Dr. Bahaa Awwad talks about ovarian cancer

agh_logoOvarian cancer is a lethal disease, because no screening is available for the general population.

“However, screening is available for those at high risk of developing the disease,” explains Dr. Bahaa Awwad, who will become Almonte General Hospital’s Chief of Obstetrics and Gynaecology in December 2014.

Women with a strong family history of cancer of the ovaries, breast, colon, rectum or endometrium, or who have the BRCA 1 or BRCA 2 gene mutations are at high risk of developing the disease.

“Genetic testing and counselling are available for women who think they may have BRCA 1 or 2,” says Dr. Awwad. “If they have these gene mutations, surgical removal of the ovaries and fallopian tubes by age 40 can cut their risk by 90 per cent.” For women with a strong family history, or who have BRCA 1 or 2 and don’t want preventative surgery, Dr. Awwad suggests they have a CA125 blood test and a transvaginal ultrasound every six to 12 months.

One in 70 women will develop ovarian cancer. “It can develop at any age, but women aged 50 to 60 are at higher risk,” says Dr. Awwad.

Exposure to high estrogen levels plays a role in ovarian cancer. “Women who have been on a higher dose of estrogen replacement therapy for a longer time, who have never been pregnant, who started menstruating before age 12 or who stopped after age 53, who have undergone fertility treatments, who have had polycystic ovary disease and smokers are at higher risk,” he adds.

There are two types of ovarian cancer. In the primary type, the cancer originates in the ovary. In the secondary type, it begins in another organ and spreads to the ovaries.

Tumours may develop in any of the ovaries’ three layers, although 70 to 90 per cent develop in the outer, or epithelium layer.

“Symptoms of ovarian cancer are often non-specific,” says Dr. Awwad. “Patients may complain of abdominal pressure, pain or discomfort or that their clothing feels tight around their waist. Pressure on the bladder or rectum may cause symptoms, and there may also be weight loss, nausea, vomiting, vaginal bleeding and swelling in the legs.”

A diagnosis to confirm ovarian cancer is done by laboratory examination of tissue or fluid.

In Stage 1 ovarian cancer, the disease is confined to one or both ovaries. Stage 2 means the cancer has spread to the pelvis, Stage 3 means it has spread to the abdomen and Stage 4 means it has spread beyond the abdomen.

“Treatment usually involves debulking: removing the ovaries, uterus fallopian tubes and as much diseased tissue as possible,” says Dr. Awwad. “This may be followed by chemotherapy, radiation or both.”

Every year, 200,000 women in North America develop ovarian cancer, and the overall survival rate is 46 per cent. “By the time ovarian cancer is diagnosed, it is often so far advanced it is terminal,” says Dr. Awwad.

Women who take birth control pills for at least five years can cut their risk of developing ovarian cancer by 50 per cent, Dr. Awwad says. “See your doctor for regular checkups, including a pelvic examination,” he adds.