September 2, 2025 • 31 mins
Ovarian cancer, the second most common gynecologic malignancy, can be cured 90-95% of the time when caught early.
Speaking of Women's Health Podcast Host talks through the risk factors like family history, BRCA gene mutations, obesity, and personal reproductive factors that are essential for early detection and prevention.
• Risk increases with age (over 50), family history, and BRCA gene mutations
• BRCA1 carriers face 35-70% lifetime risk compared to less than 2% in general population
• Pregnancy, breastfeeding, and hormonal contraceptives reduce risk by decreasing ovulation
• Tubal ligation, especially salpingectomy, dramatically lowers ovarian cancer risk
• Common symptoms include abdominal swelling, urinary changes, bloating, early satiety
• Regular pelvic exams and prompt reporting of symptoms are crucial for early detection
• Ashkenazi Jewish women have ten times higher rate of BRCA mutations
• Avoid using talcum powder near genital area as it's been linked to increased risk
• Consider genetic counseling if strong family history exists
• Prophylactic removal of tubes/ovaries after age 40 may be recommended for high-risk women
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Episode Transcript
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Speaker 1 (00:02):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI'm back in the Sunflower House
for a new episode of theSpeaking of Women's Health
podcast, and it's September 2025, and September is Ovarian
(00:26):
Cancer Awareness Month.
Cancer of the ovary strikesfear into most all women, and
it's actually the second mostcommon gynecologic malignancy
and when found in an early stage, it can be cured up to 90 to
(00:47):
95% of the time.
I have many ovarian cancersurvivors in my practice.
Your risk of ovarian cancergets higher if there is a family
history, like in a mother or asister or even a daughter.
(01:14):
Unfortunately, ovarian canceris hard to detect and there's no
screening test, and many casesof ovarian cancer are found
after the cancer has spread toother organs, and in these cases
the cancer is much harder totreat and to cure.
(01:35):
So you might ask what causesovarian cancer?
Well, we don't know, but we doknow it can increase the risk.
Certainly there is hereditarytypes of ovarian cancer, meaning
it can run in the family, andso you really want to know your
(01:57):
family history, your biologicalfamily history mother, sister,
daughter.
The risk gets higher the morerelatives that you have with
ovarian cancer and you can havean increased risk for ovarian
cancer on the father's side, thepaternal side.
So it is important to know yourfather and his blood relatives
(02:18):
history.
If you have a family history ofother types of cancers, like
colorectal cancer, breast cancer, that can be associated with an
increased risk of ovariancancer, because these cancers
can be caused by an inheritedmutation or change in certain
genes that cause a family cancersyndrome.
(02:40):
That can increase the risk ofovarian cancer.
That can increase the risk ofovarian cancer.
Women who have never beenpregnant or if they have their
first full-term pregnancy afterage 35, or who were never able
to carry a pregnancy to term,also have a higher risk of
(03:05):
ovarian cancer.
If you're over the age of 50,the likelihood of developing
ovarian cancer increases withage.
Like most cancers, if you carrythe BRCA gene, mutations in
BRCA1 and BRCA2 are responsiblefor most, but not all, of the
inherited ovarian cancers.
For most but not all of theinherited ovarian cancers,
(03:33):
mutations in BRCA1 and 2 areabout 10 times more common in
those who have an AshkenaziJewish descent than those in
just the general United Statespopulation.
The lifetime ovarian cancerrisk for women with BRCA1 is
estimated to be between 35% and70%, which means if 100 women
have BRCA1, there's going to be35 to 70 of them who would get
(03:54):
ovarian cancer.
For women with BRCA2 mutation,the risk has been estimated
between 10% and 30% by age 70.
Estimated between 10 and 30% byage 70.
And these mutations increasethe risk for primary peritoneal
carcinoma and fallopian tubecarcinoma.
In comparison, the averagepopulation, the ovarian cancer
(04:18):
risk for females is less than 2%.
Now, if you haven't heard theprior podcast that I did with a
medical breast specialist, drHolly Peterson, on big gene
mutations, intermediate genemutations and lesser gene
mutations, that's a really goodpodcast to go back and listen to
(04:39):
.
Also, at the beginning ofseason three in January, I did
an interesting podcast withgenetic counselor Ryan Noss on
the GINA law.
So if you or a loved one has agenetic mutation and you have
(04:59):
offspring, that's reallycritically important to
understand the GINA law andperhaps the best time for
testing Now.
Other risk factors for ovariancancer is being overweight or
having a very high BMI.
Obesity has been linked to ahigher risk of developing many
(05:22):
cancers, including uterine orendometrial cancer.
The current informationavailable for ovarian cancer and
obesity is not as clear Obesewomen that have a body mass
index of at least 30, which isconsidered obese, most likely
have a higher risk of developingovarian cancer, but not
necessarily the most aggressivetypes, like the high grade
(05:46):
serous cancers.
Obesity may also negativelyaffect the overall survival of a
woman with ovarian cancer, justlike with any medical condition
metabolic syndrome, diabetes,hypertension, sleep apnea all of
these things tend to compoundwhen there's too much visceral
(06:09):
body fat.
Now, talcum powder has beenlinked to ovarian cancer.
And, importantly, what are someof the things that you can do
to lower your risk of ovariancancer?
If you don't yet have ovariancancer, if you've got women in
your life that you're concernedabout, certainly, studies show
(06:33):
that women who have children andwho breastfeed, as well as who
use hormonal contraceptives likeestrogen, progesterone pills,
patches or a vaginal ring, aremuch less likely to develop
ovarian cancer, because thesefactors decrease the number of
times that a woman ovulates, andstudies suggest if you reduce
(06:54):
ovulation, you can reduce therisk of ovarian cancer.
