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Ovarian Cancer—What You Need to Know

Online Health Chat with Mehdi Kebria, MD

October 12, 2012

Introduction

Cleveland_Clinic_Host: Ovarian cancer is a malignant tumor that develops in a woman's ovaries, the reproductive organs that hold a woman's eggs. The American Cancer Society estimates that in the United States in 2012, about 22,280 new cases of ovarian cancer will be diagnosed. While it is the ninth most common cancer among women, it is the fifth leading cause of cancer-related deaths among women. A woman’s risk of getting ovarian cancer during her lifetime is about 1 in 71. In women who have the BRCA1 and BRCA2 genes, breast cancer is associated with ovarian cancer.

According to the American Cancer Society, when ovarian cancer is diagnosed in its earliest stage it has a 94 percent survival rate. Therefore, it is vital to receive annual gynecology examinations as a woman. It is important for you to know as much as you can about this form of cancer.

This web chat will discuss the risk factors of ovarian cancer, its causes, prevention, signs and symptoms, treatment options, the importance of early detection, and the latest in research and treatment.

For More Information

On Cleveland Clinic
At Cleveland Clinic’s Department of Gynecologic Oncology, our team approach of involving multiple specialists can be the most important factor in long-term survival. Gynecologic pathologists, radiologists, medical oncologists and other Cleveland Clinic specialists collaborate to provide a careful blend of accurate diagnosis, surgical skill, leading-edge radiation therapy and advanced chemotherapy.

Cleveland Clinic gynecologic oncologists understand the fear and uncertainty a diagnosis of cancer bring. Our specialized services and supportive care, such as access to support groups and home care, arranged by clinical nurse specialists who also provide counseling, are available to help you through this difficult time.

Cleveland Clinic’s Department of Gynecologic Oncology offers patients first-class care with the latest technology, including:

  • Access to the latest techniques in the management of gynecologic cancers including the newest drug treatments and access to clinical trials through our membership in the Gynecologic Oncology Group, sponsored by the National Cancer Institute.
  • Minimally invasive surgery (robotic-assisted laparoscopic surgery) used in the management of some early cervical, uterine and ovarian cancers, including lymph node dissections and other staging procedures.
  • A gynecology chemotherapy unit located within the department for patient convenience and staffed by specially trained nurses.
  • The Radiation Therapy Center provides the latest, most sophisticated radiation therapy equipment and the latest gynecology oncology treatments, such as interstitial therapy to custom -design delivery of radiation.
  • Color Doppler flow imaging with studies that identify blood flow changes associated with early ovarian cancer tumor.
  • The LEEP procedure, which uses state-of-the-art technology to remove precancerous cells from the cervix more easily.

In conjunction with the OB/GYN & Women’s Health Institute, Cleveland Clinic offers genetic counseling, social work and palliative care.
Cleveland Clinic OB/GYN & Women’s Health Institute was ranked the best in Ohio, and third in the nation for gynecology by U.S.News & World Report.

On Your Health
MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult


For Appointments

To make an appointment with Mehdi Kebria, MD at Fairview Hospital Moll Cancer Center or any of the other gynecologic oncology specialists at Cleveland Clinic main campus and Hillcrest Hospital, please call 216.444.6601or call toll-free at 866.320.4573 or 800.223.2273, ext 46601.


About the Speakers

Mehdi Kebria, MD joined Cleveland Clinic in 2012. He specializes in the management of ovarian, uterine, cervical and vulvar cancers, robotic surgery and minimally invasive surgery in gynecology.

Dr. Kebria is a member of the Society of gynecologic oncology, American College of Obstetricians and Gynecologists, Society of Laparoendoscopic Surgeons, and American Association of Gynecologic Laparoscopist. He has been honored by Western Association of Gynecologic Oncologists, American Association of Gynecologic Laparoscopists, and the Society of Laparoendoscopic Surgeons.

Dr. Kebria did his fellowship training in gynecologic oncology at Mayo Clinic in Rochester, Minn, and his residency in Obstetrics and Gynecology at MetroHealth Medical Center in Cleveland, Oh. Dr. Kebria completed his internship in general surgery at the University of Connecticut Health Center/John Dempsey Hospital, in Farmington, Conn. He graduated from medical school at Shahid Beheshti University of Medical Sciences in Tehran, Iran.

Dr. Kebria sees patients at Cleveland Clinic Main Campus and at Cleveland Clinic Cancer Center at Fairview Hospital, Moll Pavilion.


Let’s Chat About Ovarian Cancer - What You Need to Know

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic expert Dr. Mehdi Kebria. We are thrilled to have him here today to discuss ovarian cancer. Let’s begin with some of your questions.


Risk Factors for Ovarian Cancer

solo_flyer: What are the risk factors for ovarian cancer?
Dr_Kebria: The risk factors for ovarian cancer include family history of breast and ovarian cancer, BRCA mutation, having no previous pregnancy, use of assisted reproductive technology and smoking.

Use of oral contraceptives, tubal ligation and having multiple children are protective against ovarian cancer.


