Nancy asks:
What is borderline ovarian cancer? Is it still cancer? Can you describe what the borderline diagnosis category of ovarian cancer means?

Christina Chu, MD responds:
Borderline ovarian cancer, or low malignant potential tumors (LMP tumors) are cancers of the ovary that behave in a benign fashion. Under the microscope, the cancerous cells do not appear to invade the underlying tissues. Patients diagnosed with LMP tumors are usually younger than patients with the usual epithelial ovarian cancer.

Patients are most often treated and cured by surgical removal of the tumors. While patients may have disease spread outside the ovary, most patients do not require chemotherapy unless the implants outside of the ovary show some evidence of invading into the underlying tissues.

Amanda asks:
I am 38 years old. My grandmother was diagnosed with ovarian cancer aged 82 years old, her sister also has ovarian cancer.

What are my risks and what tests should I do, and starting at what age?

Lori Smith, CRNP and Sarah Kim, MD responds:
The lifetime risk for developing ovarian cancer in general population is approximately 1.82 percent. Several factors may increase your risk of ovarian cancer. Having one or more of these risk factors doesn't mean that you're sure to develop ovarian cancer, but your risk may be higher than that of the average woman. These risk factors include: inherited gene mutation, family history, age, infertility and nulliparity.

The most significant risk factor for ovarian cancer is having an inherited mutation in one of two genes called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but they're also responsible for about 5 percent to 10 percent of ovarian cancers. You're at particularly high risk of carrying these types of mutations if you're of Ashkenazi Jewish descent.

Another known genetic link involves an inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC). Individuals in HNPCC families are at increased risk of cancers of the uterine lining (endometrium), colon, ovary, stomach and small intestine. Risk of ovarian cancer associated with HNPCC is lower than is that of ovarian cancer associated with BRCA mutations.

Sometimes, ovarian cancer occurs in more than one family member but isn't the result of any known inherited gene alteration. Having a family history of ovarian cancer increases your risk of the disease, but not to the same degree as does having an inherited genetic defect. If you have one first-degree relative - a mother, daughter or sister - with ovarian cancer, your risk of developing the disease is 5 percent over your lifetime. Having two affected family members increases your risk to approximately 7 percent.

Women with a family history of ovarian cancer are encouraged to seek genetic counseling to discuss their individual risk factors.

Maryann Asks:
I have many of the symptoms that are mentioned: bloating, s/s irritable bowel with constipation. I also have had repeated ultrasounds noting ovarian cysts.

My doctors do not seem to think that there is any concern. Are there any other tests or should I get a second opinion?

Christina Chu, MD responds:
While the symptoms that you mentioned are common in women with ovarian cancer, fortunately most women who have these symptoms do NOT have cancer. Without knowing your age, medical history, the details of your symptoms, and being able to examine you, it is not possible to make specific recommendations to you regarding evaluation and treatment.

However, it rarely hurts to seek a second opinion if you feel that your current physicians are not addressing your needs. Before you do that, I would suggest that you speak with your physician and be frank about your concern that you might have ovarian cancer. Your physician may be able to alleviate your concern or, if indicated, order specific tests to aid in further evaluation.