Ovarian Cancer Day: Expert On Epithelial Ovarian Cancer? What Are The Risk Factors?

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World Ovarian Cancer Day is observed on 8 May every year. "No Woman Left Behind," is the theme for World Ovarian Cancer Day 2023.

One on each side of the uterus, the ovaries are a pair of pelvic organs in the female reproductive system. Fallopian tubes are paired organs on each side of the uterus and the peritoneum is the epithelial lining of the abdominal cavity.

Cancers that begin in the epithelial cells that line the ovary, fallopian tubes, or peritoneum are collectively called as epithelial ovarian, fallopian tube, and peritoneal cancer. These cancers share many similarities with ovarian cancer in biology, symptoms, and treatments.

According to Globocan 2020 data, approximately 3,00,000 women were diagnosed with ovarian cancer, and it accounted for 200000 deaths. 1 in 78 women has the risk of getting ovarian cancer in her lifetime.

Epithelial ovarian cancers arise either from the fimbriated end of the fallopian tube or probably from the implantation of fallopian tube cells into ovarian surface epithelium after ovulation a process known as endosalpingiosis. Another theory says that they arise from inclusion cysts beneath the ovarian surface.

Cancer subtypes

Type I tumors are low grade and when confined to the ovary as in early stages, they have an excellent prognosis. These tumors include low-grade serous, endometrioid, clear cell, and mucinous carcinomas expansile grade1/grade2 types.

In contrast, type II tumors are high-grade tumors, mostly presenting at advanced stages approx 70% of cases, and have a poor prognosis. These are predominantly high-grade serous carcinomas (HGSCs), clear cell carcinomas, carcinosarcomas, and undifferentiated carcinomas.

Type I tumors are thought to arise from either ovarian surface epithelium and müllerian inclusions, or endosalpingiosis following ovulation. They can also arise from endometriosis. In contrast, the HGSCs (type II) arise from the fimbriated end of fallopian tubes/STIC lesions.

Risk factors

Any factor that increases the chance of getting a disease/cancer is called a risk factor. Any woman having a risk factor does not mean that she will get cancer or not having risk factors doesn't mean that she will not get cancer.

• Low parity, nulliparity, and infertility
• Women who never breastfed
• Women who had received estrogen replacement therapy only for more than 10 years without progestin were at increased risk (especially post-menopausal hormone therapy)
• In many geographical regions of the world, ovarian cancer incidence varies. Western countries have an incidence of ovarian cancer that is 3 to 7 times higher than in Japan.
• Ashkenazi Jews ethnicity are at increased risk
• Age- as you get old risk increases
• Family history of ovarian / breast, endometrial, and colorectal cancer
• Family or personal history of certain genetic mutation, e.g., BRCA genes, MMR proteins
• Various other genetic diseases, such as Lynch syndrome and hereditary nonpolyposis colorectal cancer (HNPCC).
• Endometriosis
• Obesity

There are several lifestyle changes and preventive methods that can reduce your risk of developing the disease

• It has been found in many studies that women who have given birth, breastfed their babies, and intake OC pills are at a lower risk of ovarian cancer.
• Eating a healthy diet that is rich in fruits and vegetables and contains whole grains, and proteins can help reduce the risk of ovarian cancer. We should also limit the consumption of processed and red meats.
• Engaging in regular physical activity can help reduce the risk of ovarian cancer. Aim for at least 30 minutes of moderate exercise most days of the week.
• Maintaining a healthy weight is a marker of a healthy being, and rightfully so because being overweight or obese can increase the risk of many diseases including ovarian cancer.

Management of Women at High Risk for Ovarian Cancer

The management of a woman must be individualized depending upon several factors such as the age of the patient and reproductive desires. She should be evaluated by a geneticist and oncologist.

There are no recommended guidelines for screening for ovarian cancer. However, certain societies suggest screening of women with high-risk to undergo TVS trans vaginal ultrasound and CA125, as well as mammogram/MRI breast.

The NCCN guidelines recommend risk-reducing Bilateral salpingo-ophorectomy (BSO), at 35 to 40 years of age for BRCA1 carriers and at 40 to 45 years of age for BRCA2 carriers. If the family is completed and does not wish fertility hysterectomy with BSO is suggested.

For women with a family history or personal history of Lynch syndrome hysterectomy with BSO after childbearing is complete and colonoscopy annually.

"An ounce of prevention is worth a pound of cure"- Benjamin Franklin.

Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.