Ovarian cancer is the fifth leading cause of cancer death among women in the United States, with approximately 19,000 new diagnoses and 13,000 deaths occurring each year. The disease, among the most difficult gynecologic cancers to treat, originates in the ovaries, the small almond-shaped reproductive organs that produce eggs and hormones in women.[1] While every patient’s experience is different, recent research has shown that exposure to talc contaminated with asbestos is a significant risk factor.[]
Types of Ovarian Cancer
Ovarian cancer happens when cells in the ovaries grow out of control and spread into nearby tissue. There are several types of ovarian cancer, and they differ based on where in the ovary they start.[3]
Epithelial Cells
Epithelial cells form the most common type of ovarian cancer. They start in the cells that line the surface of the ovary, fallopian tubes, or abdominal cavity and end up covering the outer surface of the ovary. There are several subtypes of epithelial ovarian cancer cells, including:
- High-Grade Serous Ovarian Carcinoma (HGSOC). HGSOC makes up about 75% of all epithelial ovarian cancers and is the subtype most consistently linked to talc exposure.[4] Its symptoms include bloating, pelvic pain, and trouble eating. Most women are diagnosed at a later stage (III or IV). It is difficult to treat. Surgery combined with chemotherapy is the standard approach.
- Low-Grade Serous Ovarian Carcinoma (LGSOC). This is a less aggressive version of the serous type. It grows slowly and generally has a better outlook than the high-grade type.
- Clear Cell Ovarian Carcinoma (CCOC). This is a rare subtype that is sometimes linked to endometriosis. It is frequently diagnosed in younger women and is caught at an earlier stage, but it tends to resist standard chemotherapy.
- Endometrioid Ovarian Carcinoma. Representing approximately 10% of epithelial ovarian cancers, it can be either slow-growing (low-grade) or faster-growing (high-grade), though low-grade is more typical.
- Mucinous Carcinoma. This rare type of ovarian cancer tends to stay within the ovary longer than other types. The tumors tend to be large, and it can be tricky to diagnose because it looks similar to cancer that has spread from other organs, like the colon. The prognosis is good when caught early.
- Borderline Ovarian Tumors. Also called “low malignant potential” tumors, they’re abnormal but not fully cancerous. They represent roughly 15% of epithelial ovarian cancers and though they don’t invade nearby tissue the way typical cancers do, they can spread and come back.
Germ Cell Tumors
These cancers start in the egg-producing cells of the ovary. They’re rare and most often affect younger women and girls.
- Immature Teratomas. These tumors are made up of poorly developed cells. They are less common than non-cancerous teratomas and are usually treated with surgery and chemotherapy.
- Dysgerminomas. These are the most common type of malignant germ cell tumor. They are most often seen in teenagers and women in their twenties and are typically treated with surgery, sometimes followed by chemotherapy or radiation.
- Yolk Sac Tumors. This is a rare and fast-moving type of germ cell tumor that represents about 15% of germ cell tumors. It is typically diagnosed in young women around age 18–19 and grows and spreads quickly, which makes it challenging to treat.
Stromal Cell Tumors
These are extremely rare cancers that start in the connective tissue of the ovary — the cells that give it structure and produce hormones. They are very rare.
- Granulosa Cell Tumors. These are seen in 2–5% of all ovarian cancers and are the most common type of malignant stromal tumor. They produce hormones, which can cause unusual symptoms such as early puberty in young girls, irregular periods, or unexpected vaginal bleeding in postmenopausal women. They come in adult and juvenile forms and are often caught early. Advanced cases may need chemotherapy.
- Sertoli-Leydig Tumors. These rare tumors sometimes produce male hormones. They can be managed with surgery and possibly chemotherapy.
Rare Ovarian Cancer Subtypes
Some ovarian cancers are so uncommon that they don’t fit neatly into the categories above.
- Ovarian Carcinosarcoma: These tumors contain both epithelial and stromal. They are aggressive and most often diagnosed in women who have gone through menopause. Treatment typically includes surgery and chemotherapy.
- Small Cell Carcinoma of the Ovary (SCCO): This extremely rare and highly aggressive cancer is only seen in about 0.1% of ovarian cancers. The median age at diagnosis is just 23. It is very difficult to treat; options include surgery, chemotherapy, and radiation, but outcomes are challenging.
Symptoms of Ovarian Cancer
As is true with mesothelioma, the early symptoms of ovarian cancer are easy to overlook or to attribute to other conditions. Common symptoms include:
- Bloating or swelling of the abdomen
- Pelvic or abdominal pain
- Difficulty eating or feeling full quickly
- Frequent or urgent need to urinate
- Unexplained fatigue
- Changes in bowel habits
- Unexplained weight loss or gain
If you are persistently experiencing these symptoms, it’s important to see your doctor as soon as possible for an examination, especially if you have a history of using talc-based products for feminine hygiene.