So, pregnancy and breastfeedingWomen who have been pregnant
and carried the baby to termbefore age 26 have a lower risk
of ovarian cancer than women whohave not, and that's true with
breast cancer, especially underthe age of 18 to 20.
(07:15):
And breastfeeding may lower theovarian cancer risk further
because it stops ovulation manytimes for several months Not
always, and usually once solidsare introduced, by six months,
there is ovulation.
Now, interestingly, womenwho've used hormonal
contraceptives.
(07:36):
So we're not talking about theIUD, we're not talking about the
diaphragm or spermicides.
We're talking about usingsomething that has an estrogen
and a progestin in it thatinhibits ovulation, and this
risk is lower the longer thetime pills are used and it
continues for several yearsafter the pill is stopped.
(07:57):
Now other forms of birthcontrol, like tubal ligation,
especially complete removal ofthe tube, salpingectomy
dramatically reduces the risk ofovarian cancer.
In fact, in women at high riskfor ovarian cancer but who are
still just a little too young tolose their ovaries, many times
(08:20):
they'll undergo completesalpingectomy.
Many times they'll undergocomplete salpingectomy.
Maybe use of certainintrauterine devices may be
associated with slightly lowerrisk of ovarian cancer, but not
as consistently and the data isnot as robust as with hormonal
contraceptives.
So incessant ovulation isn'treally what the body was
(08:43):
designed to do.
Incessant ovulation isn'treally what the body was
designed to do.
Now, if you have a hysterectomyand you remove the uterus but
leave the ovaries, but take outthe tubes.
This also does reduce ovariancancer.
Menopause itself does not causeovarian cancer, and neither
(09:13):
does taking menopausal hormonetherapy.
Now what are the symptoms ofgetting ovarian cancer?
Well, early on there may bevery few symptoms.
The first sign may be aslightly enlarged ovary.
The ovaries are located deepwithin your pelvic cavity, so a
(09:35):
lot of times swelling is notnoticed until it's more advanced
.
Women typically seek care whenthey notice abdominal swelling
due to fluid that accumulates inthe abdomen.
Some women may notice urinarychanges such as increased
frequency or discomfort withurination.
Now, most urinary frequency andpain with urination is from
bladder infections or otherbladder problems, but one always
has to think about ovariancancer.
(09:57):
Symptoms of more advancedovarian cancer include a swollen
abdomen caused by buildup offluids produced by the tumor,
lower abdominal and leg pain, asudden weight loss or weight
gain, nausea, swelling in thelegs and change in bowel or
(10:19):
bladder function.
Also, women with ovarian cancermay complain of abdominal
bloating, gas, heartburn,intolerance to certain foods or
what we call early satiety, kindof getting filled up a little
too fast.
When these symptoms occur, manytimes the tumor has spread
(10:41):
outside the ovary.
Tumor has spread outside theovary and unfortunately, despite
a lot of common urban myths,there is no reliable screening
test for ovarian cancer.
So we're getting down to how canyou protect yourself from
getting ovarian cancer?
And you have been listening tothe Speaking of Women's Health
(11:01):
podcast.
I'm your host, dr Holly Thacker, in the Sunflower House in
September of 2025.
September is Ovarian CancerAwareness Month and we're
talking about how one canprotect themselves from ovarian
cancer and it's not easy, butthere are steps that you can do
(11:21):
to be proactive.
Get a regular pelvic exam.
If you have any irregularvaginal bleeding or abdominal
pain or discharge, you need tobring it to your women's health
clinician's attention.
You also need to bring it toyour healthcare team's attention
(11:43):
if there's a close familymember, like a mother, sister or
daughter or grandmother, withovarian cancer.
Discuss your risk factors withyour physician.
Do not use talcum powder on ornear the vulva or vagina.
Eat a heart.
Healthy whole food diet healthywhole food diet.
(12:05):
And if you're not planningpregnancy or breastfeeding, talk
to your healthcare clinicianabout extended use of hormonal
contraception to reduce the riskof ovarian cancer.
Make sure you tune into ourfuture podcast with nurse
practitioner Dana Leslie, wherewe're going to talk about how we
(12:27):
profile different types ofhormonal contraceptives and just
contraception in general,depending on the woman's profile
.
And then if you have the BRCAgene or a strong family history,
you may need to be referred forgenetic counseling.
And even if your geneticcounseling is negative, if there
(12:50):
is a strong family history ofovarian cancer, you may want to
consider removal of the tubesand the ovaries after completing
your family after age 40.
Removing the ovaries before age40, even with estrogen therapy,
(13:10):
does still confer some increasein neurologic problems.
So ideally we like women tomake it to age 40.
Now there is a survivaladvantage to keeping your
ovaries up to age 65, unlessthere's BRCA gene, diseased
ovaries or a family history ofovarian cancer and it's kind of
(13:34):
an individual decision.
And so if a woman is over 65,especially if she knows she's
going to take a systemic orvaginal estrogen, post
hysterectomy and oophorectomy,estrogen post hysterectomy and
oophorectomy I usually recommend, if they're in there and you're
(13:54):
over 65 or you don't know whatyour family history is, to go
ahead and take the ovaries.
But under that age 65, even ifyou're in menopause, there's
still substances that theovaries make.
So we don't go around justdoing ovary removal on all women
who are past childbearing.
Now for some women and also itdepends on the family history of
the onset of breast and ovariancancer, but sometimes with
(14:17):
BRCA1, it's recommended to eventake the ovaries and tubes
before the age of 40.
Now if you're going to undergoremoval of ovaries and tubes and
you're not planning to have invitro fertilization to carry a
pregnancy, I usually willrecommend that the uterus be
(14:39):
taken out at the same time,because then you can just give
estrogen, and estrogen alonereduces breast cancer.
