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Ovarian cancer is the most deadly disease of the female reproductive system, with most cases diagnosed in later stages. Yet while ovarian cancer affects 1 in 70 women in the United States, many women have never discussed the risk with their doctor.

According to Dr. Sharyn Lewin, a gynecologic surgical oncologist at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, talking with your doctor is especially important for women with a personal or family history of premenopausal breast cancer, ovarian cancer and other cancers. These women may have a genetic abnormality that greatly increases their risk for the disease.

"While we can link only 10 to 13 percent of ovarian cancers to hereditary causes, it's important that these women are aware of their risks and preventive strategies," states Dr. Lewin, assistant clinical professor in the Division of Gynecologic Oncology of the Department of Obstetrics and Gynecology at the Columbia University College of Physicians and Surgeons. "Women with mutations in the BRCA1 or BRCA2 genes — most commonly seen with premenopausal breast cancer, but also with pancreatic cancer — have a 10 to 60 percent chance of developing ovarian cancer, as much as 45 times the risk of the general population. Another genetic syndrome called HNPCC is a red flag for ovarian cancer, as well as cancer of the colon, uterus, stomach and small bowel. Any woman with a personal history of these cancers, or who has more than one immediate family member with the diseases, should talk with her doctor about being tested for these genes.

"Unlike with cervical cancer, there isn't an effective way at present to screen the general population for ovarian cancer, but there are important ways women can reduce their risk," continues Dr. Lewin.

Prevention

While most women's lifetime risk for having ovarian cancer is less than 2 percent, women with one of the three high-risk genetic mutations (or defects) have between 10 and 60 percent lifetime risk. This risk increases with age.

"For women testing positive for mutations in BRCA1, BRCA2 or HNPCC, I recommend that if they aren't trying to have children, they should have their ovaries and fallopian tubes removed — something that can be done by minimally invasive surgery," states Dr. Lewin. "This effectively reduces their chances of getting ovarian cancer.

"Women with high-risk genetic mutations wanting to have children can choose to be monitored by a combination of regular blood testing and ultrasound evaluation. However, this method has limitations and most ovarian cancers aren't detected until they reach a later stage."

Another option is freezing their eggs prior to having their ovaries and tubes removed. These eggs can be fertilized by in vitro fertilization and implanted in their uterus.

Beyond genetic testing, preventing ovarian cancer means being aware of its symptoms, although they often appear only after the cancer has spread. "Ninety percent of ovarian cancers are not genetic, so it is important that women know the warning signs. Persistent symptoms like abdominal pain, urinary urgency and bloating would warrant evaluation, especially if digestive and urinary conditions are ruled out," Dr. Lewin says.

"While women cannot control the genetic and environmental factors that give rise to this cancer, there is a lot they can do to make a difference, including preventive measures like good diet, exercise and annual doctor's exams," she adds. "Oral contraceptives have also been shown to reduce risk for ovarian cancer."

Why Surgical Experience Is Important

After diagnosis is made, the next step is surgery to remove the cancer. Research has shown a major difference in outcomes between surgeons with expertise in this type of surgery and those without.

"Surgeons with specialized training and experience can maximally remove tumors in more than 75 percent of cases, compared with 25 percent or less for inexperienced surgeons. This translates to a 50 percent improvement in survival, adding more than a year to a patient's life," says Dr. Lewin. "In cases of early-stage ovarian cancer, we can improve recovery time by using minimally invasive surgery with high-precision robotic equipment."

Additional treatment may include chemotherapy medications, radiation and immunotherapy. Treatment plans are individualized to minimize side effects while maximizing quality and length of life.

For more advanced cancers, Dr. Lewin recommends both intravenous chemotherapy and chemotherapy applied within the abdominal cavity, an approach proven to extend survival. She is also studying the use of heated chemotherapy, which has been shown to be effective in treating other cancers.

A Personal Approach

At NewYork-Presbyterian/Columbia, patients see one doctor who provides a very personalized approach to cancer care. "As gynecologic oncologists, we both operate on patients and administer chemotherapy," explains Dr. Lewin. "This fosters an intimate environment, allowing us to get to know patients and their families and make them feel comfortable."

"An important part of treating cancer is listening to the patient. This includes making sure their emotional needs are met," Dr. Lewin adds. "We understand how hard it is to go through this experience and we make an effort to give them the support they need with access to psychological counseling and peer groups."

Dr. Sharyn Lewin

Dr. Sharyn Lewin joined NewYork-Presbyterian Hospital/Columbia University Medical Center after completing her fellowship in gynecologic oncology at Memorial Sloan-Kettering Cancer Center. Before relocating to New York, she did her residency at Washington University School of Medicine in St. Louis. She graduated with honors from the University of Kansas in both her undergraduate and medical school studies. She is one of only a few female gynecologic oncology surgeons in the United States.

Dr. Lewin has extensive training in minimally invasive laparoscopic surgery and robotic techniques using the da Vinci Surgical System, and surgical expertise with early and late-stage ovarian cancer. She is helping lead clinical research studies, including the use of heated intraperitoneal chemotherapy, and has clinical experience and research interests in survivorship and quality-of-life studies as well as end-of-life care.

She has won numerous teaching and research awards, including the prestigious Society of Gynecologic Oncology's President's Award. She has authored over a dozen articles and textbook chapters. She is a participating member of the Gynecologic Oncology Group, Alpha Omega Alpha Honor Medical Society and Society of Gynecologic Oncologists.

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,353 beds. The Hospital has more than 1 million inpatient and outpatient visits in a year, including more than 220,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the most comprehensive medical research enterprise in New York City and State and one of the largest in the United States. Columbia University Medical Center is affiliated with NewYork-Presbyterian Hospital, the nation's largest not-for-profit, non-sectarian hospital provider. For more information, please visit www.cumc.columbia.edu.