Voices

13  Mar  14

SGO Clinical Practice Statement: Genetic Testing for Ovarian Cancer

October 2014

Women diagnosed with epithelial ovarian, tubal, and peritoneal cancers should receive genetic counseling and be offered genetic testing, even in the absence of a family history.

Germline BRCA1 and BRCA2 mutations account for approximately 15% of invasive ovarian carcinomas, and a somewhat higher proportion of fallopian tube or peritoneal carcinomas [1,2,3]. In contrast, borderline ovarian neoplasms are not associated with mutations in BRCA1 and BRCA2 [4]. BRCA1 and BRCA2 mutations lead to a 15-50% lifetime risk of ovarian carcinoma, with an increased risk and earlier onset associated with BRCA1 compared to BRCA2 mutations. A number of other genes have also been shown to cause hereditary ovarian carcinoma.

Nearly one-third of women with hereditary ovarian carcinoma have no close relatives with cancer, and 35% of women with hereditary ovarian carcinoma are older than 60 years at diagnosis. Therefore, all women diagnosed with ovarian, fallopian tube or peritoneal carcinoma, regardless of age or family history, should receive genetic counseling and be offered genetic testing. Careful pre- and post-test counseling is essential to understanding genetic testing options and results. Genetic counseling and testing can be conducted by genetic counselors, as well as other knowledgeable medical professionals.

Identification of hereditary cancer susceptibility allows for identification of cancer risk in other organs. Additionally, genetic results are valuable to inform other family members about their cancer risk, allowing personalized prevention to high risk individuals, including more intensive screening and risk-reducing surgery. Family members found not to carry the mutation may also receive reassurance and avoid unnecessary screening and interventions. New therapies such as PARP inhibitors are currently being tested for the treatment of ovarian carcinoma associated with mutations in BRCA1 and BRCA2 [5]. The Society of Gynecologic Oncology (SGO) encourages the medical community to offer genetic counseling and testing to all women with ovarian, fallopian tube and peritoneal carcinoma.

References

[1]        Pal T, Permuth-Wey J, Betts JA, Krischer JP, Fiorica J, Arango H, et al. BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases. Cancer 2005;104:2807–16.

[2]        Schrader KA, Hurlburt J, Kalloger WE, Hansford S, Young S, Huntsman DG, et al. Germline BRCA1 and BRCA2 mutations in ovarian cancer. Obstet Gyncol 2012;120:235-240.

[3]        Walsh T, Casadei S, Lee MK, Pennil CC, Nord AS, Thornton AM, et al. Mutations in 12 genes for inherited ovarian, fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing. Proc Natl Acad Sci USA 2011;108:18032-18037.

[4]        Romero I, Sun CC, Wong, KK, Bast RC, Gershenson DM. Low grade serous carcinoma: new concepts and emerging therapies. Gynecol Oncol 2013;130:660-666.

[5]        Kaye SB, Lubinski J, Matulonis U, Ang JE, Gourley C, Karlan BY, et al. Phase II, open-label, randomized, multicenter study comparing the efficacy and safety of olaparib, a poly (ADP-ribose) polymerase inhibitor, and pegylated liposomal doxorubicin in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer. J Clin Oncol 2012; 30(4):372–9.

Voices

18  Dec  13 dee-sparacio-blog category Dee Sparacio

Discovering CA-125 | Dee Sparacio

I didn’t even know CA-125 existed until I was diagnosed with Stage 3 ovarian cancer. CA-125 is a “tumor-associated protein” for ovarian cancer. It is found in the blood. Before surgery my CA-125 level was in the high 100’s (below 35 is considered normal). I learned from other women diagnosed with ovarian cancer that their numbers were in the 1000’s when they were initially diagnosed.

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Voices

11  Apr  13 dee-sparacio-blog category Dee Sparacio

Making Our Voices be Heard | Dee Sparacio

“Dear Congressman Holt,

I am a constituent and an eight-year ovarian cancer survivor. I respectfully request that you continue your support of ovarian cancer research …”

This is how I began an email I recently sent to my representative in Washington, DC. In the email I asked him to sign the Fitzpatrick-DeLauro Dear Colleague Letter requesting $20 million for the Ovarian Cancer Research Program, one of the Congressionally Directed Medical Research Programs at the Department of Defense. I sent this email using a system on the Ovarian Cancer National Alliance website. In sending it I added my name to the growing list of survivors who are taking an active role in advocating for research and awareness at the national and state levels.

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Voices

18  Mar  13 dee-sparacio-blog category Dee Sparacio

Waiting for a Revolution | Dee Sparacio

Over the past seven years I have met gynecologic cancer survivors at summits, conferences, workshops and at support group meetings. Many have walked alongside me at 5K’s to raise awareness and funds for research. I have even gotten to know survivors who live in the United Kingdom as part of a Facebook group. In most cases, I doubt our paths would have crossed except for the fact that we were all diagnosed with cancer.
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Voices

31  Jan  13 leigh-seamon category Leigh Seamon

‘It is Unfathomable’ | Leigh Seamon, DO, MPH, FACOG

As oncologists, we routinely discuss proposed treatments, side effects and prognoses with patients and families. But, what happens when you or your family faces the “terrible C?” Part of the healing process for me is sharing my aunt’s story. What follows is the tribute that I recently made at her funeral and by far the most difficult speech that I have ever prepared or given.