Now it does take a little bitlonger surgery and of course,
each case is unique and you needto speak to your gynecologic
oncology surgeon.
And this podcast is not medicaladvice.
(15:01):
It's just giving youinformation to empower you to be
strong and be healthy and be incharge.
But I have a number of womenpost ovary and uterus removal.
Some of them have had abnormalPAPs that progress, or fibroids
or adenomyosis, which is thelining of the uterus growing
(15:21):
into the muscle, and theyalready have a diseased uterus
and they already know they wantto be on hormone therapy.
And keeping the uterus in meansthat we have to use progestin
or progesterone or something toprevent any stimulation of the
lining of the uterus and we haveto be a lot more stingy with
the menopausal hormones andcastrated women, ie women who've
(15:46):
had their ovaries removed andare castrated, have no estrogen,
no ovarian hormones, tend tohave more intense menopausal
symptoms, particularly ifthey're younger, and I've even
had women who've had benignovarian tumors removed for
struma ovarii, which produceextra androgens, and they never
(16:07):
had a hot flash in their life.
And then at age 72, after bothovaries are removed, they have
terrible hot flashes because theovarian tumor was producing
testosterone which got convertedto estrogen and body fat.
So they never were estrogendeficient until they had their
ovarian tumors removed.
So some ovarian tumors arehormone producing, many are
(16:31):
cancers of varying degrees, somevery aggressive, some not as
much.
And then there is a class ofovarian tumors called dermoid
tumors, where the ovary cellsdifferentiate into other types
of tissue.
There may be cartilage or hairor even teeth in the tumor, and
(16:53):
usually these are removed justbased on size or bulk symptoms.
But sometimes they're observed.
So what are the stages ofovarian cancer?
If you're diagnosed withovarian cancer, the first thing
the physician usually likes totry to figure out is how far
it's gone, if it's spread.
This medical term is calledstaging.
(17:17):
The stage of a cancer describeshow much cancer is in the body.
It helps determine how seriousthe cancer is, how best to treat
it, and doctors also usuallyuse the cancer stage when
talking about general survivalstatistics.
So ovarian cancer stages rangefrom stage one through four.
(17:37):
As a rule, the lower the number, the less the cancer has spread
, and the higher the number likestage four usually means it's
spread more and it's metastatic.
Although each woman's ovariancancer experience is unique,
cancers with similar stages tendto have similar outlooks and
many times are treated in muchthe same way.
(18:02):
Now the goals of surgery forovarian cancer is to take tissue
samples to get the diagnosisand the stage To stage the
cancer.
Samples of tissues are takenfrom different parts of the
pelvis and abdomen and examinedin the lab, and the factors to
stage or classify ovarian cancerinclude the size of the tumor,
(18:24):
which is T.
Has the cancer spread outsidethe ovary or the fallopian tube?
Has the cancer reached nearbypelvic organs like the uterus or
bladder?
Has the cancer spread to lymphnodes?
N.
Has the cancer spread in thepelvis or around the aorta,
(18:45):
which is the main artery thatruns from the heart down through
the back of the abdomen andpelvis?
These are called para-aorticlymph nodes.
And then, finally, has therebeen spread or metastasis to
distant sites, which is labeledM.
So usually the tumor gets a T,n and an M rating.
(19:05):
Has the cancer spread aroundthe lungs, which can cause fluid
, or to distant organs like theliver or bones?
Sometimes, if surgery is notpossible right away, the cancer
will be given a clinical stageinstead of anatomic surgical
stage, and this is based on thephysical exam, the biopsy and
(19:27):
then the imaging test.
So, moving on to treatingovarian cancer, most women
suspected of having ovariancancer usually will have a mass
on either exam, ultrasound orCAT scan, which is computed
tomography CT scan.
Any woman with a new massshould undergo a preoperative
(19:50):
workup, including blood testsfor CA-125 and a CAT scan, if
not previously done, and themain treatments for ovarian
cancer usually involve acombination of both surgery and
chemotherapy.
Chemotherapy is strong medicinegiven through an intravenous
line to help kill the cancercells.
Unfortunately, chemotherapymany times can kill off regular
(20:14):
cells, especially fast-growingcells, like in the GI tract, the
skin, the hair.
Sometimes debulking surgeriesperform before chemo and other
times it happens afterwards.
So your individual treatmentplan depends on a lot of
different factors, includingyour overall health, your
(20:35):
personal preferences, whetheryou want to plan to have
children if you haven't hadchildren already.
Age alone is not a determiningfactor, since several studies
have shown that older women cantolerate the ovarian cancer
treatments just as well.
So it's important to discussall of your treatment options,
(20:57):
including goals and side effects, with your team to make the
decision that best fits yourneeds.
It's a scary time.
It's important to write downyour questions and to get
answers to anything that you'renot sure about, and some people,
especially if time permits, maywant to seek a second opinion
to give them more informationand feel more confident about
(21:20):
the treatment plan you choose.
Many women feel very confidentwith their expert gynecologic
oncologist and want to get rightto treatment.
Local treatments.
Some are local, meaning theytreat the tumor without
affecting the rest of the body,so local treatments include
general pelvic surgery as wellas localized radiation therapy.
(21:43):
Surgery for ovarian cancer iscomplex.
In most cases, the surgicaltreatment involves removal of
the uterus, both ovaries, thefallopian tubes, nearby lymph
nodes and the omentum, which isthe fatty apron attached to the
large intestine.
The surgeon will remove as muchof the tumor as possible, and
(22:07):
this is a medical process knownas quote debulking.
The procedure can be done inthe traditional manner through
an open incision in the abdomen.
In certain cases it's donelaparoscopically, through a very
small incision using alaparoscope.
