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Ovarian Cancer

Teresa Calderon

California State University, Channel Islands

HLTH 499: Senior Capstone Project

Dr. Ashley Winans

July 24, 2022

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Ovarian Cancer

Ovarian cancer is a collective term used to describe invasive cancers. These cells

originate from tissues and cells around the ovaries, the fallopian tubes, and epithelial cells that

line the peritoneal surfaces. Ovarian cancer has the highest mortality rate due to the lack of early

detection; causing most diagnosed patients to be present with advanced stage III and IV disease.

Patients are often diagnosed after presenting with accumulation of fluid in the abdomen, also

known as ascites, which is composed of cellular and acellular components. Globally there are

225,500 new cases diagnosed each year, with Russia and United Kingdom with the highest rates,

and China has the lowest. It is impossible to understand that we still lack the knowledge to get

help screening for ovarian cancer and decrease the mortality rates.

Risk Factors

Some people are more at risk for ovarian cancer because of certain characteristics. The

risk factors for ovarian cancer consists of genetics, age, postmenopausal hormonal therapy and

obesity. There are studies by Zhang that show Germline BRCA 1 & 2 found in 17% of patients;

which can increase their chance of other cancers like breast cancer, pancreatic cancer, prostate

cancer, melanoma and serous endometrial. Oral contraceptives and hormonal replacements

therapy has been shown to reduce the risk of developing ovarian cancer with BRCA 1 mutation

but not mucinous carcinoma. On the other hand, hormone replacement therapy, estrogen only

therapy, has shown to increase the risk of ovarian cancer in postmenopausal women by 22%.

Another important factor is obesity. Obesity increases the chance by 13% in postmenopausal

women with 5 kg weight gain who did not use hormonal replacement therapy.

Diagnosis
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Ovarian cancer is typically diagnosed later in life. The average age is 63 years old.

Women are diagnosed because they are symptomatic with ascites and gastrointestinal

dysfunction. Other symptoms include abdominal bloating, abdominal and/ or pelvic pain,

fatigue, and shortness of breath. Diagnosis typically happens at stage III and IV because the

symptoms are more severe. The work-up consists of pelvic exam, radiographic imaging and

blood work to check CA 125. Once diagnosed patients receive a laparoscopic surgery with

removal of the mass.

Prevention and Screening

There is currently no screening because of its range of histological subtypes. In the

article, Ovarian Cancer, the authors stated that the Society of Gynecologic Oncology guidelines

recommend women with invasive ovarian cancer to undergo genetic testing and genetic

counseling. Also, salpingectomy has gained favor as a prevention technique based on the

presence of precursor lesions in the fallopian tubes. In women 35 to 40 years of age who are at

higher risk a bilateral salpingo-oophorectomy is recommended. Microscopic examinations of the

entire ovaries and fallopian tubes, CA 125 blood work and transvaginal ultrasounds that are

sensitive to stage I and II can help reduce mortality rate by 10-30%.

Conclusion

Ovarian cancer has been increasing at a fast pace in the last couple years and it’s

expected to increase. It’s hard to see our loved ones being diagnosed with advanced disease but

yet as far as we are with medicine there are no guidelines to screen for ovarian cancer. We know

what classifies women at higher risk and we know how we can find it at an advanced stage, so

why not do some blood work every other year or an ultrasound in women who are 60years and
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older. We need to help decrease mortality rate in ovarian cancer since it is increasing globally at

a fast pace.
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References

Matulonis, U. A., Sood, A. K., Fallowfield, L., Howitt, B. E., Sehouli, J., & Karlan, B. Y.

(2016). Ovarian cancer. Nature reviews. Disease primers, 2, 16061.

https://doi.org/10.1038/nrdp.2016.61

Qian, F., Rookus, M. A., Leslie, G., Risch, H. A., Greene, M. H., Aalfs, C. M., Adank, M. A.,

Adlard, J., Agnarsson, B. A., Ahmed, M., Aittomäki, K., Andrulis, I. L., Arnold, N.,

Arun, B. K., Ausems, M., Azzollini, J., Barrowdale, D., Barwell, J., Benitez, J.,

Białkowska, K., … CIMBA (2019). Mendelian randomisation study of height and body

mass index as modifiers of ovarian cancer risk in 22,588 BRCA1 and BRCA2 mutation

carriers. British journal of cancer, 121(2), 180–192. https://doi.org/10.1038/s41416-019-

0492-8

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carcelli, G., Polacheck, W. J., Roque, D. M., Del Carmen, M. G., Huang, H. C., Demirci,

U., & Rizvi, I. (2021). Malignant Ascites in Ovarian Cancer: Cellular, Acellular, and

Biophysical Determinants of Molecular Characteristics and Therapy

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Skubitz, A., Boylan, K., Geschwind, K., Cao, Q., Starr, T. K., Geller, M. A., Celestino, J., Bast,

R. C., Jr, Lu, K. H., & Koopmeiners, J. S. (2019). Simultaneous Measurement of 92

Serum Protein Biomarkers for the Development of a Multiprotein Classifier for Ovarian

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Sipos, A., Ujlaki, G., Mikó, E., Maka, E., Szabó, J., Uray, K., Krasznai, Z., & Bai, P. (2021). The

role of the microbiome in ovarian cancer: mechanistic insights into oncobiosis and to
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bacterial metabolite signaling. Molecular medicine (Cambridge, Mass.), 27(1), 33.

https://doi.org/10.1186/s10020-021-00295-2

Zhang S et al. Frequencies of BRCA 1 and BRCA 2 mutations among 1,342unselected patients

with invasive ovarian cancer. Gynecol. Oncol 121, 353-357 (2021).

https://pubmed.ncbi.nlm.gov/21324516