Hereditary ovarian cancer

By Dr Niti Raizada

Ovarian cancer is a female-specific disease where certain cells in the ovary become aberrant and grow uncontrollably to create a tumor, roughly striking 90 percent after the age of 40, with most cases occurring post the age of 60. Many, if not all, ovarian malignancies are thought to start in epithelial cells on the fringes (fimbriae) at the end of one of the fallopian tubes.

Is ovarian cancer genetic?
Ovarian cancer is not caused by inherited genetic factors in the majority of instances. These malignancies are linked to somatic mutations acquired during the course of a person’s life, and they do not run in families.

A germline mutation-induced cancer susceptibility is normally inherited in an autosomal dominant manner, meaning that one copy of the changed gene in each cell is enough to raise a person’s risk of developing cancer. Even though ovarian cancer only affects women, the faulty gene can be passed down from either the mother or the father. It’s vital to remember that people inherit a higher risk of acquiring cancer rather than the disease itself.

Not everyone who inherits these gene mutations will get cancer in the end and the genetic foundation for ovarian cancer and the method of inheritance is unknown in many cases of ovarian cancer that occur in families. Up to 25% of ovarian tumors are linked to familial cancer syndromes, which are caused by hereditary alterations in certain genes.

Other cancers ovarian cancer patients could develop
Inherited mutations in the BRCA1 and BRCA2 genes, as well as probably some other genes that have yet to be discovered, cause this syndrome. Breast, and pancreatic cancers, as well as the ovarian, fallopian tube, and primary peritoneal malignancies, are all connected to this disease. Several other gene alterations, such as those associated with Lynch syndrome and the genes BRIP1, RAD51C, and RAD51D, have been linked to an increased risk of ovarian cancer. Women with a BRCA1 mutation are expected to have a lifetime risk of ovarian cancer of 35 to 70%. In comparison, the lifetime risk of ovarian cancer for women in the general population is less than 2%.

Can ovarian cancer be prevented?

Ovarian cancer cannot be completely avoided. However, there may be measures to lower your risk:

Birth control tablets. Consult a doctor to see if oral contraceptives are safe as it reduces the risks of ovarian cancer. However, because some medications have dangers, talk to your doctor about whether the benefits outweigh the risks in your situation.

Consult a doctor about your risk factors. Inform your doctor if you have a family history of breast and ovarian malignancies. A genetic counsellor may be referred to assist determine whether genetic testing is needed. Gene mutations raise the chances of ovarian cancer. Consider ovary removal to avoid cancer.

Treatment options for ovarian cancer
Surgery: Usually treated with a combination of surgery and chemotherapy, some cases may require employing other treatment methods. Either one or both ovaries or the uterus are removed during surgery. And if needed, advanced cancer surgery is performed.

Chemotherapy: a medication treatment employing chemicals to eliminate rapidly multiplying cancer cells in the body. Chemotherapy medications can be given intravenously, orally, or may be heated and infused into the abdomen during surgery (hyperthermic intraperitoneal chemotherapy) and left in place for a period before being drained in some cases. Targeted Therapy: focused on specific weaknesses present within cancer cells, attacks these weaknesses causing cancer cells to die. Hormone therapy: uses drugs that prevent the effects of the hormone estrogen on ovarian cancer cells since some ovarian cancer cells rely on estrogen to develop. It could be used to treat some types of slow-growing ovarian malignancies.

Immunotherapy: a type of cancer treatment that makes use of the body’s own immune system. Because cancer cells develop proteins that assist them to hide from immune system cells, the body’s disease-fighting immune system may not assault them. Immunotherapy works by interfering with the immune system’s natural functioning.

Palliative care: a type of medical treatment that focuses on relieving pain and other symptoms associated with a serious illness to add an extra layer of support to your ongoing treatment. Palliative care can be used with more invasive treatments like surgery or chemotherapy.

(The author is Director - Medical Oncology and HematoOncology, Fortis Hospitals, Bengaluru.)