The ability to performcomprehensive staging and
(22:32):
removal of the largest bulk ofthe tumor has been shown to be
best performed by a specialistin gynecologic oncology, so
that's someone who's gonethrough medical school and then
an OBGYN residency and then asurgical fellowship in GYN
oncology.
In young women with low-gradetumors who still want to have
(22:55):
children, sometimes only thediseased ovary is removed, with
the remaining ovary watchedclosely for signs of cancer
through imaging labs andphysical exam.
If the tumor has spreadthroughout the abdominal cavity,
women sometimes require removalof part of the intestines to
remove as much a visible tumoras possible.
(23:17):
And removing the intestines,especially if it's the lower
ileum, can affect B12 absorptionand can come along with other
concerns.
Systemic treatments Some of thedrugs or medications used to
treat ovarian cancer aresystemic therapies because they
(23:38):
can reach the cancer cellsalmost anywhere in the body.
They can be given by mouth orput directly into the
bloodstream, and they mayinclude chemotherapy, hormone
therapy, targeted drug therapyand immunotherapy.
Chemotherapy following surgerychemotherapy is used to treat
(24:00):
cancer cells left behind and themicroscopic disease that may be
elsewhere in the body.
So most women with ovariancancer will have chemotherapy
unless their tumor is so lowgrade and only occurs within the
ovaries with cells that do notlook at all aggressive or
worrisome under the microscope.
Typically two drugs are givenin combination and the most
(24:23):
common approach is to givecarboplatinum and Paxlatol
intravenously every three weeksfor six to eight treatments, so
that can be 24 weeks or almostsix months.
Many times a port is insertedso that the veins aren't used up
(24:45):
and that can be accessed rightthrough the port.
So there's a lot of innovationsin both surgery and
chemotherapy that are ClevelandClinic OBGYN Institute and our
gynecologic oncologist teamoffers.
(25:07):
Now egg freezing may beconsidered because it can extend
fertility.
So when young women are facinglife-saving but fertility
damaging treatment for cancerthat's not just of the ovary but
also breast, colon cancer orother common ones to rapidly
freeze eggs and preserve the eggfor future use can be done.
(25:30):
Much the way that men banksperm, egg freezing is a spinoff
of in vitro fertilization.
Now, before startingchemotherapy, patients are given
fertility shots to increasetheir production of eggs, and
the eggs are retrieved orharvested as if they were
undergoing IVF.
(25:51):
So sometimes, if the woman doesnot have a partner, the eggs
can be frozen rather than beingfertilized.
But if there is a partner, it'salways much more ideal to
fertilize those eggs and freezethe embryos, as the defrost and
viability rate is much higherwith frozen embryos than frozen
(26:13):
eggs.
Early detection embryos thanfrozen eggs.
Early detection being able tofind ovarian cancer early could
certainly help our cure rates.
So this is an intense area ofresearch.
One method being tested islooking at the pattern of
proteins in the blood calledprotonomics, to see if we can
(26:35):
find proteins that may tip usoff to this.
What's new on ovarian cancerresearch?
Scientists continue to studythe genes responsible for
familial ovarian cancer, and theresearch is beginning to yield
clues about how these genesnormally work and how disrupting
their action can lead to cancer.
(26:57):
This information eventually isexpected to lead to new drugs
for preventing or treatingfamilial ovarian cancer.
Research in this area hasalready led to better ways to
detect high-risk genes andassess a woman's ovarian cancer
risk.
Assess a woman's ovarian cancerrisk and a better understanding
(27:20):
of how genetics and hormonalfactors, such as hormonal
contraceptive use and theirinteractions, may lead to better
ways for us to prevent ovariancancer, which is really the most
ideal thing to do Now.
There are several othergynecologic cancers that we do
want to be able to focus on,just in general.
(27:43):
Cervical cancer is cancer at theopening of the cervix.
It's usually caused from thehuman papillomavirus.
If you didn't hear my priorpodcast with Dr Sharon
Sutherland on cervical cancerawareness month, that's one to
really pay attention to, andcertainly if you have HPV,
(28:05):
getting yearly pap smears isimportant.
If you don't and you're overage 30, you should have a pap
and an HPV.
I'm not a big fan of only doingjust HPV testing without the
pap, but for some women thatdon't have healthcare access or
don't want to come in and beseen for a pap, there are some
(28:26):
self-collection HPV tests.
Now a lot of women are toldthey don't need one for every
five years.
I think that's a little bitlong and I think ideally to do a
pap every three to four yearsas opposed to waiting to five,
because I see otherwiseresponsible women in my practice
(28:48):
all the time who, five yearssomehow has become seven years.
It's really really ridiculousand it is very treatable,
especially if caught early, andendometrial or uterine cancer is
another cancer that is umpotentially completely curable
(29:09):
if caught early.
So if you're over 40 and youhave abnormal vaginal bleeding,
even if you're under 40 and havea family history or have a high
BMI or have diabetes, it needsto be evaluated.
And getting an endometrialsampling in the office for a lot
of women isn't too much morethan a pap smear, and so early
diagnosis for cervical anduterine cancer are more
(29:34):
successful so far than withovarian cancer.
I have a lot of women come inand say oh well, I heard you can
get an ultrasound and a CA-125.
And really they've been lookedat and they're not screening
tests.
I wish they were.
So your exams and payingattention to symptoms and
knowing your family history.
(29:54):
You know many cancers likebreast cancer and colon cancer
and pancreas cancer and cervicalcancer.
There's been some benefits withadequate vitamin D.
So I am always talking aboutvitamin D, which is not a
vitamin, it's a pro-sterilehormone and if you haven't
(30:16):
listened to my third podcast inseason one, it's all about
vitamin D and the research keepsrolling in and it's cheap and
it's safe and it's available andsometimes non-expensive.
