Search for tag: "ovarian cancer"

Dr. Jones: Let's talk about ovarian cancer awareness. Let's talk about what you can do to decrease your risk of ovarian cancer. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Ovarian cancer is one of the deadliest of gynecologic cancers. We don't have an early detection test like the Pap smear, which is very good at early detection of cervical cancer. Ovarian cancer doesn't have an early warning sign like abnormal bleeding, which gives us a heads-up about early uterine cancer. Ovarian cancer is sneaky. The symptoms of ovarian cancer, bloating, abdominal fullness with eating, pelvic discomfort, all come when the cancer has spread at least a little bit. And these symptoms are pretty common in women so that makes it difficult to know exactly who you should work up.

We've talked before about the fact that cancers, in general, are about one-third genes, one-third environment and behavior, and one-third bad luck. We know we cannot change our genes and changing our luck is sort of a cosmic thing, but what can you do to decrease your risk of ovarian cancer? The most common kinds of ovarian cancers arise from the cells on the surface of the ovary. Some of these might actually be coming from the fallopian tubes with some types of ovarian cancers that just seem to arise from the uterine lining cells that find themselves in the pelvis.

A jillion years ago when I was on a GYN cancer service in Boston, we used to say that ovarian cancer was a nun's cancer. Boston had a lot of nuns and it seemed as if these lovely women had ovarian cancer more often than we would expect. Well, we do know that nuns have a slightly increased risk of ovarian cancer, compared to women in the general population.

What is true is that there's an increased risk of ovarian cancer in women who have never had children. This has been looked at a number of ways. First, there's a decrease in the risk of ovarian cancer by 50% in women who have had their tubes tied. Women who have had their tubes tied usually have had a bunch of kids. Two, there's an increase in ovarian cancer in women who are infertile. Is it being pregnant and having kids that protects you? Is it infertility treatment, all of those hormones and things that put you at risk? Is it the cause of infertility, like endometriosis, that both makes women infertile and puts them at risk? It might be all of these.

Having said all that, I don't want women to rush out and have a bunch of kids that they might not be prepared for just to decrease their risk of ovarian cancer. It turns out that the Centers for Disease Control did a big study on contraception, and hormones, and gynecologic cancers and lo and behold, taking birth control pills lowers the risk of cancer by as much as 50%. It even lowers the risk of ovarian cancer if you have the family genes like the BRCA mutations that put you at risk for ovarian cancer. How do hormonal birth control pills do that? We don't exactly know, but it could be that ovulation, which disrupts the surface of the ovary each month, is a little bit risky with respect to ovarian cancer.

So how do you decrease your risk of ovarian cancer? If you're thinking about contraception, you may want to consider birth control pills. We don't seem to find the same protection with IUDs or implants, at least not yet as implants haven't been around that long yet for us to really know.

Another ovarian cancer prevention strategy, because there's some suggestion, and it's controversial, but that cells from the fallopian tubes may play a role in ovarian cancer. There's some suggestion that women who have their fallopian tubes removed, not their ovaries, just their tubes, have a decreased risk of ovarian cancer. So if you're thinking about having an operation to have your tubes tied, either immediately after a baby is born or later with the laparoscopy, maybe you should talk to your gynecologist of having your tubes removed. Importantly, if you have a BRCA mutation in your family and you have that mutation that is one of the genetic causes of an increased risk in ovarian cancer, you may choose to have your ovaries removed.

Now, there are some other things that may have an association with an increased risk of ovarian cancer. We don't know if these are a cause, but it seems to be an increased risk. There's a slight increased risk of ovarian cancer in women who take hormone replacement therapy after menopause. The risk is small and we don't understand the cause, but it's there to think about. And there seems to be a small increased risk of ovarian cancer in women who use talcum powder down there, on their perineum, on their lady parts. Even if the risk is low, it probably isn't necessary and we don't suggest it.

So I'm not suggesting that nuns should take birth control pills, although that has been suggested by some. And I'm not suggesting that women have more children that they're unprepared for. But there are some other health benefits of birth control pills: lighter periods, lower risk of uterine cancer, and if you're having your tubes tied or operated on to end your fertility, maybe taking the tubes out isn't a bad idea. And talcum powder on your lady parts isn't a good idea.

