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The Dose Transcript for February 8, 2023

Host: Dr. Brian Goldman

STORIES FROM THIS EPISODE

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to the dose. An estimated 3000 people are diagnosed with ovarian cancer each year in Canada. Experts last week announced that women should seriously consider having their fallopian tubes removed to prevent the cancer. So this week we're asking how can I lower my risk of ovarian cancer? Hi, Paige. Welcome to the dose.

PAIGE GIBBINGS: Hi, how are you?

BRIAN GOLDMAN: I'm just fine. And, you know, I'm kind of curious. What's the number one thing you wish women knew about ovarian cancer that they may not know?

PAIGE GIBBINGS: I wish women knew about cancer, which they might not know is probably the the different symptoms that women see when they have ovarian cancer that are very common symptoms to be seen with many other, you know, everyday health problems that they have like bloating or different tiny symptoms like that that can actually be be a big cursor to ovarian cancer.

BRIAN GOLDMAN: So you kind of wish that if they have those symptoms, they actually think ovarian cancer, which they may not think otherwise.

PAIGE GIBBINGS: Absolutely. Yeah. It can definitely just be attributed to, you know, maybe a little stressor in your life or maybe you ate something that didn't agree with you that morning.

BRIAN GOLDMAN: Okay. Well, let's get into our conversation in just a moment. But before we do that, can you give us a. Hi, my name is tell us what you do and where you do it.

PAIGE GIBBINGS: Yeah, absolutely. My name is Paige Gibbings. I am a registered nurse, but actually the clinical coordinator for the Ovarian Tumor Surgical Program at Princess Margaret in Toronto.

BRIAN GOLDMAN: Why don't you start us off by talking about the different types of ovarian cancer?

PAIGE GIBBINGS: So we have three different types of ovarian cancers. We have epithelial ovarian carcinomas, germ cell tumors and stromal cell tumors. Epithelial ovarian carcinomas account for about 85 to 90% of all cancer, all ovarian cancers that we see. It originates in the outer covering of the ovary. And nearly 70% of this of people diagnosed with this type of cancer. It's diagnosed in the advanced stages. So stage three or stage four.

BRIAN GOLDMAN: How common is ovarian cancer compared to other cancers like breast cancer?

PAIGE GIBBINGS: So ovarian cancer impacts about one in every 80 females and actually ranks fifth in cancer deaths among women. Two bunch all types of ovarian cancer together. The five year not survival rate of ovarian cancer is about 45%, and especially for the most common type of ovarian cancer being high grade serous. It is a chronic condition. So it's not really a question of if it will recur, but when.

BRIAN GOLDMAN: I've heard that it's considered the most serious women's cancer, why is that?

PAIGE GIBBINGS: So typically it actually goes undetected until very late in the stages. It's pretty much spread throughout the entire abdomen, sometimes into the thorax and the lungs. And also symptoms are very vague and nonspecific and can be caused by a plethora of other things, like you can just get very vague symptoms, bloating, swelling, feeling full bladder and bowel changes, something that you think you know, could be definitely something else and not ovarian cancer as a red flag in your head. Also, there's no screening like we see with other types of cancers, like for cervical cancer. We do pap tests every three years and we have mammograms for breast cancer. But for ovarian cancer, there's nothing really like that.

BRIAN GOLDMAN: It sounds like it's and, you know, certainly in my in my limited clinical experience in the emergency department, it tends to be diagnosed through imaging, through, you know, doing something like a CT scan or an ultrasound. Is that is that usually the way it's detected?

PAIGE GIBBINGS: Yeah, typically on a CT scan. And, you know, typically women will pass on to the emerge, you know, with increased abdominal girth, nausea, uncontrollable pain, things like that. Usually a CT scan is ordered for diagnostic purposes and then a mass is found. And sometimes, but not always. There's a mass on the ovary. It can be you can have ovarian cancer and not even have a mass on your ovary. Sometimes it's just a tumor. And then deposits of smaller tumors or nodules around the abdomen and on the surface, surrounding structures like the amount, the spleen, the liver, the bowel, and sometimes the the tumors even seen infiltrating the bowel because they're in such an intimate proximity of each other. So just because it's ovarian cancer doesn't necessarily mean on the CT scan, you'll see a massive tumor on the ovary.

BRIAN GOLDMAN: Off the top. You you said you want people or I'm putting words in your mouth, but I think you were saying the same thing that you want, you want women to be thinking ovarian cancer. And that makes even more sense if a woman knows that she's at increased risk. So what are some of the risk factors for ovarian cancer?