Old, uh, kind of establishedthings don't always get the
attention maybe that they shouldthan you know higher profile,
(30:40):
more expensive therapies ortests.
So I really want to thank ourlisteners for listening to our
Speaking of Women's Healthpodcast.
Don't miss a future one, so besure to hit subscribe or follow
wherever you listen to podcastApple podcasts, spotify, tune in
(31:04):
, amazon music wherever youlisten.
Thanks again and I'll see younext time in the sunflower house
.
Remember be strong, be healthyand be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI'm back in the Sunflower House
for a new episode of theSpeaking of Women's Health
podcast, and it's September 2025, and September is Ovarian
(00:26):
Cancer Awareness Month.
Cancer of the ovary strikesfear into most all women, and
it's actually the second mostcommon gynecologic malignancy
and when found in an early stage, it can be cured up to 90 to
(00:47):
95% of the time.
I have many ovarian cancersurvivors in my practice.
Your risk of ovarian cancergets higher if there is a family
history, like in a mother or asister or even a daughter.
(01:14):
Unfortunately, ovarian canceris hard to detect and there's no
screening test, and many casesof ovarian cancer are found
after the cancer has spread toother organs, and in these cases
the cancer is much harder totreat and to cure.
(01:35):
So you might ask what causesovarian cancer?
Well, we don't know, but we doknow it can increase the risk.
Certainly there is hereditarytypes of ovarian cancer, meaning
it can run in the family, andso you really want to know your
(01:57):
family history, your biologicalfamily history mother, sister,
daughter.
The risk gets higher the morerelatives that you have with
ovarian cancer and you can havean increased risk for ovarian
cancer on the father's side, thepaternal side.
So it is important to know yourfather and his blood relatives
(02:18):
history.
If you have a family history ofother types of cancers, like
colorectal cancer, breast cancer, that can be associated with an
increased risk of ovariancancer, because these cancers
can be caused by an inheritedmutation or change in certain
genes that cause a family cancersyndrome.
(02:40):
That can increase the risk ofovarian cancer.
That can increase the risk ofovarian cancer.
Women who have never beenpregnant or if they have their
first full-term pregnancy afterage 35, or who were never able
to carry a pregnancy to term,also have a higher risk of
(03:05):
ovarian cancer.
If you're over the age of 50,the likelihood of developing
ovarian cancer increases withage.
Like most cancers, if you carrythe BRCA gene, mutations in
BRCA1 and BRCA2 are responsiblefor most, but not all, of the
inherited ovarian cancers.
For most but not all of theinherited ovarian cancers,
(03:33):
mutations in BRCA1 and 2 areabout 10 times more common in
those who have an AshkenaziJewish descent than those in
just the general United Statespopulation.
The lifetime ovarian cancerrisk for women with BRCA1 is
estimated to be between 35% and70%, which means if 100 women
have BRCA1, there's going to be35 to 70 of them who would get
(03:54):
ovarian cancer.
For women with BRCA2 mutation,the risk has been estimated
between 10% and 30% by age 70.
Estimated between 10 and 30% byage 70.
And these mutations increasethe risk for primary peritoneal
carcinoma and fallopian tubecarcinoma.
In comparison, the averagepopulation, the ovarian cancer
(04:18):
risk for females is less than 2%.
Now, if you haven't heard theprior podcast that I did with a
medical breast specialist, drHolly Peterson, on big gene
mutations, intermediate genemutations and lesser gene
mutations, that's a really goodpodcast to go back and listen to
(04:39):
.
Also, at the beginning ofseason three in January, I did
an interesting podcast withgenetic counselor Ryan Noss on
the GINA law.
So if you or a loved one has agenetic mutation and you have
(04:59):
offspring, that's reallycritically important to
understand the GINA law andperhaps the best time for
testing Now.
Other risk factors for ovariancancer is being overweight or
having a very high BMI.
Obesity has been linked to ahigher risk of developing many
(05:22):
cancers, including uterine orendometrial cancer.
The current informationavailable for ovarian cancer and
obesity is not as clear Obesewomen that have a body mass
index of at least 30, which isconsidered obese, most likely
have a higher risk of developingovarian cancer, but not
necessarily the most aggressivetypes, like the high grade
(05:46):
serous cancers.
Obesity may also negativelyaffect the overall survival of a
woman with ovarian cancer, justlike with any medical condition
metabolic syndrome, diabetes,hypertension, sleep apnea all of
these things tend to compoundwhen there's too much visceral
(06:09):
body fat.
Now, talcum powder has beenlinked to ovarian cancer.
And, importantly, what are someof the things that you can do
to lower your risk of ovariancancer?
If you don't yet have ovariancancer, if you've got women in
your life that you're concernedabout, certainly, studies show
(06:33):
that women who have children andwho breastfeed, as well as who
use hormonal contraceptives likeestrogen, progesterone pills,
patches or a vaginal ring, aremuch less likely to develop
ovarian cancer, because thesefactors decrease the number of
times that a woman ovulates, andstudies suggest if you reduce
(06:54):
ovulation, you can reduce therisk of ovarian cancer.
So, pregnancy and breastfeedingWomen who have been pregnant
and carried the baby to termbefore age 26 have a lower risk
of ovarian cancer than women whohave not, and that's true with
breast cancer, especially underthe age of 18 to 20.
(07:15):
And breastfeeding may lower theovarian cancer risk further
because it stops ovulation manytimes for several months Not
always, and usually once solidsare introduced, by six months,
there is ovulation.
Now, interestingly, womenwho've used hormonal
contraceptives.
(07:36):
So we're not talking about theIUD, we're not talking about the
diaphragm or spermicides.
