Ovarian Cancer Causes and Risk Factors

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This is weekly dose of wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell
Hello and welcome to our show. You're listening to weekly dose of wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today our guest is Dr. Jack Yacoub, oncologist and medical director of thoracic oncology at the MemorialCare Cancer Institute at Orange Coast Memorial Medical Center. Today, we'll be discussing the signs and symptoms of ovarian cancer. How family history plays a role and the importance of regular screenings. Welcome, Dr. Jacoub.

Jack Jacoub, M.D.
Thank you.

Deborah Howell
Right off the bat, what is ovarian cancer?

Jack Jacoub, M.D.
It's a cancer of a part of the female reproductive system, in this case, the ovaries. As you know, the ovaries are hormonally functioning organs that kind of produce estrogen and maintain a woman through her premenopausal life and the importance of action. It probably doesn't have to be stated to your listeners, but also ovarian cancer encompasses other types or other locations of cancer within the abdominal cavity, including the lining of the abdominal cavity called the peritoneum. We include ovarian cancer and peritoneal cancer, all in sort of one form of the disease. And that's because during embryonic development, the lining of the cavity of the abdominal wall is very similar to that of the ovary itself. So both ovarian cancer and peritoneal cancer are are the topics we'll be talking about today.

Deborah Howell
That's a very good nutshell. Diagnosis, not diagnosis description. Now what are some of the common signs and symptoms you might experience if you've had ovarian cancer?

Jack Jacoub, M.D.
Well, unfortunately, they can be nonspecific, which partly underlies why all too often the presentation of ovarian cancer or in this case or in another uncommon scenario, primary potential cancer is in advanced settings because it's nonspecific abdominal discomfort, it's bloating. It's urinary frequency. Rarely is vaginal discharge. But that certainly would be a concern in postmenopausal women, especially if it's bloody and at times it's below its early satiety. Meaning when you eat, you get full a lot quicker and sometimes abdominal girth is increased. Just putting on your, your skirt or your pants might be a little bit tighter than usual. It can be very nonspecific. And that also kind of also Segways a little bit later on in the show in discussing screening and trying to catch this at an earlier point when they get to be fairly nonspecific.

Deborah Howell
OK, those are a lot of I haven't heard some of those I hadn't heard about frequent urination before and girth.

Jack Jacoub, M.D.
Well, it predominantly is related to pressure within the pelvic organ systems, including the bladder from masses from fluid. And the fluid buildup is called ascites which is abnormal fluid accumulation in the abdominal cavity, which can be benign. But in the context of what we're talking about, it's related to ovarian cancer. And actually, the abdominal fluid can be among the more common presentations where the abdominal girth is increased, their swelling in the belly and there's pressure on the bladder and other places. That's among the more common presentations, frankly.

Deborah Howell
Interesting. Can ovarian cancer be detected through a pap test?

Jack Jacoub, M.D.
No. It's important to know that a pap smear is looking specifically for cervical cancer, which is an which is an entirely different cancer than ovarian cancer, uterine cancer, fallopian tube, cancer, etc. but nonetheless routine gynecologic evaluation. Pelvic examination, which includes a bimanual examination that the physician is actually feeling for both and those are both ovaries in each lower quadrant and doing a pap smear at the time and obviously assessing the familial history which will cut touch on a little bit later and any symptoms that may be concerning. But a pap smear specifically is for cervical cancer. It is not for ovarian cancer.

Deborah Howell
OK, that would naturally want me to have to ask how is ovarian cancer then diagnosed and staged?

Jack Jacoub, M.D.
Well, that's a very good question. So ovarian cancer, as I mentioned, is somewhat nonspecific in late presentations are among it's actually the common presentation in most women is detected by identifying someone who is at high risk and also someone who's having routine yearly gynecologic evaluations. And from that standpoint, it's abdominal imaging if there's a question, including a pelvic ultrasound. Occasionally, there'll be laboratory testing as well included, although it's controversial to see and 125 is a well-established marker for ovarian cancer. It should always be pursued if it's elevated in someone who is post-menopausal,

Deborah Howell
and that would be like a blood test?

Jack Jacoub, M.D.
It's a blood test,

Deborah Howell
Right

Jack Jacoub, M.D.
But again, the threshold has to be there. The gynecologist has to have that on their radar to be able to identify it at an earlier stage. But often the earlier stage diseases are caught because of family history or some identifying factor that increases their woman's risk. I didn't mention that, you know, advancing age is a risk factor. As we get older, there's a higher risk of having ovarian cancer as other types of cancers, frankly. But people who have not had children, people who still have obviously their intact uterus and ovaries. People have perhaps had hormone therapies and things like that in the post-menopausal setting. These are all controversial risk factors, but it's having at times imaging for looking at the uterus or looking for some pelvic symptom that leads to the discovery. Ovarian mass. And that ultimately leads to the evaluation, which includes abdominal imaging to see n125, as I mentioned to you. And then and then a surgical evaluation not by a gynecologist. If there's suspicion of cancer, of high suspicion of cancer, by a surgeon who happens to be a gynecologist but is focused on gynecologic cancers. And that's a gynecologic oncologist and does a surgery. So that's the typical evaluation and the discovery of it. I did mention, by the way, how common this cancer is, and it's kind of important, probably for the listeners to know that this is not uncommon cancer. And overall, it's roughly around 3% of cancers in women. But it is the most common gynecologic cancer in women, and it is the most lethal. It's estimated about 20,000 or so cases will be diagnosed this year in 21-22 cases in the U.S. this year. And again, a very high percentage of those individuals ultimately will succumb to their disease, so it will touch on a little bit later about earlier detection. But identifying your risk profile is the most.