Genetic Risk Factors and BRCA Testing

Animaldoc: What are the genetic factors leading to ovarian cancer and what type of family history should be considered significant?
Dr_Kebria: Women with a family history of ovarian and breast cancer are at increased risk of ovarian cancer. BRCA gene mutation carriers also have increased risk of ovarian cancer, which is up to a 60 percent lifetime risk.

kirby: In the 1970s a malignant teratoma was fatal to my maternal grandmother. At that time these were not thought to have any genetic component for myself or for my daughter to be concerned about. Has any subsequent research changed the thinking on these tumors?
Dr_Kebria: There still is no genetic predisposition known for malignant teratomas. These tumors usually have good prognosis, since they are very sensitive to chemotherapy drugs.

Lisa888: If I my grandmother had breast cancer and my mother was diagnosed with ovarian cancer at the age of 33 years old, are there any special tests I should ask my OB/GYN for? I just turned 30 years old myself.
Dr_Kebria: Based on your family history, you are at increased risk of ovarian cancer. I would recommend that your mother get tested for BRCA mutation first. If she has BRCA mutation then you need to be tested for BRCA mutation. Even if your BRCA testing is normal, I would recommend you to visit with your gynecologist every year and have careful pelvic examination at least on annual bases. Once you approach menopausal age then you can consider surgical removal of ovaries. Birth control pills are also protective against ovarian cancer. You can start using oral contraceptive pills.

MKeller:I know that gene mutation increases my ovarian cancer risk. Does my current breast cancer have any affect on this risk?
Dr_Kebria: Yes, with your personal history of breast cancer you are at higher risk of ovarian cancer compared to general population.

caminante81:There has been mention in this chat of breast cancer increasing the risk of ovarian cancer. Does the opposite apply, as well? What are the risks of another type of cancer in someone diagnosed with ovarian cancer?
Dr_Kebria: Yes, the risk of breast cancer is higher in patients with ovarian cancer. If a person with ovarian cancer has BRCA2 mutation, she would be at increased risk of some other cancers.

honey: Is there any risk of developing breast cancer after you have been treated for ovarian cancer? Should I be tested or anyone else in my family? And is this the BRCA1 and BRCA2 test for gene mutation?
Dr_Kebria: At Cleveland Clinic all patients with ovarian cancer are offered to be tested for BRCA1 and BRCA2 mutation.

sln1959: I was diagnosed with ovarian cancer five years ago and have been cancer-free since. I have no family members with a history of breast or ovarian cancer. Would there be any benefit to having genetic testing at this point?
Dr_Kebria: Congratulations, your risk of carrying BRCA mutation is small. However, your children may benefit from your testing.

pkirk: Do you think colon cancer is linked to BRCA2?
Dr_Kebria: Yes, slightly. Patients with HNPCC (hereditary non-polyposis colorectal cancer, or Lynch syndrome) are at greater risk of colon cancer and uterine cancer.

MKeller: How common is peritoneal cancer?
Dr_Kebria: Primary peritoneal cancers are rare—about 2 percent in BRCA mutation.


Gynecologic Examinations for Ovarian Cancer

folsomsteve: What advice do I give to my 32- year old daughter regarding types and frequency of testing?
Dr_Kebria: It depends on her risk factors. For normal women with no family history of ovarian cancer, annual pelvic exam should be adequate.

annasmit: How often do you recommend routine pelvic exams and pap tests—with and without any family history?
Dr_Kebria: Once a year pelvic exam is adequate for ovarian cancer screening. Studies on CA125 and ultrasound for screening of ovarian cancer have failed to show any benefit.

For women with family history and known genetic mutations screening has to be individualized.

teal4me: Is ovarian cancer still considered a ‘silent killer’? How is it diagnosed?
Dr_Kebria: I do not like to use this phrase for ovarian cancer. We have gotten better at treating it. Seventy percent of patients with ovarian cancer are diagnosed at advanced stages. We still don't have an effective screening tool for ovarian cancer.


Abnormal Gynecologic Signs and Symptoms

sbrowny1706: I just had a gynecological exam, but for the past six to nine months, have had a lot of breakthrough bleeding, pinkish discharge after my period for about a week after, and this continues monthly. My neighbor died of ovarian cancer, and another friend in the neighborhood said if I ever had bleeding besides my period, I should be concerned.
Dr_Kebria: I think you need to bring this to the attention of your gynecologist. Breakthrough bleedings need to be evaluated. You need to have an ultrasound of pelvis and possibly an endometrial biopsy to rule out abnormalities of the endometrial lining.

gladly: What are the symptoms of ovarian cancer to watch out for? Do they vary with age?
Dr_Kebria: The risk of ovarian cancer increases with age. Symptoms are often nonspecific, which means the symptoms can be seen with many other benign conditions. The most common symptoms are abdominal bloating, early satiety, unintentional weight loss or weight gain, and fatigue.


Medications and Oral Contraceptives

MKeller: I had to stop using oral contraceptive pills due to my breast cancer. Will the protective effect remain?
Dr_Kebria: Yes, it will remain to some degree.

