Is there anything I can do to decrease the risk that I will get ovarian cancer?

Surgically removing your ovaries and fallopian tubes is the only proven method for reducing your risk of ovarian cancer. Your fallopian tubes will also be removed because you are also at high risk for developing fallopian tube cancer.

Your genetic counsellor or doctor can refer you to a gynecologist, usually one that specializes in cancer (gynecologic oncologist). This is the specialist who will discuss your risk management options with you, and perform the risk-reduction surgery.

Screening

Is ovarian cancer screening an option?

Unfortunately, there are no reliable tests for screening as they are not able to detect ovarian cancer at an early stage.

Ovarian cancer is difficult to detect early. The symptoms of ovarian cancer can be subtle and mistaken for other conditions. For this reason, when ovarian cancer develops, it is often found at a later stage when it’s harder to treat it successfully.

Learn about the signs & symptoms of ovarian cancer

Symptoms associated with ovarian cancer are often vaguenon-specific and can be mistakenly attributed to other causes. These symptoms can often be experienced by women without ovarian cancer.

Common symptoms include:

  1. Bloating – increased abdominal size/persistent bloating
  2. Eating – difficulty eating or feeling full quickly
  3. Pain – in pelvic or abdominal areas
  4. Urinary symptoms – urgency or frequency

Occasionally there can be other symptoms such as changes in bowel habits, extreme fatigue or unexplained weight loss. Just because you have the symptoms does not mean you have ovarian cancer.

However, if the symptoms are:

  • New – they are not normal for you and may have started in the last year
  • Persistent – they have been present for more than 3 weeks
  • Frequent – you notice the symptoms happen frequently

…then it is important that you see your doctor.

Source: Ovarian Cancer Canada

The following tests are used to assess symptoms related to ovarian cancer they have also been used to screen women at high risk, but they are not reliable.

Pelvic exam

During a pelvic exam, your doctor will lightly touch or press on your lower abdomen. They will try to feel the ovaries and uterus for size, shape, and feel.

Transvaginal ultrasound

A transvaginal ultrasound is a procedure that uses sound waves to make an image of the uterus, ovaries, fallopian tubes and cervix.

CA-125 blood test

This blood test checks the levels of a protein in the blood called CA125. Levels of CA125 may be higher in women with ovarian cancer.

 

OCCEnOvarian Cancer Canada is the only national charity dedicated to overcoming ovarian cancer. One of their goals is to alert women at high risk for ovarian cancer of their risk and the actions they can take. Visit their website to learn more.

Why aren’t these tests reliable for screening?

Your ovaries and fallopian tubes are small and located deep in the middle of your body, surrounded by other larger organs. For this reason, it’s hard to detect ovarian cancer at an early stage using medical imaging such as ultrasound. It’s also difficult for a doctor to feel your ovaries from the outside of your body. The CA125 blood test is also not an effective screening tool because levels of CA125 may also be higher due to other conditions, such as fibroids and endometriosis. In addition, CA125 levels are not always elevated in the presence of ovarian cancer.

 


Risk-reducing surgery

taking birth control pills

Birth control pills reduce the risk of ovarian cancer by 50% – 60%[1] . It is important to be aware that there are other risks associated with birth control pills such as increased risk of breast cancer, blood clots and stroke. Talk to your doctor for more information.

Surgery that removes a woman’s ovaries and fallopian tubes before there is any sign of ovarian cancer is known as a risk-reducing or prophylactic bilateral salpingo-oophorectomy (BSO). This surgery is only recommended to women whose ovarian cancer risk is much higher than average.

For a BRCA mutation carrier, a BSO can reduce the risk of developing ovarian, fallopian tube, and peritoneal cancer by 80% or more.

Peritoneal cancer is cancer that develops in your peritoneum (the lining of your abdomen). The risk of developing peritoneal cancer is 2 – 4% in the 20 years following surgery. [2]

What is the recommended age for a woman to have a BSO?

It is recommended that women who carry a BRCA mutation have their ovaries and fallopian tubes removed between age 35 and 40.

Factors that will affect what is the ideal age for you are:

  • whether you carry a BRCA1 or a BRCA2 mutation
  • family history (specifically, the youngest age at which a female relative developed ovarian cancer)

You can still have this surgery if you are over 40, provided you are in good health. This is something you should discuss with your doctor.

What is involved in a BSO?

A BSO involves removing your ovaries and fallopian tubes. This surgery is done by a gynecologic surgeon or gynecologic oncologist.

After the surgery, tissue from your ovaries and fallopian tubes would be examined by a pathologist to check for any sign of early cancer.

ovarian_anatomy_diagram


There are three main types of risk-reducing BSOs:

1. Laparoscopic BSO

 

 laparoscopic_oophorectomy

During laparoscopic surgery the surgeon will usually make a few small incisions (usually 0.5–1.5 cm long): one in your belly button and one or two above each ovary. A tube with a tiny camera is inserted through one of the incisions to allow the surgeon to see your ovaries. The surgeon will then remove your ovaries and fallopian tubes through the other incisions.

This surgery uses smaller incisions which reduces recovery time to about two weeks. Scars from this surgery will be small if it is able to be performed this way.

 


2. Abdominal BSO

 

abdominal_oophorectomy

There are some cases where the surgeon has to make one large incision to remove your ovaries. The surgeon would make a bikini incision – a horizontal incision just above the pubic bone – to complete the surgery. This surgery has a longer recovery time than the laparoscopic BSO (about six weeks).


