Handbook of Genetic Counseling/Ovarian Cancer

Ovarian Cancer

Contracting

• Before we get started, I want to give you a chance to ask any questions or express any concerns that you may have.
• What issues do you want to make sure we discuss? What do you want to gain from our session today?
• Our plan:
  • talk about your medical history and diagnosis
  • discuss your family history in a little more detail
  • talk about the genetics of hereditary cancers
  • we'll explain what we see and discuss your risks
  • talk about genetic testing - what it tests, limitations
  • discuss ways for you to stay healthy

Medical History

• Tell me how you got to this point. How was your ovarian cancer diagnosed?
• Fill out intake with details.
• Any other medical illnesses, surgeries, or hospitalizations?

Family History

• Update pedigree with details. A pedigree is our "physical exam". Gives us clues as to whether the cancer is hereditary. It's important to know who has AND who doesn't have cancer.
  • Very specific questions about the cancer in different family members
  • Age at diagnosis
  • Current age & screening practices
  • Age at death & specific cause of death
  • Primary site of cancer (type, location, stage, laterality)
  • Metastasis or any new primary cancers
  • Methods of treatment/surgery
  • Any types of precancerous lesions
  • Ethnic background
  • Environmental exposures
  • Lifestyle issues (diet, exercise, stress)
  • Screening habits of "unaffected" relatives
  • Any other medical conditions that may be associated with cancer
  • any family hx of early heart attacks, blindness, deafness, birth defects, or multiple miscarriages

Cancer Epidemiology

• Cancer is the uncontrolled growth of cells. All cancers are genetic, but not all are inherited. It is a multifactorial disorder, caused by both genetic and non-genetic factors.
• Cancer is a very common disease. 1 in 2 men and 1 in 3 women will develop some form of cancer in their lifetimes. The most common cancer sites are lung, breast, prostate, and colon.
• In the U.S., 1 in 55 women will develop ovarian cancer (1.8% lifetime risk)
  • 5-10% of all ovarian cancer is hereditary (meaning that it runs in families)
  • 90% of this is caused by a BRCA1 or BRCA2 mutation
• In the U.S., 1 in 8 women will develop breast cancer over their lifetimes.
  • Average age of developing cancer is 62 (2/3 of the women will be over 55)
  • 5-10% of all breast cancer is hereditary. Of this, 2/3 (66%) of it is due to a BRCA1 or BRCA2 mutation
  • This gene is the link between breast and ovarian cancer.

Red Flags

• How do we know when a cancer is hereditary? We look for clues (red flags).
• What makes us suspicious:
  • more than one generation affected
  • multiple close relatives affected on the same side of the family
  • early age of onset (before 50)
  • bilateral cancer or more than one type of cancer in the same person
  • rare or unusual cancers

Genes and Chromosomes

• Hereditary cancers are caused by a change in a specific gene that is passed on

through a family

• • Genes are made of DNA. They have all the instructions for how our bodies grow and develop.
  • When there is a change in a gene, it causes the cell to not work properly, so it can grow out of control and become cancerous.
• Genes are packaged on chromosomes. Chromosomes come in pairs, and we inherit one from mom and one from dad.
• This gene is autosomal dominant, so only need one copy of it to inherit a higher risk of cancer. There is a 50% chance of getting it from our parents. If we carry the gene, then we have a 50% chance of passing it on.

Notes

The information in this outline was last updated in 2002.