Ovarian Cancer A Guide For Journalists On Ovarian Cancer .

Ovarian cancerA guide for journalists onovarian cancer and its treatment

ContentsOverviewSection 1 Ovarian CancerSection 2 EpidemiologySection 3 on 1: Ovarian Cancer4i. Types of ovarian cancer4ii. Causes and risk factors5iii. Symptoms and diagnosis5iv. Staging6Section 2: Epidemiology7i. Incidence & mortality7ii. Prognosis8Section 3: Treatment9i. Surgery9ii. Chemotherapy9References102/ 10

ContentsOverviewSection 1 Ovarian CancerSection 2 EpidemiologySection 3 TreatmentReferencesOverviewOvarian cancer is diagnosed in nearly a quarter of amillion women globally each year. It is the eighth mostcommon cancer in women and the seventh leadingcause of cancer death among women, responsible forapproximately 140,000 deaths each year. It has thehighest mortality rate of all gynaecological cancers.1The prognosis for ovarian cancer patientsis poor, particularly when the disease isdiagnosed in its later stages.2 Symptoms areambiguous and often misdiagnosed3, 4 sothe majority of patients are only identifiedin the advanced stages of the disease.2Ovarian cancer is therefore often referred toas “The Silent Killer”.In most cases front-line treatment (withsurgery and chemotherapy) does not stopthe disease returning. Most women withadvanced ovarian cancer will have a relapsefollowing initial treatment, usually within15 months of initial diagnosis.8 There is areal need for new, more effective treatmentoptions for women with ovarian cancer.The current standard of care for ovariancancer - surgery and chemotherapy - hasremained unchanged for many years andthe 5-year US survival rate has improvedby only 9% since 1975.5 Statistics show thatjust 45% of women with ovarian cancer arelikely to survive for five years compared toup to 89% of women with breast cancer.6, 7This guide provides an overview of ovariancancer, including its incidence, risk factors,symptoms, diagnosis and treatment options.3/ 10

ContentsOverviewSection 1 Ovarian CancerSection 2 EpidemiologySection 3 TreatmentReferencesSection 1Ovarian canceri. Types of ovarian cancerThe vast majority (over 90%) of ovariantumours arise from the uncontrolledgrowth and replication of epithelial cellswhich form the surface of the ovary.Cancer involving this type of cell is knownas epithelial ovarian cancer.9 Other typesof ovarian cancer develop from the eggproducing germ cells or the connectivetissue around the ovary known as stromalcells.10 If detected at a very early stage,ovarian cancers can usually be removedsurgically and this can be potentiallycurative. However, there are often no clearlyidentifiable initial symptoms and in themajority of cases the cancer has spreadto other parts of the body (metastasised)before the patient is diagnosed.Figure 2 Types of ovarian cancerEpithelial cancer, accounting for90% of maligant ovarian cancers1Empty follicleCorpus luteumGerm cell cancer startsfrom germ cells (cellsthat are destined to formeggs) within the ovariesFigure 1 Anatomy of ovariesOvulationStromal cell cancerbegins in the cellsthat hold the ovariestogether and producefemale hormonesFallopian TubeGrowing follicleMature egg1. Source: Rosen DG et al. (2010). Front Biosci. 4/ 10

ContentsOverviewSection 1 Ovarian Cancerii. Causes and risk factorsThe underlying mechanism that leads toovarian cancer is not well understood, but itis thought to be linked to reproduction andovulation. A number of factors may increasea woman’s risk of developing ovariancancer:Family history: If a woman’s mother orsister has had ovarian, breast, or uterinecancer she is at greater risk of developingovarian cancer.11Age: The risk of ovarian cancer increaseswith age. Women over 50 have the highestrisk of developing ovarian cancer.12Childbirth and menopause: Women whohave not had children, never taken thecontraceptive pill, who started menstruatingat an early age or whose menopausestarted later than average have a higherrisk of developing ovarian cancer. Mostovarian cancers are diagnosed after themenopause.11Genetics: Certain genetic traits can alsoincrease the risk of developing ovarianSection 2 EpidemiologySection 3 Treatmentcancer. For example women with mutationsin the BRCA1 or BRCA2 genes (1 inevery 500 women) have a 23-54% risk ofdeveloping ovarian cancer.12Previous gynaecological problems:Women who have previously had ovariancysts or endometriosis are also more likelyto develop ovarian cancer.12Lifestyle: Obesity, smoking and a sedentarylifestyle are linked to an increased risk ofovarian cancer.12iii. Symptoms and diagnosisEarly diagnosis has the potential to improvesurvival rates but symptoms of ovariancancer, particularly in the early stages maybe ambiguous and non-specific makingearly diagnosis difficult.3 They can beconfused with symptoms of other lesssevere diseases, particularly gastrointestinalcomplaints. In addition, there is no routine,simple test to accurately and reliably detectovarian cancer in the general population soreliable screening for the disease is not yetfeasible.13ReferencesThis means the majority of women are notdiagnosed until the disease has reached anadvanced stage when the tumour may belarge and could have spread (metastasised)to other parts of the body. Approximately70% of women with ovarian cancer arediagnosed at stage III or IV (see staging) ofthe disease.12Cancerous cells can greatly increase thevolume of peritoneal fluid (the natural fluidthat coats and lubricates the lining of theabdomen and covers internal organs) inovarian cancer. This can cause the buildup of fluid in the abdomen called asciteswhich is a common complication of ovariancancer that can cause swelling, fatigue andshortness of breath.Being aware of the frequency andcombination of certain symptoms can helpwith early diagnosis. Symptoms to watchout for include:4, 14Persistent bloating Abdominal painIrregular periodsLoss of appetiteFatigueChange in bowel movements constipation, excess wind Abnormal vaginal bleedingMethods of diagnosis vary from country tocountry but typically when a woman goesto her doctor with symptoms, she will begiven a physical examination. If this raisesany concerns, a number of additional testsmay be performed: A blood test to check for raised levels ofa protein in the blood called CA-125 A n MRI (Magnetic ResonanceImaging) or CT (Computerised (Axial)Tomography) scan U ltrasound15Exploratory surgery of the abdomen knownas a laparotomy, or less invasive keyholesurgery known as a laparoscopy, is requiredto confirm diagnosis and determine howadvanced the ovarian cancer is.8, 165/ 10