3. Total Hysterectomy

hysterectomy_diagram

 

You may choose to have your uterus and cervix removed (a hysterectomy) at the same time as your BSO. It may be done laparoscopically or abdominally.

Issues to consider in deciding whether to have a hysterectomy include:

Risk of endometrial cancer
High-risk women who decide to take the drug tamoxifen to lower their risk of breast cancer will be at an increased risk of developing uterine cancer.

HRT options
If you are premenopausal, hormone replacement therapy (HRT) may be offered to you after an oophorectomy to manage the side effects. The type of HRT offered to you will be dependent on whether or not your uterus has been removed.

History of uterine or cervical problems
A hysterectomy might be recommended if you have a history of problems with your uterus or cervix (e.g., prolapse, cervical dysplasia).

 


Andrea talks about her experience of ovarian surgery

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What are the side-effects of a risk-reducing BSO?

The most common side-effects after an oophorectomy are:
  • Hot flashes and night sweats
  • Vaginal dryness and irritation
  • Decreased sex drive
  • Insomnia (difficulty sleeping) and fatigue
  • Urinary problems (incontinence and infections)
  • Memory and concentration problems

Removing your ovaries will cause many changes to your body. If you are premenopausal at the time of the surgery, you will be put into an abrupt surgical menopause because of the sudden drop in your hormone levels (estrogen, progesterone and testosterone). Learn more about menopause.

The menopausal side effects of a BSO are often difficult for younger, premenopausal women who haven’t started going through natural menopause. Their menopausal symptoms come on very suddenly and may be more severe than in women who experience a natural menopause.

Not everyone experiences these side effects or feels them at the same intensity.

If you are premenopausal, removing your ovaries may also increase your risk as you age of developing heart disease or cognitive problems (attention, thinking and memory problems). You would also have an increased risk of developing osteoporosis (bone thinning) as you age.

What can I do to manage the symptoms of surgical menopause?

Management of menopausal symptoms is very individualized, based on your own health history, family history, and situation.

Making the following healthy lifestyle choices can also help manage some of your symptoms:

  • Minimizing alcohol, caffeine, and spicy foods
  • Exercise
  • Stopping smoking

If you were premenopausal before you had a BSO, hormone replacement therapy (HRT) may be offered to you to manage menopausal symptoms and for protection from cardiovascular disease, osteoporosis and cognitive problems. These are oral or transdermal (through the skin) medications that contain hormones such as estrogen and progestins. Your doctor can explain the risks and benefits of HRT and advise you on which type of HRT is best for you.

For women who have medical reasons that prevent them from using hormones, hot flashes can be treated with non-hormonal alternatives, such as low dose anti-depressants and anti-seizure medications.

The symptoms of vaginal dryness or irritation can be treated with vaginal moisturizers and lubricants.
A local estrogen (estrogen applied directly to the vagina) may be recommended to treat these symptoms if you are not taking HRT.

Farah and Natalie talk about going through early menopause

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…the bigger impact is the oophorectomy for what it does internally. How it affects you. Hot flashes, I hardly sleep through the night anymore, those things are harder to deal with…

Natalie
Some women find that removing their ovaries doesn’t change their body at all while others, like Farah and Natalie, notice a big difference in their bodies after surgery.

Listen to women talk about
changes after an oophorectomy


Making your decision to have a
risk-reducing oophorectomy

Tracy, Melissa and Tori talk about making their decision

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I’m not ready…there’s long-term risks: bone health, cardiovascular health. What’s worse? That’s where I’m at.

Melissa
Tracy knew immediately that she wanted a BSO while Melissa is struggling with her decision. It is a difficult decision to remove your ovaries before you have any sign of ovarian cancer. Many women choose to have the surgery at some point, but it can be hard to know when you are ready. Tori wants to delay her surgery until after she has a child.

Your decision is very personal and will depend on what is right for you at this time in your life. It is important to understand how your age impacts your risk – you may want to discuss this with your doctor or genetic counsellor.

Andrea talks her relief after her oophorectomy

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I just felt like I had a little bomb or bombs inside my body and I just wanted them removed.

Andrea

reflection questions

It can be hard to know when to have ovarian surgery. While you are making your decision ask yourself these questions:

  • Do I understand my risk of developing ovarian cancer at my age?
  • How worried am I about my ovarian cancer risk?
  • Do I want to become pregnant in the future?
  • Am I prepared to deal with sudden and possible long-term menopausal symptoms?
  • Do I need support in making this decision? Would it help to connect other women who have gone through this?
  • It may be helpful for you to keep a journal of your experiences and reflections. Your feelings may change over time. Writing down your thoughts can help you cope with difficult feelings. Writing in a journal can also give you important insights as you make decisions and reflect on your situation.

 

questions to ask your doctor

You may want to ask these questions when you talk with your gynecologist or gynecologic about managing your ovarian cancer risk:

  • Based on my age, family history, and BRCA mutation, what do you recommend to manage my risk?
  • If I choose risk-reducing surgery, which surgical procedure would you recommend? What are the pros and cons of each procedure?
  • How will I feel after the surgery? How long will it take me to recover?
  • Are you prepared to deal with sudden and long-term menopausal symptoms?
  • What kinds of side effects have your patients experienced after surgery? How did you help them manage those side effects?
  • I am concerned about dealing with the side effects of surgical menopause. How do you feel about the use of HRT, and what are the other options are available for dealing with menopausal symptoms?
  • If I decide not to have surgery or at least delay it for the time being, what other options would you recommend?
  • Is there anything else I should consider as I make this decision?
  • Write down any other questions that you would like to ask.