# 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.