Deborah Howell
Absolutely. And what are some risk factors or lifestyle influences that may contribute?

Jack Jacoub, M.D.
I mentioned the familial history. Okay. This is sort of a major area to focus in on because of how nonspecific the symptoms and presentations are of. You know, the risk factors are fairly nonspecific, getting older hormonal intake. What kind of body habit as someone has, etc. Those are somewhat, you know, clear cut. But but there's so nonspecific. But the family history is actually quite powerful. There are two cancer syndromes that exist. There are many cancers and actually two there that we are well aware of and have a fairly good understanding of their implications to ovarian cancer as well as other cancers. one of them is called the Lynch Syndrome, which is associated with other cancer sites, including colon cancer, uterine cancer and ovarian cancer. And the other, more common cancer syndrome is related to something called BRCA1 or BRCA2 mutation mutations that are genetic and those are related to DNA repair function. That is the one that maybe the listeners are aware are familiar with, because in the recent media exposure of Angelina Jolie and another individuals have come forth about their hereditary breast cancer or the hereditary ovarian cancer. Oftentimes it is related to, as I mentioned, the BRCA mutations. Now that is a separate type of hereditary cancer syndrome. In another way, it's called breast-ovarian cancer syndrome, and the risk of having breast and ovarian cancer is exceptionally high in both of those are genetic disorders. So in total, about 10% of people with ovarian cancer have one of these disorders. But it is very common for someone with ovarian cancer to have a familial history, and a familial history does. Even if they didn't have those genetic disorders, frankly by itself, increases the risk of having ovarian cancer in a woman and increases that something in the range of threefold, if not more.

Deborah Howell
Wow.

Jack Jacoub, M.D.
It's just 5% increase. So just the familial history alone should be able to identify that, you know, risk sufficient risk that would warrant fairly, you know, strict surveillance schedule or more closer follow up from the gynecologists in regards to the development of ovarian cancer or those other cancers. They mentioned, of course, breast, colon, uterine, etc..

Deborah Howell
Right.

Jack Jacoub, M.D.
And in women, in men, prostate cancers, including included in some of those ed cancer syndromes, pancreatic cancer as well. So and oftentimes, if there is a familial history of ovarian cancer and that person has been diagnosed with ovarian cancer or if there is no familial history and that person's been diagnosed with ovarian cancer, as well as the primary peritoneal cancer I mentioned in the beginning, those individuals should also see a geneticist because they should have a fairly comprehensive medical pedigree taken. History taken. And then further testing as needed because it impacts them, but it also impacts the rest of their family.

Deborah Howell
OK, so what else should a woman do if she's experiencing any of the symptoms that you outlined?

Jack Jacoub, M.D.

Well, she should immediately bring up her primary care physician if the primary care physician is functioning as her women's health doctor, meaning that they're doing the pelvic examinations and pap smears, et cetera. And then or tour gynecologist if she has a gynecologist who is responsible for those aspects of her care. But either way, they need it. She needs to bring this up to the physician right away. And then from there, they can elect to refer to a gynecologist or they're in the hands of a gynecologist. Do the abdominal imaging do or sa125? There's another blood test to do some other blood test as well, in addition to complete blood count chemistry panels, kidney liver function like that. And then if the risk is or the appearance of the imaging, or if there's any concern about what's happening, the person probably see a gynecologic oncologist because they may require surgery.

Deborah Howell
Yeah. And as you said,

Jack Jacoub, M.D.
and by the way that is the cornerstone of therapy for this cancer in the earlier stages. But the majority of women get both the combination of chemotherapy and surgery.

Deborah Howell
Okay, so and as you said, it is the most lethal form, so you got to stay proactive about your ovarian health.

Jack Jacoub, M.D.
Absolutely. You know, in regards to the therapy of ovarian cancer that actually has also recently accelerated over the past few years, this is a disease that's considered to be drug-sensitive. So we have many drugs, chemotherapy drugs, targeted drugs, biologic drugs that are active and have been proven to work in this setting and have been approved by the FDA, for example. But in the field, in the research field as well, there's many trials hosted by several cooperative groups throughout the country that women who unfortunately are confronted with advanced disease or recurrent ovarian cancer hopefully we have access to. But it's a very ripe field for not only robust research, but there's a lot of very good therapies that are available now and that are there in the pipeline that will be available very soon for these women. But. Again, the bigger messages. Early detection,

Deborah Howell
Early detection before,

Jack Jacoub, M.D.
That's when you can cure things.

Deborah Howell
OK. Do you have a source that you would like to refer our listeners to if they want to learn more?

Jack Jacoub, M.D.
Oh, probably. There's an ovarian cancer foundation that they can perhaps search, and they can find there's a whole host of information in regards to that. The American side of clinical oncology, ASCO also has a very good educational portion regarding not only ovarian cancer, but most cancers and specifically gynecologic malignancies. I would tell the viewers ASCO would be a very good source in our Society of Clinical Oncology. Both of those would be wonderful sources for information.

Deborah Howell
Great. Thank you so, so much, Dr. Jacoub. We could do a couple of hours together, but then maybe you'll come back and join us again very soon, I hope.

Jack Jacoub, M.D.
Appreciate it. Thank you very much.

Deborah Howell
It's been so great to have Dr. Jacoub on the program today to talk to us about ovarian cancer. Ladies, get your screenings, OK? To listen to the podcast. For more information, please visit MemorialCare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have yourself a fantastic day!