PAIGE GIBBINGS: Yeah, definitely. Some increased risk factors are for ovarian cancer would be if you have a family history of breast or ovarian cancer, breast cancer and ovarian cancer, very close correlation to each other. Or if you have tested positive for the BRCA, one or two mutations could definitely increase your risk of ovarian cancer. Ah, increased age as well over the age of 55 or post being postmenopausal with your ovaries and fallopian tubes intact.

BRIAN GOLDMAN: For for those of us who aren't in the know, how do you get tested for BRCA1 or BRCA2? Who's eligible for that kind of testing?

PAIGE GIBBINGS: Yeah. So. So if you're worried that you're at a increased risk for for having the BRCA1 or BRCA2 mutations like, you know, you had an aunt that had breast cancer that you're not really you don't really know much about. You can get testing done at your family doctor. And I know actually do some labs do offer it for a fee.

BRIAN GOLDMAN: So you won't be excluded. You won't be told no, you can't get the test if you ask for it, you can get it. You might have to pay for it.

PAIGE GIBBINGS: Yeah. Yeah.

BRIAN GOLDMAN: Should someone with female reproductive organs get genetic testing done to get a better idea of their risk?

PAIGE GIBBINGS: Yeah, I think that that would be, you know, one way to. To find out if you're at a higher risk. But just because you do have the BRCA1 or BRCA2 mutation doesn't necessarily mean you're going to develop ovarian cancer. It just puts you at an increased risk.

BRIAN GOLDMAN: And is it just BRCA1 and BRCA2 or are there other genes that can be tested as well?

PAIGE GIBBINGS: Typically, when you have testing done, they do test for a lot of other genes, but we've seen correlation with the BRCA1 and BRCA2 mutation with ovarian cancer. Those are the two, the two main ones.

BRIAN GOLDMAN: So you've you've mentioned some of the factors that increase the risk. What factors can decrease a woman's risk of getting ovarian cancer?

PAIGE GIBBINGS: Definitely a prophylactic bilateral piccolo For me, which is the removal of both ovaries and fallopian tubes. For women, if they test positive for the BRCA1 or BRCA2 mutation, that surgery can be offered. Also, there's been some research, too, about an opportunistic sparking activity, which is the removal of bilateral fallopian tubes during another gynecological procedure that the woman is already having. Also, maintaining a healthy diet and exercise is very important to decrease your risk of not only ovarian cancer, but any cancer.

BRIAN GOLDMAN: And when you say a healthy diet, you're talking about, you know, what kind of diet are we talking about?

PAIGE GIBBINGS: A balanced diet, You know, fruit, vegetable, protein, definitely carbohydrates to decrease and processed foods as well.

BRIAN GOLDMAN: Do smoking or alcohol intake increase? The risk?

PAIGE GIBBINGS: Definitely could increase the risk.

BRIAN GOLDMAN: So, you know, you were talking about about women who have coincidentally had their tubes and ovaries removed. But when it comes to getting ovarian cancer, which is more important to have removed, which is which is the place where ovarian cancers begin, I mean, they're called ovarian cancers, does that mean they originate in the ovaries?

PAIGE GIBBINGS: Yeah, not actually, no. To, typically for most ovarian cancers, especially their most rapidly dividing ones, the high grade serous that I was talking about, the cancer doesn't start in the ovary at all. It actually starts on the tip of the floating tube and then spreads to the ovary and beyond. So if you do a gynecological surgery that's already planned, like, for example, if you're having a C-section and you know, you don't want to have children anymore or you're having a hysterectomy for reasons like excessive bleeding or fibroids or cysts something other than just necessary for this procedure, they would remove the fallopian tubes at that time to prevent the risk of cancer of developing in the most common area that cancer that ovarian cancer originates while sparing the ovaries, because the ovaries do help secrete different hormones and things like that that are useful later in life.

BRIAN GOLDMAN: And we're talking about surgery because of a statement that came out last week from the Ovarian Cancer Research Alliance. It was endorsed by the Society of Gynecologic Oncology. They're encouraging women, even those women who don't have a high genetic risk to have their fallopian tubes removed once they're done having children. And if they happen to be planning to have gynecologic surgery. So how is it that that's become a recommendation now?

