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Ovarian Cancer: It’s Not All About the Genes!

Ovarian cancer is the fifth most common cancer for women, but it is Canada’s most fatal women’s cancer. In 2016, an estimated 2,800 Canadian women will be diagnosed with ovarian cancer, and approximately 1,750 will die from the disease. 

Ovarian Cancer Basics

Ovarian cancer is a malignant tumour that starts in cells of the ovary and can metastasize, or spread, to other parts of the body. There are different types of ovarian cancer, classified according to the cell from which they start and comprised of distinct sub-types.

  1. Epithelial ovarian carcinomas: the most common type (approximately 90%) of ovarian cancer.
  2. Germ cell ovarian cancer: represents 5-10% of ovarian cancer diagnoses, and tends to affect women in their twenties.
  3. Sex cord stromal cell cancer: accounts for less than 5% of ovarian cancer.
  4. Extra-ovarian primary peritoneal carcinoma: is a rare type of ovarian cancer that can develop outside of the ovaries, in the peritoneum.

Determining the type of cancer, via biopsy, is crucial. Ovarian cancer is not simply one disease, but a spectrum of diseases that respond differently to treatment.

Risk factors

All women run the risk of ovarian cancer simply by virtue of the fact that they have ovaries. Like most cancers, ovarian cancer is the result of many risk factors. Among these, a family history of the disease is often considered the most important factor for developing ovarian cancer. However, statistics show us that only about 5%–10% of women with ovarian cancer have a family member who were diagnosed with this disease. Moreover, it is not clear whether the family’s pattern of cancer is due to the inherited genetic risk itself, the shared lifestyle factors including diet and environment, mere chance, or a combination of these factors.

BRCA gene mutations

The BRCA gene became a mainstream topic in May 2013 when actress Angelina Jolie went public about her preventive double mastectomy after discovering that she carries this inherited mutation. Breast Cancer Gene 1 (BRCA1) and Breast Cancer Gene 2 (BRCA2) normally help control the growth of cancer cells (tumour suppressors genes). Women who test positive for BRCA1 or BRCA2 gene mutation are considered at increased risk for both breast and ovarian cancer. However, in spite of the emphasis placed on the BRCA gene by the media and the pharmaceutical industry we must bear in mind that only a small number of ovarian cancers (5%–10%) are related to a specific inherited genetic abnormality and that not all women with mutations in these genes will develop ovarian or breast cancer. Therefore, it is important for women to fully assess their risk profile with a qualified healthcare practitioner before they make a decision on treatment.

Warning Signs

**Note: Information below is merely for reference and should not be considered to be a diagnostic tool. Please see a qualified healthcare practitioner for a full work up.

In its early stages, ovarian cancer may not cause any signs or symptoms. They may appear once the tumour grows into surrounding tissues and organs. The following warning signs can be associated with ovarian cancer, but they can also be caused by several other health conditions. Any concern or unusual symptom should be discussed with your healthcare provider.

Possible Warning Signs of Ovarian Cancer:
Abnormal vaginal bleeding
Vaginal spotting in post-menopausal women
A lump that can be felt (palpable) in the pelvic or abdominal area Feeling of bloating or pressure in the pelvic or abdominal area
Pain in the legs, lower back, pelvis or abdomen
Painful intercourse
Need to urinate often (frequency) or intense need to urinate (urgency) Buildup of fluid in the abdomen (ascites)
Unintentional weight loss

Diagnosing Ovarian Cancer

At this time, there are no reliable screening tests available for ovarian cancer, but a number of standalone tests are currently in development. If you have signs or symptoms of ovarian cancer, your doctor will usually perform a combination of a complete pelvic exam, transvaginal or pelvic ultrasound and CA-125 blood test. They may also use a CT/PET scan, but ultimately, the only definitive way to determine if you suffer from ovarian cancer is through a biopsy.

Ovarian Cancer Research

Ovarian cancer research is an evolving field involving more than 60 ovarian cancer researchers across the country. This growing research community has led to a number of recent discoveries including the FANCI gene – an emerging ovarian cancer susceptibility gene – currently investigated by a group of researchers led by Dr. Patricia Tonin from the Research Institute of the McGill University Health Centre. The FANCI gene works with BRCA1 and BRCA2 genes to repair damaged DNA.

Cancer research is big business. On the website of Ovarian Cancer Canada, we can read that they support a concerted effort to obtain an immediate additional investment of $10 million in federal funding. This type of research provides extremely valuable information, but it tends to focus on genetics and is often aimed at testing targeted treatments. Given the well-accepted fact that most cancers – including ovarian cancers – result from a combination of factors in which genetics only account for less than 10% one must really wonder why we are not placing more emphasis on investigating the other contributing factors accounting for up to 90 % of the ovarian cancer cases including diet and lifestyle factors?

At this time, ovarian cancer is often diagnosed in its late stages which is associated to poor outcomes. So by and large, your best route is still prevention. There are a number of lifestyle and dietary changes you can make to help lower your risk of ovarian cancer. These factors equate for a far greater percentage than our ‘bad genes’ and we have a direct control over them. So a genetic predisposition should only serve as a catalyst to adopt a healthier lifestyle. 

Chantal Ann Dumas, ND

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