Ovarian Cancer         Marilyn C. Jerome, M.D. 5215 Loughboro Road, Suite 500          Washington, DC 20016
Ovarian cancerDefinitionIncidenceRisk factorsGenetic testingSymptomsTesting+tumor markersScreening
Definition     Ovarian cancer forms from ovarian tissue on the             surface of the ovary (epithelial cancers)      ...
Incidence                                 Lifetime incidence is 1.48%                                             NCI esti...
NumbersOvarian cancer is the ninth most common cancer of women but fifth in mortalityThe majority of cases are diagnosed...
Risk Factors1. Family History: a first degree relative with ovarian cancer increases risk to 5%, 2 relatives:7%2. Heredi...
What is BRCA 1 & 2Genetic mutations that occur in less than 1% of the populationIf you are Ashkenazi: 2.5%These genes p...
Significance of BRCA 1 &2Breast cancer incidence increases from 12% to 75- 85%First degree relative with breast cancer i...
Am I a candidate for genetic testing?Who should be tested1. Multiple family members with breast and ovarian cancer: multi...
Preventive strategies in BRCA carriersIncreased surveillance: twice yearly exams and sonograms, CA-125Preventive bilater...
Factors that decrease risk1. Oral contraceptives: 4 years of use reduces risk 50%2.Tubal ligation and hysterectomy3. Bi...
hard hharfrightening?hard hharfrightening?hard hharfrightening?1. Highest mortality of the gynecologic cancers2. Symptom...
Symptoms1. Bloating, abdominal distention2. Clothing doesn’t fit3. Pelvic pain, often vague, including pressure in abdo...
Is it GI or ovarian cancer?1. GI symptoms often fluctuate2. Ovarian symptoms worsen over time3. Have a pelvic exam4. I...
Diagnosis1. Pelvic exam: ovarian enlargement2. Rectal exam: mass near rectum3. Abdominal exam: fluid (ascites), mass4....
Pelvic ultrasound1. Ultrasound to visualize pelvic anatomy2. Abdominal and vaginal approaches3. Full bladder4. Visuali...
CA-1251. Ovarian cancer marker not specific or sensitive enough for diagnosis2. Used to monitor the effects of treatment...
Tumor markers: What is new?THERE IS NO AVAILABLE TUMOR MARKER FOR OVARIAN CANCER SCREENINGOva 1: evaluates 5 tumor marke...
CT scan and other tests1. Preoperative test to determine involvement of adjacent organs, bowel and bladder, omentum, lymp...
Routine Screening1. Pelvic exam2. Discuss family history with MD3. Genetic testing for high risk individuals4. Pelvic ...
Screening high risk women1. Pelvic exams twice yearly2. Ultrasounds twice yearly3. Tumor markers: CA-1254. Prophylacti...
Screening in low risk women?Screening women of averageriskStudies do not prove that screening women of average risk impro...
Prophylactic Oophorectomy1. Preventive removal of both ovaries and fallopian tubes to prevent ovarian cancer, not 100% (2...
Are there risks to prophylacticoophorectomy? 1. Surgical risks include bleeding, infection, injury to  bowel or urinary t...
Can I still get ovarian cancer ifmy ovaries have beenremoved?1. Peritoneal carcinomatosis or primary peritoneal cancer2....
ConclusionImprove understanding of frequency of ovarian cancerUnderstand significance of certain symptomsImportance of ...
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Ovarian Cancer: Symptoms, Diagnosis and BRCA Testing for High Risk Individuals

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Sibley Memorial Hospital's Knowledge is Power lecture series on Ovarian Health. Presented by Marilyn Jerome Foust, M.D., on September 13, 2012.

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  • The purpose of the ovary is to produce female hormones and ova or eggs for ovulation and reproduction.
  • Family history is the most significant risk factor
  • How does one decide if there might be a genetic predisposition to ovarian and breast cancer
  • Ovarian Cancer: Symptoms, Diagnosis and BRCA Testing for High Risk Individuals

