You may have seen the headlines recently: Cobie Smulders, star of How I Met Your Mother and the new drama Stumptown, revealed having ovarian cancer made her a “better person” and “grateful for being here.” Around the same time, Anna Friel, star of Netflix’s binge-mystery Marcella, revealed she nearly died after a cyst on her ovary burst. She’s fully recovered, and went on to get pregnant.
Both women faced these issues in their twenties. Could you be in danger? And what’s the difference between ovarian cancer and an ovarian cyst anyway?
Here, we break down everything about ovarian cysts, cancer, and when it’s time to get checked out.
What are Ovarian Cysts?
Ovarian cysts are usually harmless, sac-like substances filled with a clear liquid that typically form in a woman’s ovary each month. Rarely malignant, ovarian cysts are fairly common since most form during a woman’s regular, monthly cycle—predominantly during the premenopausal, reproductive years—and typically resolve on their own.
In more severe cases, when these cysts grow, they can cause an abrupt onset of severe pelvic pain, nausea, and vomiting. (Friel, with a distended stomach, was told to “pull your tummy in” during a photo shoot, which led her to discover it was filled with blood.)
If cysts persist more than a few months or when they are starting to be more than 5cm in size, it’s time to seek medical care, according to Dr. James Stuart Ferriss, assistant professor and gynecological oncologist at the Johns Hopkins University School of Medicine. These cysts can lead to cramping and, in rare cases, may cause a severely painful condition called torsion where the ovaries twist around its ligaments. As painful as torsion may be, fortunately, it is also a rare and non-cancerous condition linked to ovarian cysts.
“There are different kinds of cysts that can form in the ovary for reasons that we don’t fully understand,” says Ferriss. “Cysts with clear fluid without any echoing on the ultrasound to suggest that there’s blood or mucus or any other types of fluid tend to resolve on their own.”
What is Ovarian Cancer?
Ovarian cancer is really an umbrella term since most cancer linked to the ovary starts in the fallopian tubes and can develop in several areas surrounding the ovaries. On average, women have a 1.3 percent chance of acquiring ovarian cancer, yet it is still fairly rare with more than 22,500 cases per year, according to the National Cancer Institute.
The key to distinguish between benign cysts and ovarian cancer: persistence. When cysts are persistent and continue to grow, this could be a possible sign of cancer.
There is no clear cause of ovarian cancer, however women carrying the rare BRCA1 and BRCA2 genes are at 30 to 40 percent higher risk of developing ovarian or breast cancer. Actress Angelina Jolie, whose mother succumbed to breast cancer in 2007, had a mastectomy as well as her ovaries and fallopian tubes removed in 2013 after learning she had the BCRA1 gene.
Other reproductive factors, identified to place women at a slightly higher risk, include late menopause, endometriosis and infertility, in addition to environmental and lifestyle factors like obesity.
What are the Symptoms?
Unfortunately, the symptoms of ovarian cancer are so subtle and often undetected. It could be anything from getting full quickly, persistent bloating that won’t go away, subtle changes in your GI tract, pelvis fullness and pain, irregular and strange bleeding, which are generally common symptoms for women, which is what makes detecting the cancer tricky.
More severe symptoms typically don’t occur until a cyst has grown very large or has started to apply pressure to other organs in the abdomen, or if the ovarian cancer has spread to remote organs.
If persistent, these could be some of the common signs/symptoms of ovarian cancer:
- Abdominal bloating
- Lower abdominal pressure or pelvic pain pressure
- Loss of appetite
- Frequent urination
- Irregular bleeding
- Pain during sexual intercourse
- Feeling full after eating little
- Nausea, vomiting
What’s the Prevention and Treatment?
Unfortunately, there is no clear prevention or testing against ovarian cancer, however researchers have found that birth control pills are linked to a lower risk of getting the disease. Additionally, tubal ligation (i.e. getting your tubes tied) or having the fallopian tubes removed have also been linked to reducing the risk of acquiring ovarian cancer.
“We do not recommend biopsies of ovarian cysts when that is the only abnormality noted on imaging,” says Ashley F. Haggerty, MD, assistant professor of obstetrics and gynecology at the Hospital of the University of Pennsylvania. “Women with a diagnosis of ovarian cancer should be offered genetic testing since this is important information for them and their family and also provides additional treatment options for drugs that are approved for those patients.”
Women with increased genetic risk of ovarian cancer are recommended to remove the fallopian tubes and the ovaries once childbearing is complete, according to Haggerty, or by age 35 to 45 depending on the mutation.
“If you do not have a higher genetic risk, then there is no routine testing that is done to screen for ovarian cancer,” says Haggerty. “If you have a cyst that is found on imaging or an exam, you doctor may order more specific gynecologic imaging to assess if the cyst looks simple or more concerning.”
Even though annual blood and ultrasounds are not recommended to detect ovarian cancer for the average woman, you should begin to educate yourself on your family history and pay close attention to your body and to more persistent symptoms.
“This doesn’t leave your average patient with many options,” says Ferriss. “The message we have to settle with at the moment is that we have to educate everyone on the symptoms and looking for the persistent nature of those symptoms. I think if you have a family history of breast or other cancer it’s worth having a conversation with your provider.” And to ensure your house is safe for you and the entire family, don’t miss this essential list of 100 Ways Your Home Could Be Making You Sick.