PAIGE GIBBINGS: I think it's become a recommendation now, because we do know that that ovarian cancer does originate most of the time in the fallopian tube or in the tip of the fallopian tube, and then it spreads that way. So if we are removing the fallopian tubes, which is the the originating body for the ovarian cancer, then we actually are decreasing the risk immensely for somebody developing ovarian cancer because we're removing that risk pretty much entirely.

BRIAN GOLDMAN: And if you just get the fallopian tubes removed, that can be enough to lower your risk.

PAIGE GIBBINGS: Absolutely. Typically, like I said, for most ovarian cancers, especially the most aggressive and life threatening types, they actually begin in the fallopian tube and then spread typically beyond over removing a structure where most ovarian cancers begin. We're actually decreasing the development or the risk of developing ovarian cancer immensely.

BRIAN GOLDMAN: And, you know, there's there's some new thinking about the idea of preserving the ovaries and only removing the tubes that that the ovaries may continue to be useful beyond the reproductive life of the woman.

PAIGE GIBBINGS: Yeah, actually, ovaries women's ovaries secretes a lot of hormones that could be very useful later in life. These hormones that they secrete help decrease the risk of heart disease and osteoporosis and sexual dysfunction for the woman. And they're at a much, much lower risk of developing ovarian cancer because typically the ovaries are not where ovarian cancer begins.

BRIAN GOLDMAN: Are there risks or pitfalls to this kind of surgery.

PAIGE GIBBINGS: In an opportunistic removal of the fallopian tubes, the woman would already be having another planned gynecological surgery. So by doing this extra part of the procedure, we're not putting the woman at any higher risk that she would be if she were already having a C-section or a hysterectomy. And we're also sparing the ovaries as well. So we're actually helping the women because they're not going to need any or most likely not going to need any synthetic hormone replacement therapy after getting a surgery like this.

BRIAN GOLDMAN: Obviously, women are going to be listening to us who are terrified of having ovarian cancer, of getting ovarian cancer. Maybe they've got somebody in the family who's had it. Can you imagine women going to a gynecologist now and saying, please, please remove my fallopian tubes?

PAIGE GIBBINGS: Yeah, No, definitely, I, I can. I feel for those women and I understand what they're going through. And I see it every day. And I don't think that a lot of women really necessarily know about. There's not a lot of research about it. It's not it's not as big as when you say breast cancer or something like that. So I definitely feel for women being fearful and and worried and, you know, wanting to do all they can to prevent something like this.

BRIAN GOLDMAN: That's what they want. Will they get it? How much pushback are they likely to get from gynecologists?

PAIGE GIBBINGS: It really depends on what they're asking, I think. I mean, if they're already going in for a gynecological surgery, there's not much harm or really much more effort to remove the fallopian tubes, if that's something that they wish to do.

BRIAN GOLDMAN: Can you talk a little bit more about the symptoms of ovarian cancer, what women should watch out for?

PAIGE GIBBINGS: Yeah, absolutely. So the symptoms of ovarian cancer are really quite broad, very nonspecific. I've had many women that I see in the clinic just, you know, have shrug their shoulders at a different symptoms that they've seen or kind of pushed them aside because they got other things going on their lives in their lives, or they kind of attributed them to different stressors or things like that. But typically, we see, you know, bloating or swelling in the abdomen, not necessarily like a dense abdomen, but but almost like a fluid filled abdomen feeling full or having difficulty eating or finishing meals, only being able to eat, you know, half of your meal or a quarter of your meal, and then having to put it away and eat it again. Abdominal discomfort or cramps. Sometimes this pain is very, very intense and sometimes it's, you know, intense and intermittent and then kind of goes away and then intense again, changes in bowels, bladder habits. So either constipation or diarrhea and urinating more often or more frequently menstrual irregularities, especially in women who are post-menopausal. So spotting and things like that, and then excessive fatigue and tiredness.

BRIAN GOLDMAN: Boy, you know, it's it's one thing for these symptoms to be persistent over, say, three or four months, but it's another thing for them to come and go. How the heck do you begin to tweak to the possibility that it might be ovarian cancer when the symptoms seem to disappear for several months and then recur and then disappear again?