Talc and Asbestos as Risk Factors for Ovarian Cancer
Though the incidence of ovarian cancer is associated with family history, BRCA1 and BRCA2 gene mutations, and other factors, in recent decades, research has added the use of talcum powder in the genital area to the list of risk factors. Talc is a naturally occurring mineral that is frequently found near asbestos deposits, and commercial talc products have repeatedly tested positive for asbestos contamination.[5]
The connection between talc and ovarian cancer has been the subject of significant scientific investigation. Researchers have found that talc particles applied to the genital area can migrate through the reproductive tract to the ovaries, where they trigger the same type of chronic inflammation that leads to the development of malignant mesothelioma in individuals exposed to asbestos. The same asbestos fibers responsible for causing malignant pleural mesothelioma and asbestos-related lung cancer have been identified in talc products and in the ovarian tissue of women diagnosed with ovarian cancer.[6]
A 2020 meta-analysis found that women who regularly used talc-based products in the perineal area had a statistically significant increased risk of developing ovarian cancer compared to those who did not,[ and the International Agency for Research on Cancer (IARC) has classified perineal use of talc-based body powder as “possibly carcinogenic to humans.”[7]
Diagnosing Ovarian Cancer
Physicians use several different tests to diagnose and confirm the presence of ovarian cancer. They include:[8]
- Pelvic examination. During a routine pelvic exam, a physician may feel abnormalities in the shape, size, or texture of the ovaries that warrant further investigation.
- Transvaginal ultrasound (TVUS). This imaging test uses sound waves to create a picture of the ovaries and surrounding tissue, allowing physicians to detect masses or cysts.
- CA-125 blood test. CA-125 is a protein that is often elevated in the blood of women with ovarian cancer. While its presence alone doesn’t confirm ovarian cancer, it is often used in combination with other diagnostic tools.
- CT or PET scan. Computerized tomography and positron emission tomography scans help determine the size and spread of tumors and whether cancer has metastasized to other areas of the body.
- Biopsy. A definitive diagnosis of ovarian cancer requires laboratory analysis of a tissue sample, typically obtained during surgery.
If ovarian cancer is confirmed, the next step is staging — determining how far the cancer has spread. Stage 1 indicates cancer confined to one or both ovaries. Stage 4 is advanced cancer that has spread to distant organs, including the liver or lungs. The stage of the disease will determine the treatment plan.
Treatment of Ovarian Cancer
The treatment for ovarian cancer depends upon the stage and type of cancer, the patient’s overall health, and her wishes. Options include surgery, chemotherapy, targeted therapy, and immunotherapy, as well as combinations of these approaches.
- Surgery aimed at removing as much of the tumor as possible is typically the first line of treatment. This process is known as debulking. It may involve removal of one or both ovaries, the fallopian tubes, the uterus, and nearby lymph nodes.
- Chemotherapy is commonly administered following surgery, using platinum-based drugs such as carboplatin and paclitaxel to destroy remaining cancer cells.
- Targeted therapy uses drugs such as PARP inhibitors (olaparib, niraparib) that block specific proteins cancer cells need to grow, and has been particularly effective in patients with BRCA mutations.
- Immunotherapy helps the body’s own immune system recognize and attack cancer cells.
If you have symptoms or have been diagnosed with ovarian cancer, it’s important that you seek specialized care at a comprehensive cancer center, where gynecologic oncologists and surgeons specialize in ovarian cancer treatment.
Ovarian Cancer Victims Seek Justice
Thousands of lawsuits have been filed against talc companies alleging that long-term use of their talc products caused ovarian cancer and mesothelioma in women who used them for feminine hygiene. Jury verdicts in these cases have resulted in multi-million and multi-billion dollar awards to plaintiffs, with courts finding that manufacturers knew of the potential asbestos contamination in their products and failed to warn consumers.
The most notable legal action taken by ovarian cancer victims has involved Johnson & Johnson’s Baby Powder. For decades, Johnson & Johnson aggressively marketed its iconic baby powder as a feminine hygiene product, even as the company was increasingly aware of the serious health risks it posed.[9] Internal documents have shown that Johnson & Johnson pivoted its marketing strategy toward women’s perineal use of the product for feminine hygiene. It is this specific use that has been linked to elevated ovarian cancer risk.
Despite the International Agency for Research on Cancer having classified perineal talc use as “possibly carcinogenic,” and the company’s own talc supplier including that warning on the product shipments the company received, Johnson &Johnson did not warn its customers of the risk they faced. A Reuters investigation found that, despite the company having known since at least the early 1970s that small amounts of asbestos had occasionally been detected in its raw talc and finished baby powder products, it continued targeting women in its advertising. This information has led to over 60,000 claims being filed against the company, and though the claims were delayed by the company’s attempt at avoiding liability through a controversial bankruptcy strategy, its petitions for protection have been rejected multiple times, and the cases have proceeded to trial. In one of the most notable instances, a St. Louis jury awarded $4.69 billion to 22 plaintiffs who alleged that Johnson & Johnson’s Baby Powder caused their ovarian cancer. Additionally, multiple claims have been filed against the company, accusing it of specifically targeting deceptive marketing at black women.[10]
Help for Ovarian Cancer Victims
If you have been diagnosed with ovarian cancer and you have a history of using talc-based powder, an asbestos and talc litigation lawyer can help you determine whether you are eligible to file a claim for compensation for your medical bills and other damages.
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