We're talking about usingsomething that has an estrogen
and a progestin in it thatinhibits ovulation, and this
risk is lower the longer thetime pills are used and it
continues for several yearsafter the pill is stopped.
(07:57):
Now other forms of birthcontrol, like tubal ligation,
especially complete removal ofthe tube, salpingectomy
dramatically reduces the risk ofovarian cancer.
In fact, in women at high riskfor ovarian cancer but who are
still just a little too young tolose their ovaries, many times
(08:20):
they'll undergo completesalpingectomy.
Many times they'll undergocomplete salpingectomy.
Maybe use of certainintrauterine devices may be
associated with slightly lowerrisk of ovarian cancer, but not
as consistently and the data isnot as robust as with hormonal
contraceptives.
So incessant ovulation isn'treally what the body was
(08:43):
designed to do.
Incessant ovulation isn'treally what the body was
designed to do.
Now, if you have a hysterectomyand you remove the uterus but
leave the ovaries, but take outthe tubes.
This also does reduce ovariancancer.
Menopause itself does not causeovarian cancer, and neither
(09:13):
does taking menopausal hormonetherapy.
Now what are the symptoms ofgetting ovarian cancer?
Well, early on there may bevery few symptoms.
The first sign may be aslightly enlarged ovary.
The ovaries are located deepwithin your pelvic cavity, so a
(09:35):
lot of times swelling is notnoticed until it's more advanced
.
Women typically seek care whenthey notice abdominal swelling
due to fluid that accumulates inthe abdomen.
Some women may notice urinarychanges such as increased
frequency or discomfort withurination.
Now, most urinary frequency andpain with urination is from
bladder infections or otherbladder problems, but one always
has to think about ovariancancer.
(09:57):
Symptoms of more advancedovarian cancer include a swollen
abdomen caused by buildup offluids produced by the tumor,
lower abdominal and leg pain, asudden weight loss or weight
gain, nausea, swelling in thelegs and change in bowel or
(10:19):
bladder function.
Also, women with ovarian cancermay complain of abdominal
bloating, gas, heartburn,intolerance to certain foods or
what we call early satiety, kindof getting filled up a little
too fast.
When these symptoms occur, manytimes the tumor has spread
(10:41):
outside the ovary.
Tumor has spread outside theovary and unfortunately, despite
a lot of common urban myths,there is no reliable screening
test for ovarian cancer.
So we're getting down to how canyou protect yourself from
getting ovarian cancer?
And you have been listening tothe Speaking of Women's Health
(11:01):
podcast.
I'm your host, dr Holly Thacker, in the Sunflower House in
September of 2025.
September is Ovarian CancerAwareness Month and we're
talking about how one canprotect themselves from ovarian
cancer and it's not easy, butthere are steps that you can do
(11:21):
to be proactive.
Get a regular pelvic exam.
If you have any irregularvaginal bleeding or abdominal
pain or discharge, you need tobring it to your women's health
clinician's attention.
You also need to bring it toyour healthcare team's attention
(11:43):
if there's a close familymember, like a mother, sister or
daughter or grandmother, withovarian cancer.
Discuss your risk factors withyour physician.
Do not use talcum powder on ornear the vulva or vagina.
Eat a heart.
Healthy whole food diet healthywhole food diet.
(12:05):
And if you're not planningpregnancy or breastfeeding, talk
to your healthcare clinicianabout extended use of hormonal
contraception to reduce the riskof ovarian cancer.
Make sure you tune into ourfuture podcast with nurse
practitioner Dana Leslie, wherewe're going to talk about how we
(12:27):
profile different types ofhormonal contraceptives and just
contraception in general,depending on the woman's profile
.
And then if you have the BRCAgene or a strong family history,
you may need to be referred forgenetic counseling.
And even if your geneticcounseling is negative, if there
(12:50):
is a strong family history ofovarian cancer, you may want to
consider removal of the tubesand the ovaries after completing
your family after age 40.
Removing the ovaries before age40, even with estrogen therapy,
(13:10):
does still confer some increasein neurologic problems.
So ideally we like women tomake it to age 40.
Now there is a survivaladvantage to keeping your
ovaries up to age 65, unlessthere's BRCA gene, diseased
ovaries or a family history ofovarian cancer and it's kind of
(13:34):
an individual decision.
And so if a woman is over 65,especially if she knows she's
going to take a systemic orvaginal estrogen, post
hysterectomy and oophorectomy,estrogen post hysterectomy and
oophorectomy I usually recommend, if they're in there and you're
(13:54):
over 65 or you don't know whatyour family history is, to go
ahead and take the ovaries.
But under that age 65, even ifyou're in menopause, there's
still substances that theovaries make.
So we don't go around justdoing ovary removal on all women
who are past childbearing.
Now for some women and also itdepends on the family history of
the onset of breast and ovariancancer, but sometimes with
(14:17):
BRCA1, it's recommended to eventake the ovaries and tubes
before the age of 40.
Now if you're going to undergoremoval of ovaries and tubes and
you're not planning to have invitro fertilization to carry a
pregnancy, I usually willrecommend that the uterus be
(14:39):
taken out at the same time,because then you can just give
estrogen, and estrogen alonereduces breast cancer.
Now it does take a little bitlonger surgery and of course,
each case is unique and you needto speak to your gynecologic
oncology surgeon.
And this podcast is not medicaladvice.
(15:01):
It's just giving youinformation to empower you to be
strong and be healthy and be incharge.
But I have a number of womenpost ovary and uterus removal.
Some of them have had abnormalPAPs that progress, or fibroids
or adenomyosis, which is thelining of the uterus growing
(15:21):
into the muscle, and theyalready have a diseased uterus
and they already know they wantto be on hormone therapy.