PAIGE GIBBINGS: Yeah. So typically they typically that's why why women are diagnosed in such advanced stages because these symptoms, do they have them a little bit. Then they kind of disappear and they have them a little bit that they kind of disappear and then they happen and they stay and they become very intense. And then that's typically when they seek they seek help or or they go to the doctor and have these scans and then they're diagnosed very late in their in their trajectory in terms of what to look for, you know, to to get diagnosed early. It's it's it's hard to say. It's hard to say in terms of of just kind of knowing yourself and and thinking, you know, this seems a little off or the symptoms lingering a little too long or there's nothing in my life else that could be causing this and and and getting checked at the doctor.

BRIAN GOLDMAN: You know I think I think a lot of us push the thought of having cancer out of our minds. And when the symptoms do begin to go away, we think, oh, good, I don't need to worry about this now. I think what you're saying is not necessarily true, especially if you have risk factors, especially if you're over the age of 55.

PAIGE GIBBINGS: Yeah, exactly. Yeah. If you you know, if you think if you think something is a little bit off, it's your best, best bet to be safe and just go get it. Get it checked. Yeah.

BRIAN GOLDMAN: So what do we know about things that we can do in our lives short of surgery to prevent to help prevent ovarian cancer?

PAIGE GIBBINGS: I mean, there's only a couple of things, really. If you have family members that have had breast or ovarian cancer, it's very important that you go get yourself tested for the mutation and also just staying fit, being active, eating a balanced, balanced, non processed diet and kind of just being alert to these possible symptoms and the possibility of this this this ovarian cancer.

BRIAN GOLDMAN: For people who are listening to this podcast and wondering about their risk of all of their. In cancer. What would you recommend that they do as a first step?

PAIGE GIBBINGS: As a first step? I would probably just just tell them to check in with their selves, you know, go back to the symptoms that I listed and and think back a few months. Did you experiencing any experience, any of these symptoms out of the ordinary or, you know, sometimes were these symptoms lingering a little bit too long? And if you think, yes, I would just contact your family doctor or go to a walk in and and get some diagnostic testing.

BRIAN GOLDMAN: And what if they don't have a family doctor as an increasing number of Canadians don't have one?

PAIGE GIBBINGS: Yeah, a walk in clinic is definitely a good alternative to that. I know that it's not as as clean centered because they don't really know you as a person or if the symptoms, you know, are really worrisome and really severe. You can go to your emergency department as well.

BRIAN GOLDMAN: Well, Page giving, you know, this is a very serious subject, but you've brought some clarity to it. And I want to thank you for appearing on The Dose.

PAIGE GIBBINGS: Thank you so much for having me.

BRIAN GOLDMAN: Paige Gibbings is a registered nurse and the clinical coordinator for the Ovarian Tumors Surgical Program at the Princess Margaret Cancer Center. Here's your dose of smart advice. Ovarian cancer is not the most common type of cancer, but it's one of the most deadly. Unfortunately, all too often women get diagnosed when the cancer is incurable. And unlike cancer of the cervix or breast, ovarian cancer has no screening test like a pap smear or mammogram. All of this makes preventing ovarian cancer a top priority. Knowing your risk is important. One such factor is your age. It's most often diagnosed at age 55 and older. Hormone therapy to control menopausal symptoms increases the risk. Women who have never been pregnant are also at higher risk. Endometriosis is another risk factor. If you have blood relatives who have been diagnosed with ovarian cancer, you may also be at increased risk. Some ovarian cancers are caused by BRCA1 and BRCA2, the genes that also increase the risk of breast cancer. Here's the thing. Most ovarian cancers begin inside the fallopian tubes and not the ovaries. There is growing evidence that having your tubes surgically removed can eliminate the risk of some ovarian cancers. That's why the Ovarian Cancer Research Alliance is urging women who are finished having children and are scheduled to have gynecologic surgery to ask that their fallopian tubes be removed at the same time. This is something you can discuss with your health care provider. Other things you can do to lower your risk include getting regular exercise, eating a balanced diet, and avoiding cigarets and alcohol. Ovarian cancer is often deadly because it's hard to diagnose the most common symptoms. Things like abdominal bloating, feeling full quickly and frequent or urgent urination are often mistaken for other conditions. If you have those kinds of symptoms, don't just pass them off as something minor. Talk to your health care provider. If you have topics you'd like discussed or questions answered. Our e-mail address is the dose at cbc.ca. You can find the dose wherever you get your podcasts. If you like this episode, please rate us five stars so more people can find us. This edition of the Dose was produced by Stephanie Dubois. Our senior producer is Colleen Ross. The dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider now. Dr. Brian Goldman. Until your next dose.

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How can I lower my risk of ovarian cancer? - Transcript

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