Gynecologic Cancer Awareness Month - MyriadMyRisk

September is Ovarian Cancer Awareness Month

Ovarian Cancer


Ovarian Cancer Stage IIB
Ovarian Cancer Stage IIB

Quick Facts

  • Annual cases: ~22,2801
  • Median age at diagnosis: 631
  • Overall 5-year relative survival rate: ~46%1
  • Lifetime risk in general population: 1.3%1
  • Risk with an affected 1st degree relative: 2.0-3.1x the general population risk2,3

Ovarian cancer develops in the pelvis from 3 main types of cells: epithelial cells (cells that cover the ovaries and pelvic organs), germ cells (cells that produce the eggs) and stromal cells (cells that form the supporting or structural tissue holding the ovaries together).

Ovarian adenocarcinomas are the most common ovarian malignancies, accounting for about 85% to 90% of all ovarian cancers. Subtypes include serous, mucinous, endometrioid, clear cell and undifferentiated. The main focus of this document is epithelial ovarian carcinomas.
Ovarian cancer often goes undetected. Often the cancer is found after it has spread within the pelvis and abdomen. As a result the cancer is difficult to treat.

Fallopian tube and primary peritoneal cancer are closely related to epithelial ovarian cancer.

NCCN Recommends that all patients diagnosed with ovarian cancer undergo genetic testing.

1 in 7 ovarian cancers are due to BRCA mutations4-7

  • Women with a BRCA mutation have an up to 63% chance of developing ovarian cancer by age 70.
  • Although the majority of hereditary ovarian cancer is associated with a BRCA mutation, there are as many as 6% of ovarian cancers that have mutations in genes other than BRCA1 and BRCA2.8

69% of BRCA positive ovarian cancer patients are diagnosed over the age of 50.9

44% of BRCA positive ovarian cancer patients have no family history of cancer.9

There are no screening test recommendations for ovarian cancer at this time.

Transvaginal ultrasonography and CA-125 testing may be considered at the discretion of healthcare providers.

Surgical Management
Risk reduction options: Birth control pills; injectable hormonal contraceptives; pregnancy; breastfeeding; tubal ligation; hysterectomy; bilateral salpingo-oophorectomy; saplingectomy; other contraception that prevents ovulation; low-fat diet.

Demographics: Older age

Lifestyle: Smoking

Medical History: Early menarche/late menopause, obesity, fertility drugs; estrogen hormonal therapy

Inherited: Personal history of breast cancer, family history of ovarian cancer; inherited genetic syndromes

Myriad MyRisk® Genes Associated with Ovarian Cancer
Myriad MyRisk® Genes Associated with Ovarian Cancer: BRCA1, BRCA2, MLH1, MSH2, MSH6, PMS2, EPCAM, TP53, STK11, BRIP1, RAD51C, RAD51D

Early Stage Cancer Surgery to remove the tumor is the primary treatment. The grade of the cancer, which determines aggressiveness, may suggest watchful surveillance or treatment with chemotherapy after surgery.
Advanced Stage Cancer Surgery for staging and cytoreduction (tumor removal) is generally indicated. This includes removal of tumor tissue and the uterus along with the fallopian tubes and ovaries (total abdominal hysterectomy with bilateral salpingo-oophorectomy). In addition, the omentum, fluid in the pelvis or abdominal cavity, and lymph nodes in the pelvis and abdomen may be removed and analyzed. Treatment options following surgery include combination chemotherapy, which involves more than one medication at a time. Different routes administrating chemotherapy, such as intraperitoneal chemotherapy, may be suggested. Patients who are too weak to have full staging and cytoreduction surgery or who may have tumor that cannot be resected are sometimes treated with chemotherapy as the first treatment. Clinical trials for combination chemotherapy, biologic therapy and/or targeted therapy may be considerations.

BRACAnalysis CDx

olaparib, LynparzaMutations in BRCA1 or BRCA2 cause Hereditary Breast and Ovarian Syndrome (HBOC). Now mutations in the BRCA1 and BRCA2 genes provide an indication for treatment with Lynparza™ (olaparib) for patients with ovarian cancer. Specifically, BRACAnalysis CDx® is the only FDA approved laboratory test to be used with the PARP inhibitor, Lynparza.

Understanding a patient’s BRCA status at diagnosis informs future treatment decisions with Lynparza.