Apparently, I knew Elizabeth even prior to my birth—she was Aunt Libby. My sister, Krista, and I have very fond memories of the times we spent with her. There were ice skating and wave pool trips, movies, Easter egg and Christmas cookie decorating, totally cool summer camps at her apartment, many vacations and even a few trips to Disney.

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Voices

10  Dec  12

Ovarian Cancer

Ovarian Cancer Home | General information | Risk Factors | Symptoms
First Appointment | Diagnostic Tests | Stages | Treatment Options | Post-Treatment

Ovarian Cancer Stages

Staging is a standard way of categorizing cancers that is used to determine prognosis and treatment. The staging for ovarian cancer is as follows:

  • Stage I: Cancer is confined to one or both ovaries
    • Stage IA: Growth is limited to 1 ovary with no tumor on external surfaces
    • Stage IB: Growth is limited to both ovaries with no tumor on external surfaces
    • Stage IC: Tumor is either stage IA or IB, but with tumor on surface of one or both ovaries
  • Stage II: Cancer has spread to the uterus or other nearby organs
    • Stage IIA: Extension and/or metastases of cancer to the uterus and/or fallopian tubes
    • Stage IIB: Extension of the cancer to other pelvic tissues
    • Stage IIC: Tumor is at either stage IIA or IIB, but with tumor on surface of one or both ovaries
  • Stage III: Cancer has spread to the lymph nodes or abdominal lining
    • Stage IIIA: Tumor limited to the true pelvis
    • Stage IIIB: Metastasis of abdominal peritoneal surfaces ≤ 2 cm. in diameter
    • Stage IIIC: Peritoneal metastasis beyond the pelvis > 2 cm. in diameter
  • Stage IV: Cancer has spread to distant organs, such as the lungs or liver

Back: What tests might your gynecologic oncologist perform to determine treatment?
Next: What are the treatment options?

Photo courtesy of the Ovarian Cancer Alliance of Ohio

Voices

21  Nov  12

Ovarian Cancer

Ovarian Cancer Home | General information | Risk Factors | Symptoms
First Appointment | Diagnostic Tests | Stages | Treatment Options | Post-Treatment

Symptoms

Ovarian cancer can cause several symptoms, but these symptoms can also be caused by other common conditions. Unfortunately, in its earliest stages, ovarian cancer may not cause any noticeable symptoms. Some symptoms are so vague and can be caused by so many other more common conditions (such as gastrointestinal problems) that women may not pay attention to the symptoms that they have. When symptoms are connected with ovarian cancer, they tend to be chronic and to get worse over time.

  • Abdominal pain and bloating
  • Weight loss
  • Feeling full without having eaten very much
  • Changes in bowel habits, especially constipation
  • Needing to urinate frequently
  • A feeling of fullness in the pelvis
  • Clothes fitting more tightly around the belly
  • Nausea and vomiting
  • Fatigue
  • Lower back pain

Photo courtesy of the Ovarian Cancer Alliance of Ohio

Voices

21  Nov  12

Ovarian Cancer

Ovarian Cancer Home | General information | Risk Factors | Symptoms
First Appointment | Diagnostic Tests | Stages | Treatment Options | Post-Treatment

Risk Factors

Doctors do not know what causes most ovarian cancers. There is no way to predict whether a particular woman will get ovarian cancer. It is possible to develop ovarian cancer without being at high risk, and it is possible to be at high risk and not develop it. However, women who fall into the following groups may be more likely to develop ovarian cancer:

  • Women with a BRCA1 or BRCA2 mutation.
    • These genes are responsible for repairing damage to DNA, a routine process that occurs in all cells. When women inherit a genetic mutation, they are at higher risk for developing both breast and ovarian cancer. While the average American woman has a less than 2 percent risk of developing ovarian cancer, women with a BRCA mutation can have up to an approximate 40 percent risk of developing it. Genetic testing for these mutations is available. It is recommended that women be thoroughly counseled by a genetic counselor or other well-trained healthcare professional before having the test submitted so that they understand the implication for themselves and their families of the results. With this being said, most ovarian cancers are not hereditary.
    • BRCA1 stands for breast cancer type 1 susceptibility.
    • BRCA2 stands for breast cancer type 2 susceptibility.
  • Women with Lynch syndrome (an HNPCC genetic mutation). HNPCC stands for hereditary nonpolyposis colorectal cancer. This type of genetic mutation is associated with a strong family history of cancer, especially uterine, colon or other gastrointestinal cancers.
  • Women who have a strong family history of breast or ovarian cancer
  • Women who have a personal history of breast cancer
  • Women who are on estrogen replacement therapy only (WITHOUT progesterone) for more than five years. Women who are on estrogen replacement therapy WITH progesterone are at lower risk.
  • Women who have had endometriosis
  • Women who went through pregnancy and childbirth later in life, rather than earlier
  • Women are at increased risk for ovarian cancer as they age
  • Women who are obese, especially those who have a BMI of 30 or greater
  • Women who have had gynecologic surgery. However, not all gynecologic surgeries are equally likely to increase a woman’s risk for ovarian cancer.
    • If a woman has had a hysterectomy or her ovaries removed, her risk is reduced dramatically.
    • If a woman has had her tubes tied (a tubal ligation), her risk is also reduced.

Some things reduce a woman’s risk of developing ovarian cancer. Taking birth control pills reduces a woman’s ovarian cancer risk, with about a 50 percent reduction in risk after five years of use. Having children and breastfeeding children also seem to reduce risk.

Photo courtesy of the Ovarian Cancer Alliance of Ohio