ContentsOverviewSection 1 Ovarian Canceriv. StagingStaging determines how advanced thecancer is and whether it has spread toother parts of the body. It helps to identifythe most appropriate treatment options forthe patient. Staging of ovarian cancer isconfirmed along with surgery using:biopsiesCT scanschest X-rayscolonoscopies17Staging is defined by the FIGO(International Federation of Gynaecologyand Obstetrics) system.Section 2 EpidemiologySection 3 Treatment‘Early stage disease’ (stage I and II)describes a tumour that is localised to itsoriginal site, with no spread either to lymphnodes or other areas in the body. With earlystage disease there is the chance of a cureif the tumour can be successfully surgicallyremoved.‘Later stage disease’ (stage III and IV)refers to cancer that has spread from theoriginal site, affecting the lymph nodesor reaching other parts of the body(metastases). Late stage ovarian cancerhas a worse prognosis than earlier stagedisease.ReferencesTable 1 The stages of ovarian cancer (FIGO)Early stagediseaseStageClassificationStage ITumour confined to ovaries.Stage IITumour involving one or both ovaries and extending intotissues in the pelvic regionLater stage Stage III Tumour involving one or both ovaries and evidence ofspread to the abdominal lining outside of the pelvic regionStage IV Most advanced stage when cancer has spread to moredistant organs e.g. lungs, liver6/ 10

ContentsOverviewSection 1 Ovarian CancerSection 2 EpidemiologySection 3 TreatmentReferencesSection 2Epidemiologyi. Incidence & mortalityWorldwide Ovarian cancer is diagnosedin nearly a quarter of a million women eachyear. It is the eighth most common cancerin women and the seventh leading cause ofcancer death among women, responsiblefor approximately 140,000 deaths eachyear. These figures confirm that globally,ovarian cancer is the most deadly of thegynaecological cancers.1Europe In 2008, there were approximately41,448 deaths from ovarian cancer acrossEurope, accounting for 5.5% of all femalecancer deaths. Europeans have the highestincidence of ovarian cancer and it is thefifth most commonly diagnosed femalecancer in Europe.1Figure 3 Age standardised mortality rate for ovarian cancerOver 220,000 new casesof ovarian cancer every year140,000 women dieeach year from the diseaseNorth America Ovarian cancer is theeighth most commonly diagnosed cancerin women in North America with 23,895new cases diagnosed in 2008. It accountsfor 3% of female cancer diagnoses but5.6% of female cancer deaths in NorthAmerica.13 4 5 Age Standardised Rate ASRSource: WHO GLOBOCAN 2008Figure 4 Annual incidence and mortality rates of female cancers worldwideCancer Incidence vs Cancer Cervix530,232275,008Ovary224,747140,163Source: WHO GLOBOCAN 20087/ 10

ContentsOverviewSection 1 Ovarian Cancerii. PrognosisCancer statistics often use an ‘overall5-year survival rate’ to give a better ideaof the longer term outlook for people witha particular cancer. Over half of womendiagnosed with ovarian cancer will notlive beyond five years.6 The overall 5-yearsurvival rate for women with ovarian canceris 45%. This compares to a 5-year survivalrate of up to 89% in women diagnosedwith breast cancer.6, 7 The reasons for thispoor prognosis are that there is no effectivescreening for ovarian cancer and symptomscan be ambiguous, leading to a highpercentage of cases being diagnosed at anadvanced stage when the disease is moredifficult to treat.Section 2 EpidemiologySection 3 TreatmentReferencesFigure 5 5-year survival rate of ovarian cancer vs. breast cancerThe overall 5-year survival rate forpatients with ovarian cancer is 45%The 5-year survival rate for patientswith breast cancer is up to 89%Source: American Cancer Society. Cancer Facts and Figures 2007.Atlanta, American Cancer Society 2007.Source: American Cancer Society. Breast Cancer Facts and Figures 2009-2010.Atlanta, American Cancer Society, Inc.8/ 10