Order your BRACAnalysis CDx test kits today


Endometrial Cancer

Endometrial Cancer Stage II

Quick Facts

  • Annual cases: ~60,0001
  • Median age at diagnosis: 621
  • Overall 5-year relative survival rate: ~82%1
  • Lifetime risk in general population: 1.6%1
  • Risk with an affected 1st degree relative: 1.3-2.8x the general population risk2,3

Most cancers of the uterus are from cells that form glands in the endometrial layer and are called endometrial carcinomas. The focus of this information is on the most common type of endometrial carcinoma, known as endometrioid adenocarcinoma. More aggressive forms include clear-cell, serous and poorly differentiated carcinoma.

Endometrial cancer is often mistaken for, but is not the same as, cervical cancer, which starts in the cervix and may spread to the body of the uterus.

Any post-menopausal bleeding, or persistent or irregular bleeding in young women may be a sign of endometrial cancer and should be investigated.

Up to 5% of endometrial cancers are due to a hereditary (inherited) cause.

The most common hereditary cause of endometrial cancer is Lynch syndrome, which also increases the risk of developing colorectal, ovarian and other cancers.4


The average woman’s risk of developing endometrial cancer is 1.6% by age 70. That risk increases to up to 71% in women with a hereditary endometrial cancer syndrome like Lynch syndrome.

1 in 4 patients with endometrial cancer are appropriate for genetic testing5,6

The most common hereditary cause of endometrial cancer is Lynch syndrome, which also increases the risk of developing colorectal, ovarian, and other cancers.4

There are no regular screening test recommendations for endometrial cancer at this time.

In most cases, endometrial cancers are found by noticing related signs and symptoms, which is followed up by examination. For those at elevated or high risk, screening may include endometrial biopsies and/or transvaginal ultrasounds at regular intervals.

Demographics: Older age

Lifestyle: High fat diet; obesity

Medical History: Estrogen-only hormone replacement therapy; Tamoxifen use; other causes of excess exposure to estrogen unopposed by progesterone; polycystic ovarian syndrome (PCOS); diabetes; endometrial hyperplasia; prior radiation exposure; nulliparity; early menarche and late menopause; infertility; prior pelvic radiation therapy

Inherited: Family history of endometrial cancer; inherited genetic syndromes

Risk reduction options: Progestin-based oral contraceptive pills; hysterectomy and bilateral salpingo-oophorectomy; pregnancy; physical activity

Myriad MyRisk® Genes Associated with Endometrial Cancer: MLH1, MSH2, MSH6, PMS2, EPCAM, TP53, PTEN, STK11

7-9

Early-Advanced Stage Cancer The primary treatment for early stage endometrial cancer is surgery which may entail removal of the uterus (hysterectomy) or removal of the uterus along with the fallopian tubes and ovaries (total abdominal hysterectomy with bilateral salpingo-oophorectomy). Lymph nodes from the pelvis and along the aorta may also be removed and analyzed. Other therapies, including vaginal brachytherapy (VB), pelvic radiation, or both may be recommended either before or after surgery.

If the endometrial cancer is aggressive and/or of high grade, the surgery may be more extensive including removal of the omentum. Chemotherapy is often given along with radiation therapy.

Metastatic Stage Cancer Surgery may be appropriate to alleviate symptoms. Disseminated metastatic endometrial is typically treated with chemotherapy and radiation therapy and/or hormonal therapy.

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Know the red flags associated with hereditary cancer:

Red Flags for Hereditary Cancer
An individual with a personal or family history of any ONE of the following:

MULTIPLE

A combination of cancers on the same side of the family or in an individual

  • 2 or more: breast / ovarian / prostate / pancreatic cancer
  • 2 or more: colorectal / endometrial / ovarian / gastric / pancreatic / other(i.e. ureter / renal pelvis, biliary tract, small bowel, brain, sebaceous adenomas
  • 2 or more: melanoma / pancreatic

YOUNG

Any 1 of the following cancers at age 50 or younger

  • Breast cancer
  • Colorectal cancer
  • Endometrial cancer

RARE

Any 1 of these rare presentations at any age

  • Ovarian cancer
  • Breast: male breast cancer or triple negative breast cancer
  • Colorectal cancer with abnormal MSI/IHC, MSI associated histology††
  • Endometrial cancer with abnormal MSI/IHC
  • 10 or more gastrointestinal polyps*

††Presence of tumor infiltrating lymphocytes, Crohn’s-like lymphocytic reaction, mucinous/signet-ring differentiation, or medullary growth pattern.
*Adenomatous type.
Assessment criteria based on medical society guidelines. For these individual medical society guidelines, go to www.MyriadPro.com/guidelines.
Family members include first-, second-, and third-degree blood relatives on both your mother and father’s sides.
Certain ancestries may have greater risk for hereditary cancer syndromes (e.g., Ashkenazi Jewish ancestry)

