Actor and director Angelina Jolie has ignited another worldwide conversation about cancer, revealing in the New York Times on Tuesday that she had undergone surgery, at age 39, to remove her ovaries and fallopian tubes to prevent ovarian cancer. As she did 22 months ago, when she announced that she had had bilateral mastectomies to prevent breast cancer, Jolie cited her elevated risk of contracting the disease, the possible consequences and her desire to inform women of their options.
Only a small percentage of women inherit the same faulty gene, known as BRCA1 — the name stands for breast cancer susceptibility gene. These mutations are most commonly found in women of Eastern European Jewish descent, though other groups, including the Norwegian, Dutch and Icelandic, also have slightly higher rates of these mutations.
The average woman has a 12 percent risk of developing breast cancer sometime during her life. Women who have inherited a faulty BRCA gene are about five times more likely to get breast cancer.
What is ovarian cancer?
Ovarian cancer begins in the ovaries. Women have 2 ovaries, one on each side of the uterus in the pelvis, as shown in the picture below. The ovaries produce eggs (called ova). They are also the main source of a woman’s female hormones, estrogen and progesterone. The eggs travel through the fallopian tubes to the uterus. Here they may be fertilized and develop into a fetus.
Diagnosis of ovarian cancer
The following tests are used to diagnose ovarian cancer:
Blood Test
There is a cancer marker called CA 125 (cancer antigen 125) which is made by certain cells in the body. A high blood level of CA 125 may indicate the presence of cancer, but could also be due to something else, such as infections of the lining of the abdomen and chest, menstruation, pregnancy, endometriosis, or liver disease. This blood test is just one test among others, designed to help the doctor make a diagnosis. Normal blood levels of CA125 alone do not definitely mean there is no cancer either. They are just indications.
Ultrasound
This is a device that uses high frequency sound waves which create an image on a monitor of the ovaries and their surroundings. A transvaginal ultrasound device may be inserted into the vagina, while an external device may be placed next to the stomach. Ultrasound scans help doctors see the size and texture of the ovaries, as well as any cysts.
Laparoscopy and possibly Endoscopy
A laparoscope – a thin viewing tube with a camera at the end – is inserted into the patient through a small incision in the lower abdomen. The doctor can examine the ovaries in detail, and can also take a biopsy (extract a small sample of tissue for examination). The patient will undergo a general anesthetic for this procedure. The doctor may carry out an endoscopy to determine whether the cancer has spread to the digestive system.
Colonoscopy
If the patient has had bleeding from the rectum, or constipation the doctor may order a colonoscopy to examine the large intestine (colon). The colonoscope – a thin tube with a camera at the end – will be inserted into the rectum.
Abdominal fluid aspiration
If the patient’s abdomen is swollen the doctor may decide to carry out this test. A build up of fluid in the abdomen might indicate that the ovarian cancer has spread. A thin needle goes through the skin into the abdomen and a sample of the liquid is extracted. Some of the liquid may be drained into a bag if there is a lot of it (abdominal tap). The fluid is checked in the laboratory for cancer cells.
Chest X-ray
This test will help the doctor see if the cancer has spread to the lungs, or to the pleural space surrounding the lungs.
CT (computerized tomography) scan
X-rays are used to create a 3-dimensional picture of the target area.
