increasing from under $10 million in 1990 to over $85 million in 2001 ($74 M NCI, $10M DOD, $4.6 M CDC) (up from $75 M in 2000); there is more being spent in the private sector by the pharmaceutical companies. (NCI) However, ovarian cancer research is still drastically under-funded. More research money is needed to help scientist better understand ovarian cancer and to find a reliable and easy-to-administer screening test like the Pap smear for cervical cancer and the mammogram for breast cancer. Revised: Aug. 2002 Ovarian Cancer National Alliance

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