By Julie Bromberg
2009
Ovarian cancer is especially traumatic for young women, because treatment usually includes having both ovaries and the uterus removed, causing menopause and making pregnancy impossible. Progress is being made, however. A 2009 study found that young women with the most common type of early-stage ovarian cancer can be safely treated without losing their fertility. Whether or not the woman’s uterus was removed did not affect her more than 90% chances of surviving at least 5 years, and neither did keeping at least part of one ovary instead of removing both ovaries.
As with breast cancer, the traditional treatment approach for ovarian cancer was to remove the organs to prevent the cancer from coming back. The uterus was also removed, since it was not needed by a woman with no ovaries, and it was assumed to be safer to remove a nearby organ where cancer could grow. Younger women who were treated for ovarian cancer underwent early menopause (known as surgical menopause) because of the greatly reduced level of estrogen hormones in their bodies, and lost their ability to have children.
The treatment has been very successful at saving women’s lives, but early menopause is associated with increased risk of heart disease, osteoporosis, cognitive impairment, and early death.
The 2009 study by Dr. Jason Wright from Columbia University and his colleagues analyzed the survival rate of pre-menopausal women age 50 and younger who were diagnosed with early stage (Stage 1) epithelial ovarian cancer between 1988-2004.† The researchers compared 1,186 women who either kept at least part of one ovary or had both ovaries removed. For the one-third of the women who kept at least part of one ovary, the 5-year survival rate was the same as for women who had both ovaries removed. A second analysis of 2,911 women found that while three out of four women with ovarian cancer had their uterus removed, they had the same 5-year survival rate as women who kept their uterus. Regardless of the type of treatment they chose, more than 90% of women were still alive 5 years after their ovarian cancer diagnosis.
Since this research only included pre-menopausal women under 50 with Stage 1 ovarian cancer, it is impossible to know whether older women would have similar survival rates under similar circumstances. Fertility-preserving treatment is risky for women with stage II or later stage ovarian cancer.
The results are very similar to those for breast cancer treatment. Years ago, cancer in one breast was treated by removing one or both breasts, as well as underlying muscles. Over the years, research indicated that women lived just as long with much less radical surgery, and now early-stage breast cancer can be safely treated by removing just the cancer, rather than one or both breasts. The survival rate is identical whether a woman has a lumpectomy, mastectomy, or double mastectomies.
How Can you Detect Ovarian Cancer Early?
For all cancers, early treatment greatly increases the chances of survival. Unfortunately, the early symptoms of ovarian cancer are easily confused with less serious problems, making it difficult for women to know if they need to be tested for ovarian cancer.
If a woman has any of the following symptoms every day for more than 2 weeks, or if the symptoms are more severe or unusual for her, she should talk to her doctor about being tested for ovarian cancer:
- Feeling bloated or swelling in the stomach area
- Pain in the stomach area
- Difficulty eating or feeling full
- Going to the bathroom more often than normal
Bottom Line:
Treatments that preserve the uterus and at least part of one ovary, instead of removing the uterus and both ovaries, can be safe for women younger than 50 who have Stage 1 epithelial ovarian cancer. Premenopausal women with early-stage ovarian cancer who want to preserve their fertility should find a doctor who is experienced in that treatment and find out whether it is a safe option for them.
References:
Wright JD, Shah M, Mathew L, Burke WM, Culhane J, Goldman N, Schiff PB, and Herzog TJ. (2009). Fertility Preservation in Young Women with Epithelial Ovarian Cancer. Cancer, 115: 4118-26. DOI: 10.1002/cncr.24461
American Cancer Society. (2009, Aug. 27). How is Ovarian Cancer Diagnosed? Cancer Reference Information: Ovarian Cancer. Retrieved Nov 11, 2009, from www.cancer.org/docroot/cri/content/cri_2_4_3x_how_is_ovarian_cancer_diagnosed_33.asp
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† 85%-90% of all ovarian cancers are epithelial