And keeping the uterus in meansthat we have to use progestin
or progesterone or something toprevent any stimulation of the
lining of the uterus and we haveto be a lot more stingy with
the menopausal hormones andcastrated women, ie women who've
(15:46):
had their ovaries removed andare castrated, have no estrogen,
no ovarian hormones, tend tohave more intense menopausal
symptoms, particularly ifthey're younger, and I've even
had women who've had benignovarian tumors removed for
struma ovarii, which produceextra androgens, and they never
(16:07):
had a hot flash in their life.
And then at age 72, after bothovaries are removed, they have
terrible hot flashes because theovarian tumor was producing
testosterone which got convertedto estrogen and body fat.
So they never were estrogendeficient until they had their
ovarian tumors removed.
So some ovarian tumors arehormone producing, many are
(16:31):
cancers of varying degrees, somevery aggressive, some not as
much.
And then there is a class ofovarian tumors called dermoid
tumors, where the ovary cellsdifferentiate into other types
of tissue.
There may be cartilage or hairor even teeth in the tumor, and
(16:53):
usually these are removed justbased on size or bulk symptoms.
But sometimes they're observed.
So what are the stages ofovarian cancer?
If you're diagnosed withovarian cancer, the first thing
the physician usually likes totry to figure out is how far
it's gone, if it's spread.
This medical term is calledstaging.
(17:17):
The stage of a cancer describeshow much cancer is in the body.
It helps determine how seriousthe cancer is, how best to treat
it, and doctors also usuallyuse the cancer stage when
talking about general survivalstatistics.
So ovarian cancer stages rangefrom stage one through four.
(17:37):
As a rule, the lower the number, the less the cancer has spread
, and the higher the number likestage four usually means it's
spread more and it's metastatic.
Although each woman's ovariancancer experience is unique,
cancers with similar stages tendto have similar outlooks and
many times are treated in muchthe same way.
(18:02):
Now the goals of surgery forovarian cancer is to take tissue
samples to get the diagnosisand the stage To stage the
cancer.
Samples of tissues are takenfrom different parts of the
pelvis and abdomen and examinedin the lab, and the factors to
stage or classify ovarian cancerinclude the size of the tumor,
(18:24):
which is T.
Has the cancer spread outsidethe ovary or the fallopian tube?
Has the cancer reached nearbypelvic organs like the uterus or
bladder?
Has the cancer spread to lymphnodes?
N.
Has the cancer spread in thepelvis or around the aorta,
(18:45):
which is the main artery thatruns from the heart down through
the back of the abdomen andpelvis?
These are called para-aorticlymph nodes.
And then, finally, has therebeen spread or metastasis to
distant sites, which is labeledM.
So usually the tumor gets a T,n and an M rating.
(19:05):
Has the cancer spread aroundthe lungs, which can cause fluid
, or to distant organs like theliver or bones?
Sometimes, if surgery is notpossible right away, the cancer
will be given a clinical stageinstead of anatomic surgical
stage, and this is based on thephysical exam, the biopsy and
(19:27):
then the imaging test.
So, moving on to treatingovarian cancer, most women
suspected of having ovariancancer usually will have a mass
on either exam, ultrasound orCAT scan, which is computed
tomography CT scan.
Any woman with a new massshould undergo a preoperative
(19:50):
workup, including blood testsfor CA-125 and a CAT scan, if
not previously done, and themain treatments for ovarian
cancer usually involve acombination of both surgery and
chemotherapy.
Chemotherapy is strong medicinegiven through an intravenous
line to help kill the cancercells.
Unfortunately, chemotherapymany times can kill off regular
(20:14):
cells, especially fast-growingcells, like in the GI tract, the
skin, the hair.
Sometimes debulking surgeriesperform before chemo and other
times it happens afterwards.
So your individual treatmentplan depends on a lot of
different factors, includingyour overall health, your
(20:35):
personal preferences, whetheryou want to plan to have
children if you haven't hadchildren already.
Age alone is not a determiningfactor, since several studies
have shown that older women cantolerate the ovarian cancer
treatments just as well.
So it's important to discussall of your treatment options,
(20:57):
including goals and side effects, with your team to make the
decision that best fits yourneeds.
It's a scary time.
It's important to write downyour questions and to get
answers to anything that you'renot sure about, and some people,
especially if time permits, maywant to seek a second opinion
to give them more informationand feel more confident about
(21:20):
the treatment plan you choose.
Many women feel very confidentwith their expert gynecologic
oncologist and want to get rightto treatment.
Local treatments.
Some are local, meaning theytreat the tumor without
affecting the rest of the body,so local treatments include
general pelvic surgery as wellas localized radiation therapy.
(21:43):
Surgery for ovarian cancer iscomplex.
In most cases, the surgicaltreatment involves removal of
the uterus, both ovaries, thefallopian tubes, nearby lymph
nodes and the omentum, which isthe fatty apron attached to the
large intestine.
The surgeon will remove as muchof the tumor as possible, and
(22:07):
this is a medical process knownas quote debulking.
The procedure can be done inthe traditional manner through
an open incision in the abdomen.
In certain cases it's donelaparoscopically, through a very
small incision using alaparoscope.
The ability to performcomprehensive staging and
(22:32):
removal of the largest bulk ofthe tumor has been shown to be
best performed by a specialistin gynecologic oncology, so
that's someone who's gonethrough medical school and then
an OBGYN residency and then asurgical fellowship in GYN
oncology.
In young women with low-gradetumors who still want to have
(22:55):
children, sometimes only thediseased ovary is removed, with
the remaining ovary watchedclosely for signs of cancer
through imaging labs andphysical exam.
If the tumor has spreadthroughout the abdominal cavity,
women sometimes require removalof part of the intestines to
remove as much a visible tumoras possible.
