Clarification of cancer risks

With the hectic schedule that college women today have to endure, they may not have the time to worry about their susceptibility to female-specific cancers. Deadlines for paper and test cram sessions normally take precedence over daily health concerns.

However, the threat of diseases, such as human papillomavirus (HPV) and cervical cancer will not wait until the end of the semester to wreak havoc on a student’s health.

Women of all ages have long battled against breast cancer. Nonetheless, ovarian cancer is much harder to detect and it still poses a viable threat to women in their lifetimes. While accepting the title of 2007’s Distinguished University Professor, Dr. Santo V. Nicosia discussed the research and explained the risks of ovarian cancer for women, college-aged and older. His March 26 lecture covered advances in this “historically insidious disease.”

Ovarian cancer is a disease in which normal ovarian cells begin to grow in an uncontrolled, abnormal manner and produce tumors in one or both ovaries.” There are several types of ovarian cancer, classified by where the tumors develop. Nicosia’s research centers on epithelial ovarian cancer, which stems from the cells covering the ovaries’ outer surface.

Younger women are more prone to germ cell tumors, which derive from the cells that produce eggs. “Almost 99 percent of dermoid (epithelial) cysts are benign,” Nicosia said.

Ovarian cancer is mainly associated with older women – particularly those who are post-menopausal – but that does not mean younger women are in the clear.

“If women have two or more relatives with ovarian cancer, they should be monitored,” Nicosia said. “There’s also been some evidence, weak to moderate, regarding diet and obesity, that obesity and a certain kind of unhealthy diet may increase the risk of ovarian cancer.”

As of yet, there is no definite link between STDs and ovarian cancer, Nicosia said.

Studies also show positive results for the use of oral contraceptives in preventing the growth of malignant ovarian tumors.

“It can certainly be a means to protect you from risk, but be aware that studies have shown a clear-cut protection for women who have taken oral contraceptive therapy for five years or more. So, if you take it for just six months and interrupt, the protection may or may not be there or may be much less,” he said.

Menopausal women who undergo hormone treatment are more susceptible to ovarian cancer. For example, “with in-vitro fertilization (IVF), the women are hyper-stimulated to produce eggs,” Nicosia said.

However, as gynecologists do not want to alarm women opting for pregnancy, the concern is more for women taking certain types of hormone replacement therapy (HRT). “HRT … refers to a woman taking supplements of hormones such as estrogen … that a woman’s body should be making or used to make,” according to the National Institutes of Health.

When a woman’s menstrual cycle stops during menopause, it can change her hormone levels. Sometimes this causes hot flashes, tenderness and other related signs. Some women try HRT to relieve these uncomfortable symptoms.

“We know from laboratory experiments in animals that if we increase estrogen, the surface of the ovary grows very, very significantly. We don’t know if it also stimulates malignant transformation, but it is a fact that estrogen stimulates cell growth. If there are other genetic factors, then estrogen will facilitate that process,” Nicosia said.

Associate Professor Dr. Patricia Kruk works closely with Nicosia in the Department of Pathology and Cell Biology.

“I call it the disease that whispers,” she said. “There is a pap test for cervical cancer (and) a mammogram for breast cancer, but there is no definitive screening for ovarian cancer.”

Current ovarian cancer screenings test for the protein CA-125 in the blood. This protein is elevated in women diagnosed with ovarian cancer, but the test is not 100 percent accurate.

“There are generally no symptoms – a lot of what women feel are sort of the same symptoms of aging you would normally feel and that’s why even though the disease is less frequent, it’s generally fatal because at that point the disease has spread to other organs. Less than 15 percent of cases are diagnosed in an early stage,” she said.

Kruk explained that even with treatment, ovarian cancer often comes back within a year. “

We have found a protein called BCL-2 that seems to be high in the urine of women that have ovarian cancer,” Kruk said.

A step toward progress in early detection would incorporate testing for the protein from the simple routine urine sample collected during a woman’s annual physical.

Regarding future research, “the key to understanding ovarian cancer is to have a situation where you can detect the early precursor,” Nicosia said. “We need models, animals where epithelial cancer can be followed during its development. We need what we call a tissue-specific promoter, a carrier which will send a particular gene to the epithelial tissue in the ovary, and that has been the obstacle in today’s research.”

Studies also show remarkable progress in shrinking cancerous tumors using vitamin D treatment.

“The way people began looking at vitamin D was by realizing that ovarian cancer was more frequent in the northern latitudes where there is less sun,” Nicosia said. “This prompted a study to confirm this and it is true that vitamin D does suppress the growth of ovarian epithelial benign and cancer cells. However, it has to be at least 1,000 or more units, a high dosage of vitamin D, not the normal doses.”