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My patients tell me that they've had an ovarian cyst. "What kind?" I ask. "I don't remember," is the common answer. Well, that's not a helpful answer.

Ovarian cyst comes in two flavors, functional cysts and nonfunctional cysts. Functional cysts are usually the good kind. They arise from the function of the ovary. A woman who ovulates makes a cyst about one inch in diameter every month. And there are a lot of smaller cysts every month that go along for the ride. These functional cysts come in two types. Follicular cysts that have the eggs and corpus luteum cysts that the follicular cyst turns into after ovulation.

Now the Follicular cyst is filled with clear fluid, doesn't have much of a blood supply, and occasionally can get pretty big, as big as four inches. Getting that big isn't common, but it happens. And unless there's a lot of pain with this big cyst, the important thing is to leave it alone. These cysts go away after a few weeks. How do you know if you have one? Well, every woman with functional cysts has these, and they usually don't know about them unless they're getting an ultrasound for some reason.

We watch these cysts grow with great interest and hope in infertility therapy and in vitro fertilization. Sometimes a woman can learn she has one because it becomes bigger and causes pain. Follicular cysts can look a certain way on ultrasound, clear fluid, with a very thin cyst wall. So we know for pretty sure that these are good cysts, and we try to wait and let them go away.

After ovulation, the follicular cyst becomes a corpus luteum cyst. This is a progesterone factory whose job it is to make the hormones to prepare the uterus for pregnancy. If no pregnancy occurs with the ovulation, then these cysts go away in about two weeks. These cysts are very active making hormones, and they have a rich blood supply. If they get bumped, and you can figure out ways that they could get bumped, they can bleed and grow rapidly with blood and can hurt.

Women who have a corpus luteum cyst that bleeds a lot can come to the doctor or the emergency room and an ultrasound can usually make the diagnosis because they look like a cyst with new blood in it. We try not to operate and let the cyst go away on its own, which may take a month or so. Sometimes there's so much bleeding into the abdomen that it requires surgery, but we try not to operate and leave scars on the ovary if possible. So when a woman can tell me that she had a functional cyst or a corpus luteum cyst that required surgery or a follow-up, I know I don't have to worry because these are the good cysts.

Now, the bad cysts. There are nonfunctional cysts or neoplastic new tissue cysts new tissue cysts. Any of the tissues in the ovary can grow to make a cyst and some of these cysts can get big, really, really, really big. The biggest neoplastic cyst in recorded history was 328 pounds. That is really big. These cysts come in different types, depending on the kind of cells that made these cysts. Serous cysts, mucinous cysts, dermoid cysts, I could go on.

We usually operate to remove these cysts when they get bigger than two inches because they can grow and it's much easier to remove a cyst when it's two inches than when it's 20 inches or bigger, bigger, bigger. We cannot tell exactly what kind of cyst it is some of the time just by looking at an ultrasound, but we do know what it is when the pathologist looks at it. Some cysts are made out of egg tissue make hair and teeth and other kinds of tissues, and they look a certain way on ultrasound. But usually, we give them to the pathologist and let them figure it out. Why should you know what kind of cyst you had removed? Because some cysts tend to predict that you'll get another one.

Now, for the ugly. Some nonfunctional cysts are ovarian cancer. This is another reason that we remove nonfunctional cysts when they grow and look different on ultrasound than functional cysts. Ovarian cancer is not terribly common. About 10 per 100,000 women per year or a little more than 1% risk in a woman's lifetime.

Ovarian cancer has no symptoms when it's very small so it can be hard to catch early. When a cancerous ovarian cyst gets bigger, it can cause pain, and pressure and a feeling of abdominal fullness because we cannot always tell which cysts or cancerous on ultrasound. Although cancer cysts do tend to look quite different from functional cysts, we tend to want to remove cysts when they grow, and especially if we find them in women who are post-menopausal and shouldn't be making cysts.

So if you've had surgery or medical care for an ovarian cyst, you should keep a record of what kind of cyst it was. Get a copy of the report from your doctor and keep it in your medical records. Ovarian cysts come in different types, and we have different concerns, and different follow-up, for women with some cysts. In fact, any woman who has had surgery on her reproductive organs should have a copy of her operative report and pathology in her permanent medical records.