(23:17):
And removing the intestines,especially if it's the lower
ileum, can affect B12 absorptionand can come along with other
concerns.
Systemic treatments Some of thedrugs or medications used to
treat ovarian cancer aresystemic therapies because they
(23:38):
can reach the cancer cellsalmost anywhere in the body.
They can be given by mouth orput directly into the
bloodstream, and they mayinclude chemotherapy, hormone
therapy, targeted drug therapyand immunotherapy.
Chemotherapy following surgerychemotherapy is used to treat
(24:00):
cancer cells left behind and themicroscopic disease that may be
elsewhere in the body.
So most women with ovariancancer will have chemotherapy
unless their tumor is so lowgrade and only occurs within the
ovaries with cells that do notlook at all aggressive or
worrisome under the microscope.
Typically two drugs are givenin combination and the most
(24:23):
common approach is to givecarboplatinum and Paxlatol
intravenously every three weeksfor six to eight treatments, so
that can be 24 weeks or almostsix months.
Many times a port is insertedso that the veins aren't used up
(24:45):
and that can be accessed rightthrough the port.
So there's a lot of innovationsin both surgery and
chemotherapy that are ClevelandClinic OBGYN Institute and our
gynecologic oncologist teamoffers.
(25:07):
Now egg freezing may beconsidered because it can extend
fertility.
So when young women are facinglife-saving but fertility
damaging treatment for cancerthat's not just of the ovary but
also breast, colon cancer orother common ones to rapidly
freeze eggs and preserve the eggfor future use can be done.
(25:30):
Much the way that men banksperm, egg freezing is a spinoff
of in vitro fertilization.
Now, before startingchemotherapy, patients are given
fertility shots to increasetheir production of eggs, and
the eggs are retrieved orharvested as if they were
undergoing IVF.
(25:51):
So sometimes, if the woman doesnot have a partner, the eggs
can be frozen rather than beingfertilized.
But if there is a partner, it'salways much more ideal to
fertilize those eggs and freezethe embryos, as the defrost and
viability rate is much higherwith frozen embryos than frozen
(26:13):
eggs.
Early detection embryos thanfrozen eggs.
Early detection being able tofind ovarian cancer early could
certainly help our cure rates.
So this is an intense area ofresearch.
One method being tested islooking at the pattern of
proteins in the blood calledprotonomics, to see if we can
(26:35):
find proteins that may tip usoff to this.
What's new on ovarian cancerresearch?
Scientists continue to studythe genes responsible for
familial ovarian cancer, and theresearch is beginning to yield
clues about how these genesnormally work and how disrupting
their action can lead to cancer.
(26:57):
This information eventually isexpected to lead to new drugs
for preventing or treatingfamilial ovarian cancer.
Research in this area hasalready led to better ways to
detect high-risk genes andassess a woman's ovarian cancer
risk.
Assess a woman's ovarian cancerrisk and a better understanding
(27:20):
of how genetics and hormonalfactors, such as hormonal
contraceptive use and theirinteractions, may lead to better
ways for us to prevent ovariancancer, which is really the most
ideal thing to do Now.
There are several othergynecologic cancers that we do
want to be able to focus on,just in general.
(27:43):
Cervical cancer is cancer at theopening of the cervix.
It's usually caused from thehuman papillomavirus.
If you didn't hear my priorpodcast with Dr Sharon
Sutherland on cervical cancerawareness month, that's one to
really pay attention to, andcertainly if you have HPV,
(28:05):
getting yearly pap smears isimportant.
If you don't and you're overage 30, you should have a pap
and an HPV.
I'm not a big fan of only doingjust HPV testing without the
pap, but for some women thatdon't have healthcare access or
don't want to come in and beseen for a pap, there are some
(28:26):
self-collection HPV tests.
Now a lot of women are toldthey don't need one for every
five years.
I think that's a little bitlong and I think ideally to do a
pap every three to four yearsas opposed to waiting to five,
because I see otherwiseresponsible women in my practice
(28:48):
all the time who, five yearssomehow has become seven years.
It's really really ridiculousand it is very treatable,
especially if caught early, andendometrial or uterine cancer is
another cancer that is umpotentially completely curable
(29:09):
if caught early.
So if you're over 40 and youhave abnormal vaginal bleeding,
even if you're under 40 and havea family history or have a high
BMI or have diabetes, it needsto be evaluated.
And getting an endometrialsampling in the office for a lot
of women isn't too much morethan a pap smear, and so early
diagnosis for cervical anduterine cancer are more
(29:34):
successful so far than withovarian cancer.
I have a lot of women come inand say oh well, I heard you can
get an ultrasound and a CA-125.
And really they've been lookedat and they're not screening
tests.
I wish they were.
So your exams and payingattention to symptoms and
knowing your family history.
(29:54):
You know many cancers likebreast cancer and colon cancer
and pancreas cancer and cervicalcancer.
There's been some benefits withadequate vitamin D.
So I am always talking aboutvitamin D, which is not a
vitamin, it's a pro-sterilehormone and if you haven't
(30:16):
listened to my third podcast inseason one, it's all about
vitamin D and the research keepsrolling in and it's cheap and
it's safe and it's available andsometimes non-expensive.
Old, uh, kind of establishedthings don't always get the
attention maybe that they shouldthan you know higher profile,
(30:40):
more expensive therapies ortests.
So I really want to thank ourlisteners for listening to our
Speaking of Women's Healthpodcast.
Don't miss a future one, so besure to hit subscribe or follow
wherever you listen to podcastApple podcasts, spotify, tune in
(31:04):
, amazon music wherever youlisten.
Thanks again and I'll see younext time in the sunflower house
.
Remember be strong, be healthyand be in charge.
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