MKeller: Are there any other drugs that increase ovarian cancer risk?
Dr_Kebria: I am not aware of any other than fertility drugs.


Ovarian Cancer Prognosis

herbs: Is ovarian cancer curable? I am really scared about my diagnosis.
Dr_Kebria: Yes, it is curable. Two factors vastly determines the outcome: stage of cancer at the time of diagnosis and sensitivity to chemotherapy. Currently, we do not have any control over that. The one modifiable factor for improving the outcome of advanced ovarian cancer is a successful debulking procedure, meaning to reduce the size of the disease to no visible disease with an aggressive surgery.


Surgery for Ovarian Cancer

MKeller: I am 29 years old and just found out I have a mutated BRCA2. I am on chemotherapy for breast cancer, but I am already fretting about the timing for ovary removal. Everyone says to wait until I am 39 years old, but I am scared of waiting. Please give me some guidance.
Dr_Kebria: BRCA2 mutation carriers are at increased risk of ovarian cancer; this risk starts to rise around the age of 35 years old. I would recommend you to have close monitoring with a visit with a gynecologic oncologist every six months. Also, you should  consider getting an ultrasound and CA 125 every six months or once every year. Once you complete your family and perhaps after the age of 35 years, you can consider risk-reducing surgery.

MKeller: If I have to go on tamoxifen for five years until I am 35 years old, what is the use in waiting for ovary removal if I am not planning on a family?
Dr_Kebria: Compared to patients with BRCA1 mutation, your risk is smaller. However, if you have completed your family, then removal of your ovaries is an option, I have to tell you that using tamoxifen also increases the risk of uterine cancer. Therefore, you may want to consider having a laparoscopic or robotic hysterectomy at the same time.

pkirk: Does the risk of ovarian cancer decrease with age if one is BRCA2 positive and if one has had their ovaries removed?
Dr_Kebria: With removal of the ovaries, the risk of ovarian cancer is significantly reduced—with over 98 percent risk reduction. It also reduces risk of breast cancer by 50 percent. As women with BRCA age, their risk of cancer increases.

pkirk: Do you recommend surgery and then chemotherapy for ovarian cancer?
Dr_Kebria: Absolutely, yes. A good surgery though

 

Egg Preservation

kathy3k9: My sister has been diagnosed with cancer, and my mother and I are investigating the egg freezing process for her before her chemotherapy begins. She is anxious to do this. Can you please tell me where and what the process is to get this done?
Dr_Kebria: She needs to undergo egg retrieval process first, which means that her ovary must be stimulated with hormonal drugs to produce multiple eggs. A needle is inserted into the ovary under ultrasound guidance to remove the eggs, and then the eggs are preserved. It can take about four to six weeks to complete this.

Most of the time women preserve their ovarian function during chemotherapy and are able to become pregnant after completion of chemotherapy. We can also put the ovaries to sleep during chemotherapy with hormonal suppression. That way they are not affected as much by chemotherapy.

 

Alternative Therapy

caminante81: My aunt was recently diagnosed with ovarian cancer and has undergone a complete hysterectomy and is now undergoing chemotherapy. Are there any holistic or supplemental therapies that you can suggest that may help her? I know there are many ‘quack’ therapies on the Internet. Also, are there any warning signs we as her family members should watch for? I am not a blood relation to her, but she does have sisters and a daughter who are concerned about the genetic factor in ovarian cancer. Dr_Kebria: I do not believe in holistic therapies. First-degree family members of anyone with ovarian cancer are at increased risk of breast and ovarian cancer. In my opinion, the best approach would be genetic testing on the affected person. If this is abnormal, family members need to be tested.

 

Clinical Trials

pkirk: Are there any clinical trials going on at Cleveland Clinic using PARP (poly [ADP-ribose] polymerase) inhibitors for Stage 4 ovarian cancer? If so, what are the criteria to be in a clinical trial?
Dr_Kebria: I am not sure at this time if our PARP-inhibitor trial is active or not. I know we had one a couple of month ago. I would encourage you to call our gynecologic oncology office to inquire about that.

You may also review the current clinical trials that are ongoing at Cleveland Clinic. Please go to www.clevelandclinic.org/cancerclinicaltrials.

pkirk: Are there any clinical trials going on at Cleveland Clinic for stage 4 ovarian cancer?
Dr_Kebria: Yes, there are some trials available. For trials at Cleveland Clinic you may go to www.clevelandclinic.org/cancerclinicaltrials. You may also visit the NIH site for clinical trials which is http://cancer.gov/clinicaltrials.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic expert Mehdi Kebria, MD is now over. Thank you, Dr. Kebria, for taking your time to answer questions today about ovarian cancer.
Dr_Kebria: Thanks for all of your questions and participation.


Contact Information

For information about ovarian cancer basics from Cleveland Clinic Center for Consumer Health Information, please go to:
http://my.clevelandclinic.org/disorders/menopause/hic_menopause_and_ovarian_cancer.aspx

If you need more information, click here to contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!

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