Ovarian Cancer References

  1. Surveillance, Epidemiology and End Results Program, National Cancer Institute (seer.cancer.gov) Dec 10, 2013.
  2. Goldgar DE, Easton DF, Cannon-Albright LA, Skolnick MH. Systematic population-based assessment of cancer risk in first-degree relatives of cancer probands. J Natl Cancer Inst. 1994 Nov 2;86(21):1600-8. PubMed PMID: 7932824.
  3. Stratton JF, Pharoah P, Smith SK, Easton D, Ponder BA. A systematic review and meta-analysis of family history and risk of ovarian cancer. Br J Obstet Gynaecol. 1998;105(5):493-499
  4. American Society of Clinical Oncology: Ovarian Cancer (http://www. cancer.net/cancer-types/ovarian-cancer) Dec 10, 2013.
  5. Pal T, et al. BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases. Cancer. 2005 Dec 15;104(12):2807-16.
  6. Risch HA, McLaughlin JR, Cole DEC, et al. Prevalence and penetrance of germline BRCA1 and BRCA2 mutations in a population series of 649 women with ovarian cancer. American Journal of Human Genetics. 2001;68:700-710
  7. Zhang S. et al. Frequencies of BRCA1 and BRCA2 mutations among 1,342 unselected patients with invasive ovarian cancer. Gynecol oncol. 2011 May 1;121(2):325-7
  8. SGO Clinical Practice Statement: Next Generation Cancer Gene Panels Versus Gene by Gene Testing. Society of Gynecologic Oncology. March 2014.
  9. Alsop K, Fereday S, Meldrum C, et al. BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer: a report from the Australian Ovarian Cancer Study Group. J Clin Oncol. 2102;30:2654-2663.
  10. Narod SA, et al. Oral contraceptives and the risk of hereditary ovarian cancer. N Engl J Med. 1998;339:424-428
  11. Rebbeck TR, et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med. 2002;346(21):1616-1622
  12. American Society of Clinical Oncology: Ovarian Cancer (http://www. cancer.net/cancer-types/ovarian-cancer) Dec 10, 2013.
  13. American Society of Clinical Oncology: Ovarian Cancer (http://www. cancer.net/cancer-types/ovarian-cancer) Dec 10, 2013.
  14. National Cancer Institute: Ovarian Cancer treatment (http://www.cancer.gov/cancertopics/pdq/treatment/Ovarian/patient) Dec 10, 2013.

Endometrial Cancer References

  1. Surveillance, Epidemiology and End Results Program, National Cancer Institute (seer.cancer.gov) Dec 10, 2013.
  2. Lucenteforte E, Talamini R, Montella M, Dal Maso L, Pelucchi C, Franceschi S, La Vecchia C, Negri E. Family history of cancer and the risk of endometrial cancer. Eur J Cancer Prev. 2009 Apr;18(2):95-9. doi: 10.1097/CEJ.0b013e328305a0c9. PubMed PMID: 19337055
  3. SGO Clinical Practice Statement: Next Generation Cancer Gene Panels Versus Gene by Gene Testing. Society of Gynecologic Oncology. March 2014.
  4. National Cancer Institute Genetics of Breast and Gynecologic Cancers–for health professionals (PDQ®). http://www.cancer.gov/types/breast/hp/breast-ovarian-genetics-pdq#link/_2724_toc
  5. Hendriks YM, et al. Cancer risk in hereditary nonpolyposis colorectal cancer due to MSH6 mutations: Impact on counseling and surveillance. Gastroenterology 2004. 127;17-25.
  6. Provenzale D et al. NCCN Clinical Practice Guidelines in Oncology®: Genetic/Familial High-Risk Assessment: Colorectal. V1.2015. Available at www.nccn.org.
  7. Gruber SB, Thompson WD. A population-based study of endometrial cancer and familial risk in younger women. Cancer and Steroid Hormone Study Group. Cancer Epidemiol Biomarkers Prev. 1996 Jun;5(6):411-7. PubMed PMID: 8781735.
  8. American Society of Clinical Oncology: Endometrial Cancer (http://www.cancer.net/cancer-types/uterine-cancer) Dec 10, 2013.
  9. American Cancer Society: Endometrial Cancer (http://www.cancer.org/cancer/endometrialcancer/index) Dec 10, 2013.
  10. National Cancer Institute: Endometrial Cancer treatment (http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/patient) Dec 10, 2013.

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