Maybe someday, we'll have a universal electronic medical record and all of it will be there for your doctor to help you. But until then, keep your own copies on file and thanks for joining us on The Scope.

updated: July 9, 2020
originally published: August 11, 2016

Dr. Jones: If you're having a hysterectomy for problems with your uterus, should you have your ovaries removed the same time? This is Dr. Kirtly Jones from obstetrics and gynecology at the University of Utah Healthcare, and this is The Scope.

Announcer: Covering all aspects of women's health this is the seven domains of women's health with Dr. Kirtley Jones on The Scope.

Dr. Jones: A recent study from Sweden published in the British Journal of Surgery found that women who have their ovaries removed were at higher risk of colon cancer. A more careful look at the numbers found that this was a study looking back through the Swedish Patient Registry, about 200,000 women who had their ovaries removed for one reason or another compared to thousands, hundreds of thousands of women who did not. They found that removing the ovaries increased the chance of developing colon cancer in the future by 30%.

Now, Scope listeners are smart about numbers and they should be asking themselves right now 30% of what? Although 30% increase is a scary figure, the real rate of colon cancer in women who did not have their ovaries removed, was 1.3/100. And in women who had their ovaries removed it was 1.6/100 and that was a 30% increase, but it's not so scary when you look at the real numbers.

Now this was a study looking back at health histories. And maybe women who had their ovaries removed had other health risks for colon cancer, but there is another strong set of scientific evidence that estrogen protects against colon cancer. In general, women get colon cancer later in life than men. In the women's health initiative, a prospective randomized placebo controlled trial - the gold standard of medical evidence - found that taking estrogen slightly decreased the risk of colon cancer compared to women who were taking placebo, about 30%.

Finally, in a lab, adding estrogens to colon cancer cells partly inhibits their growth. There's plausible evidence in the laboratory. There's a prospective randomized trial and there's some big data that says taking out your ovaries puts you at increased risk of colon cancer. However, women don't think of colon cancer as being a woman's problem, even though about 1 in 24 women, about 4% of women will get colon cancer in their lifetime compared to 1 in 21 men. So it isn't that uncommon.

Women think about ovarian cancer as being a woman's problem. The lifetime risk of ovarian cancer is 1 in 75, significantly less common than colon cancer in women. Of course taking the ovaries out just decreases the risk of colon cancer but taking up the ovaries mostly but not completely decreases the risk of ovarian cancer. The famous Nurses Health Study followed thousands of women for many years and looked at their health outcomes if there were other conditions that are more likely in women who have their ovaries removed. Coronary heart disease is more common in women who've had their ovaries removed and osteoporosis bone thinning is more common in women who have had their ovaries removed. Lung cancer, believe it or not, is more common in women who had their ovaries removed. Breast cancer is less common, of course, in women who've had their ovaries removed.

So your surgeon is in your tummy to perform a hysterectomy because you have too much bleeding, and you're under anesthesia and you're about 50 years old. Should you have your ovaries removed? Removing the ovaries adds very little to overall risk of the surgery and your ovaries look normal.

This is a conversation you should have had with your surgeon long before you were in the operating room. What are your risks of ovarian cancer? Do you have ovarian cancer in your immediate family? Do you carry a BRCA mutation that increases your risk of breast and ovarian cancer? Did your best friend die of ovarian cancer and it's your number one fear and you can't stop thinking about it? Then the answer is probably yes. Talk to your surgeon about removing your ovaries.

However, in one study, about 98% of women who had their ovaries removed at the time of the hysterectomy were not at increased risk of ovarian cancer. In the end, weighing the risks and benefits, it's a highly personal decision. Although a Mayo Clinic paper and the Nurses Health Study that looked at all causes of death found out that women who had their ovaries removed in the past for non-cancerous reasons died just a little younger than women who didn't.

This decision is one for you to make with your doctor, but you should come to your appointment prepared. You can just google, "Should I have my ovaries removed" and there lots of choices, but I would suggest the website at the University of Wisconsin as an excellent interactive tool. Google, "Should I have my ovaries removed University of Wisconsin" and it'll get you there. But it's also on our website.

Full disclosure, I am the OB/GYN editor for Healthwise, the non-profit patient education company who created this patient decision document. Get the facts, not just the fears and make the right decision for you, and thanks for joining us on The Scope.

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