    1. 1. Ovarian Cancer Marilyn C. Jerome, M.D. 5215 Loughboro Road, Suite 500 Washington, DC 20016
    2. 2. Ovarian cancerDefinitionIncidenceRisk factorsGenetic testingSymptomsTesting+tumor markersScreening
    3. 3. Definition Ovarian cancer forms from ovarian tissue on the surface of the ovary (epithelial cancers) Or from malignant germ cellsFallopian tube cancers act and are treated as ovarian
    4. 4. Incidence Lifetime incidence is 1.48% NCI estimates: 22,000 new cases per year, with 15,000 deathsCompare to breast cancer with 229,000 new cases and 39,000 deaths
    5. 5. NumbersOvarian cancer is the ninth most common cancer of women but fifth in mortalityThe majority of cases are diagnosed after the cancer has spread to adjacent organsEarly detection improves survival outcome
    6. 6. Risk Factors1. Family History: a first degree relative with ovarian cancer increases risk to 5%, 2 relatives:7%2. Hereditary breast and ovarian cancer: BRCA 1 & 2 mutation carriers, Lynch Syndrome3. Age4. Nulliparity: pregnancy is protective5. Hormones: prolonged HRT, fertility drugs are controversial6. Other cancers: breast, colon, uterine, rectum
    7. 7. What is BRCA 1 & 2Genetic mutations that occur in less than 1% of the populationIf you are Ashkenazi: 2.5%These genes protect against breast and ovarian cancerCan be inherited from maternal or paternal sides of the familyAutosomal dominant inheritance: 50% of children of an affected woman will carry1 in 10 women with ovarian cancer have gene 7
    8. 8. Significance of BRCA 1 &2Breast cancer incidence increases from 12% to 75- 85%First degree relative with breast cancer increases risk 2 times ( negative for BRCA)Ovarian cancer incidence increases from 1.4% to 25- 40%First degree relative with ovarian cancer increases risk 3 times ( negative for BRCA)Increased risk of a second breast cancerIncreased risk for family members 8
    9. 9. Am I a candidate for genetic testing?Who should be tested1. Multiple family members with breast and ovarian cancer: multiple generations, multiple family members, <50 years old, maternal or paternal side2. Premenopausal breast cancer3. Male breast cancer4. Ashkenazi Jewish background5. Bilateral breast cancer, breast and ovarian6. Triple negative breast cancer
    10. 10. Preventive strategies in BRCA carriersIncreased surveillance: twice yearly exams and sonograms, CA-125Preventive bilateral salpingo-oophorectomy after childbearingBreast surveillance: twice yearly exams, yearly mammography and MRI, preventive medication (tamoxifen), preventive mastectomy 10
    11. 11. Factors that decrease risk1. Oral contraceptives: 4 years of use reduces risk 50%2.Tubal ligation and hysterectomy3. Bilateral salpingo-oophorectomy reduces risk-but not 100%4. BSO also reduces risk of subsequent breast cancers by 50%
    12. 12. hard hharfrightening?hard hharfrightening?hard hharfrightening?1. Highest mortality of the gynecologic cancers2. Symptoms can be vague and often do not appear until the cancer is advanced: order an ultrasound early sooner than later3. Symptoms often present for months before diagnosis is made4. Often diagnosed at later stages5. Requires extensive surgery and chemotherapy6.Long term survival rates are improving but still not great
    13. 13. Symptoms1. Bloating, abdominal distention2. Clothing doesn’t fit3. Pelvic pain, often vague, including pressure in abdomen, pelvis, back or legs4. Urinary urgency, bladder pressure5. Early satiety-feeling full when eating6. Persistent gas, nausea, indigestion7. Change in bowel habits8. Painful intercourse9. Fatigue10. Advanced ovarian cancer: shortness of breath
    14. 14. Is it GI or ovarian cancer?1. GI symptoms often fluctuate2. Ovarian symptoms worsen over time3. Have a pelvic exam4. If GI symptoms do not improve, see your gynecologist5. Gynecologic exam is important: although not all ovarian cancers are easily palpable, evaluation of symptoms can lead to further testing
    15. 15. Diagnosis1. Pelvic exam: ovarian enlargement2. Rectal exam: mass near rectum3. Abdominal exam: fluid (ascites), mass4. Pelvic ultrasound5. Tumor markers6. CT scan
    16. 16. Pelvic ultrasound1. Ultrasound to visualize pelvic anatomy2. Abdominal and vaginal approaches3. Full bladder4. Visualizing the ovaries5. Characteristics of ovarian cyst6. Characteristics of cancer: bilaterality, complex cysts with solid components,septations, thickened walls, nodularity, pelvic fluid collection
    17. 17. CA-1251. Ovarian cancer marker not specific or sensitive enough for diagnosis2. Used to monitor the effects of treatment3. Can be elevated due to other conditions4. Often normal levels in early stage disease
    18. 18. Tumor markers: What is new?THERE IS NO AVAILABLE TUMOR MARKER FOR OVARIAN CANCER SCREENINGOva 1: evaluates 5 tumor markersmore sensitive than CA-125for ovarian masses that will be surgically excisedreferral to oncologistHE4: combines with CA-125 and menopausal status to predict malignancy 18
    19. 19. CT scan and other tests1. Preoperative test to determine involvement of adjacent organs, bowel and bladder, omentum, lymph nodes2. CT scan may be used to biopsy a mass3. Used to monitor recurrence4. Chest x-ray5. Abdominal and pelvic MRI6. Colonoscopy-invasion of colon
    20. 20. Routine Screening1. Pelvic exam2. Discuss family history with MD3. Genetic testing for high risk individuals4. Pelvic ultrasounds and tumor markers for high risk individuals, more frequent exams5. No good screening tool for women of average risk: a screening test must have be able to reliably detect early stage disease without excessive false positives (e.g. mammography)
    21. 21. Screening high risk women1. Pelvic exams twice yearly2. Ultrasounds twice yearly3. Tumor markers: CA-1254. Prophylactic oophorectomy
    22. 22. Screening in low risk women?Screening women of averageriskStudies do not prove that screening women of average risk improve mortality statisticsOvarian cysts are often found on ultrasound, most of which are not malignantOnce these are found, follow-up is needed to prove that they are not growingReducing anxiety / increasing anxietyIncreased testing can lead to increased surgical procedures with inherent risks of surgery
    23. 23. Prophylactic Oophorectomy1. Preventive removal of both ovaries and fallopian tubes to prevent ovarian cancer, not 100% (2-3% incidence of occult malignancy)2. Recommended for BRCA 1 & 2 carriers after childbearing3. May be recommended for those with strong family history of breast and ovarian cancer without a known mutation4. Decreases ovarian cancer risk 95% and breast cancer by 50%5. Can be done laparoscopically with minimal recovery time
    24. 24. Are there risks to prophylacticoophorectomy? 1. Surgical risks include bleeding, infection, injury to bowel or urinary tract 2. Menopausal symptoms 3. Possible increased risks of osteoporosis and cardiac disease.
    25. 25. Can I still get ovarian cancer ifmy ovaries have beenremoved?1. Peritoneal carcinomatosis or primary peritoneal cancer2. Symptoms can be vague
    26. 26. ConclusionImprove understanding of frequency of ovarian cancerUnderstand significance of certain symptomsImportance of genetic testing for high risk individualsUnderstand importance of annual examinationsUsefulness of radiologic and blood testsRisks and benefits of ovarian cancer screening

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