Ovarian Cancer in Young Women - Types, Treatment, and Prognosis

What is Different About Ovarian Cancer in Young Women?

Does ovarian cancer occur in young women?. Istockphoto.com/Stock Photo©bbtomas

Ovarian Cancer in Young Women

Ovarian cancer does occur in young women, yet there are several ways it is different than in older women.  What are some of these differences?

Differences Between Ovarian Cancer in Younger Women and Older Women

Although epithelial ovarian cancer is infrequent in women under 40 years of age, it can and does occur in young women. When found in a woman's 40s, or before she reaches them, it is more often related to hereditary factors and BRCA1 or BRCA2 (genes that greatly increase one's risk of both ovarian and breast cancer).

Even at earlier ages, especially when there is a family history of these cancers, paying attention to persistent abdominal and pelvic symptoms is important.

Common Types of Ovarian Cancer in Young Women

Ovarian cancer is actually a spectrum of diseases, and there are more than 30 known subtypes. Each type can behave differently and respond differently to treatment plans. There are two major categories of ovarian cancer that occur mainly in younger women: germ cell and sex-cord stromal tumors. Here is a brief overview of each:

Germ Cell Tumors

These cancers arise from the cells in the ovary that are meant to become eggs and are rare, representing only 5% of all ovarian cancers. Around 70% of these tumors are diagnosed early, but they tend to be fast growing tumors.  These tumors are most commonly found in women in their early 20's.  The main sub-types in this category include:

  • Dysgerminomas
  • Endodermal sinus tumors
  • Immature teratomas

Tumor markers -These cancers often produce tumor markers -- LDH, AFP and hCG -- that are measurable in the blood. These are essentially clues that may help physicians determine, even before surgery, what the likely sub-type is.  If you recognize hCG, it is because it is the hormone that's tested for in pregnancy tests.

  Since these tumors may secrete this hormone, and since one of the symptoms of ovarian cancer is abdominal distention, these tumors are at first sometimes misdiagnosed as pregnancy.

Treatments - Surgery is required to determine the exact subtype and see if the cancer has spread.  Many women are concerned that choosing surgery as a treatment option will affect their fertility. In many cases, however, only one ovary needs to be removed, so fertility is often -- though not always -- able to be spared. In this case, the other ovary, fallopian tube and the uterus are left in place, and pregnancy can usually occur normally.  They tend to be very sensitive to chemotherapy and therefore are often curable, especially when found in early stages.  The treatment for immature teratoma is more complex than for the other germ cell tumors.

Sex Cord Stromal Tumors

These cancers begin in the connective tissue cells that essentially hold the ovaries together and produce hormones such as estrogen, progesterone and testosterone.

They represent about 6% of all ovarian cancers and mainly occur in young women. In general, they tend to be slow growing tumors. The main subtypes are;

  • Granulosa stromal cell
  • Sertoli-Leydig tumors

Granulosa stromal cell tumors may produce a hormone called inhibin, which can be used as a tumor marker. Diagnosis is usually made in an early stage of the disease, and the “adult” form (usually found in patients over age 40) is usually not very aggressive. However, the so-called “juvenile” form (most but not all cases arise in the first 20 years of life) is more often found in advanced stages. Unfortunately, it is not very responsive to chemotherapy.

Malignant (cancerous) Sertoli and Sertoli-Leydig cell tumors are quite rare. Most are either benign or non-aggressive cancers. The vast majority are found in early stages and are very curable with surgery alone. Since they produce either estrogen or testosterone, early symptoms usually have something to do with hormonal changes. These symptoms may include facial hair growth, low voice, and early puberty and/or abnormal periods.

Genetics and Hereditary Ovarian Cancer

As noted above, genetics plays an important role for some women who develop ovarian cancer at a young age.  Talk to your doctor.  Learn about hereditary breast and ovarian cancer.  Genetic testing is now available.

Ovarian Cancer and Fertility

As noted above, surgery may allow one of the ovaries to be left in place.  It's important to note that even with an ovary present, chemotherapy can sometimes cause ovarian failure which is permanent.  Before treatment make sure you take time to talk to your doctor about preserving your fertility before cancer treatment.

Coping and Support

Cancer is a frightening disease even if you have one of these tumors which is caught early and highly curable.  Ask a lot of questions. Learn how to research your cancer online. Reach out to family and friends for support.  There is a strong community of young adult ovarian cancer survivors who are very active in social media.  Several even have blogs in which they share their cancer journey, such as Fran Dresher's Cancer Schmancer.  Likewise there is a very active group of young people who have survived cancers of all types called Stupid Cancer: The Voice of Young Adult Cancer.

It's not fair to have to face cancer when you're young - or at any age.  Thankfully we're learning more about survivorship and ways to help women (and men) thrive throughout and after cancer treatment.  And, if you're having days when it really feels unfair, keep in mind that studies now tell us that what we only speculated about before.  Cancer does change people in good ways not just bad!

Sources:

Isaacs, C., and B. Peshkin. Management of patients with hereditary and/or familial breast and ovarian cancer. UpToDate. Updated 07/05/15. http://www.uptodate.com/contents/management-of-patients-with-hereditary-and-or-familial-breast-and-ovarian-cancer

National Cancer Institute. BRCA1 and BRCA2: Cancer Risk and Genetic Testing. Updated 04/15/15. http://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet

National Cancer Institute. Ovarian Germ Cell Tumors Treatment (PDQ). 0212/16. http://www.ncbi.nlm.nih.gov/books/NBK66014/#CDR0000062935__1

Ray-Coquard, I., Brown, J., Harter, P. et al. Gynecologic Cancer InterGroup (GCIG) consensus review for ovarian sex cord stromal tumors. International Journal of Gynecologic Cancer. 2014. 24(9 Suppl 3):S42-7.

Simone, C., Markham, M., and D. Dizon. Chemotherapy in ovarian germ cell tumors: A systematic review. Gynecologic Oncology. 2016 Feb 9. (Epub ahead of print).

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