MIchael Hunter, MD on Medika Life

Tennis Legend Has Ovarian Cancer

LEGENDARY TENNIS PLAYER CHRIS EVERT is sharing information about her recent cancer diagnosis. Here is a tweet from her:

Evert shared more details about her journey in the cancer realm, co-authoring an article with sports journalist Chris McKendry. It is a story of early detection, surgery, and chemotherapy for cancer that began in the tennis great’s fallopian tube.

Today, we look at Chris Evert’s experience before turning to some takeaway messages about cancers of women’s ovaries and fallopian tubes.

Here is how it began, according to a text from Evert to her friend McKendry:

“I can’t talk right now, but the pathology report came back today and revealed I have a malignant tumor in my fallopian tube; going in for more surgery next week then chemo … f — — me…”

Fortunately, the cancer is in an early stage. Evert discovered cancer while having a preventative removal of her uterus (hysterectomy). There appears to be no cancer elsewhere in her body. Now, Evert is receiving chemotherapy.

Ovarian cancer numbers, signs, and symptoms

We typically include cancer in the fallopian tubes under the general category of ovarian cancer. The fallopian tubes extend from the right and left ovaries to connect to the uterus.

There are an estimated 21,410 cases of ovarian cancer in the United States annually, according to the US Surveillance, Epidemiology, and End Results (SEER) database. Ovarian cancer represents 1.1 percent of all cancers and corresponds to about one in 10,000 women.

Photo by Adam Winger on Unsplash

The Mayo Clinic (USA) explains that when ovarian cancer first develops, it is often not associated with apparent symptoms. When symptoms occur, they are often attributed to other, more common conditions. Here are some of the symptoms that may occur:

  • Weight loss
  • Abdominal swelling or bloating
  • Quickly feeling full when eating
  • Pelvic discomfort
  • Tiredness
  • Back pain
  • Bowel changes (for example, constipation)
  • A need to urinate frequently

Please see a health care professional if you have any symptoms of concern.

Ovarian cancer risk factors

It is not clear what causes cancer, but we know of risk factors that increase the probability of getting the disease. Ovarian cancer begins when cells in the ovaries or fallopian tubes develop genetic (DNA) changes or mutations. The cellular DNA instructs the cell what to do.

Mutations can lead the genes to tell the cells to grow and multiply quickly. The result? A mass or tumor of cancer cells. Unfortunately, the cancer cells can break off (metastasize) to spread to other parts of the body.

The American Cancer Society offers these risk factors for ovarian cancer:

  • Being overweight or obese
  • Having no full-term pregnancies before age 35
  • Taking menopausal hormone therapy (estrogen alone or in combination with progesterone)
  • A family history of breast, ovarian, or colorectal cancer
  • A personal history of breast cancer
  • Fertility treatment (in vitro fertilization (IVF) appears to increase a type of ovarian cancer known as “borderline” or “low malignant potential.”
  • Smoking increases the risk of mucinous ovarian cancer

Ovarian cancer — Inherited genetics

The next category applies to our tennis star — her sister died of ovarian cancer in 202 at age 62. The two sisters raced through the airport to make their flight to the WTA Finals in Singapore in October 2017 when Chrissie realized that her sister Jeanne was out of breath and couldn’t keep up.

  • A family cancer syndrome — Up to 25 percent of ovarian cancers are a part of family cancer syndromes secondary to inherited changes (mutations) in specific genes.

In the case of the Evert sisters, both had an inherited mutation in BRCA1 (breast cancer gene #1).

Photo by Artem Kovalev on Unsplash

Ovarian cancer can run in families; the more relatives with the disease, the higher the risk. And remember — this increased risk can come from your mother or your father’s side of the family.

Mutations in the BRCA gene are responsible for most inherited ovarian cancers. BRCA mutations are ten times more common in those who are Ashkenazi Jewish, compared with the general population in the United States.

Listen to this frightening statistic: The lifetime chances of getting ovarian cancer for women with a BRCA1 mutation is 35 to 70 percent. For those with a BRCA2 mutation, the risk by age 70 is between 10 and 30 percent.

Relevant to Chris Evert, these mutations also increase the risk of fallopian tube cancer. In contrast, the lifetime ovarian cancer risk in the general population is less than two percent.

Ovarian cancer prognosis

What are the odds of survival for our beloved tennis star? The US SEER database informs us that the overall survival chances are about 29 percent for ovarian cancer.

Chris Evert joins the 16 percent of those with ovarian cancer who catch it early (having risk-reducing surgery as a “preventative” maneuver). When caught in a localized stage, the odds of surviving ovarian cancer are 93 percent.

Early detection matters — for those with regional disease, the survival rates drop to 75 percent, and if the disease spreads to distant sites, it is 30 percent, looking at the 2011 through 2017 time frame. Fortunately, long-term survival rates have been improving significantly over time.

Ovarian cancer — Lowering your risk

The Mayo Clinic reminds us that there is no sure way to prevent ovary cancer. However, women may reduce their risk by taking birth control pills (oral contraceptives). These medicines have other risks, so it is crucial to dialog with well-informed healthcare professionals.

If you have a family history of breast or ovarian cancers, please discuss this with a health care team member. You may be referred to a genetics counselor. If you have a concerning gene mutation that increases your risk of ovarian cancer, many women consider surgery to remove their ovaries and fallopian tubes as a preventative maneuver.

Someday, we may have a better way to catch ovarian cancer early:Detecting Cancer: Dogs, Electronic Noses, and MoreOVARIAN AND PANCREAS CANCERS are challenging to diagnose early. In this context, I am delighted to bring you good news…medium.com

Left ovarian cancer, Stage IC3, high-grade serous type

As is the case for many women, Chrissie Evert had no noticeable symptoms. This lack of symptoms is not surprising, as early-stage ovarian cancer is challenging to detect. Evert also had annual tests for the cancer antigen 125 protein in her blood, and her imaging (ultrasounds and MRIs) was unrevealing. In this context, listen to Evert:

“I am so lucky. ” Evert speaks with the conviction of someone who has witnessed the unlucky. Continuing, she offers this advice: “Be your own advocate. Know your family’s history. Have total awareness of your body, follow your gut and be aware of changes. Don’t try to be a crusader and think this will pass.”

Ovarian cancer is uncommon. If you have a family history of breast or ovarian cancer, get genetic counseling and testing if indicated). Thank you for joining me today. One more thing: Inherited genetics such as the breast cancer gene mutations (BRCA1 and BRCA2) can affect men, too.

Today, one week ago, I saw this disturbing observation published: “Despite unequivocal recommendations for universal genetic testing in ovarian cancer, only 34 percent of patients [in the USA] with commercial insurance were tested between 2008 and 2018 — clear evidence it remains underused.”

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Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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