Ovarian Cancer And Weight

Overview

Ovarian cancer (OC) is caused by the growth of abnormal cells in the ovaries and is one of the most dangerous types of gynaecological cancer in females around the world. This cancer has two types, epithelial and non-epithelial. OC is more common in developed countries, and in terms of continents, Europe has the highest rate, while Africa has the lowest. Even though it only makes up 3-5% of all cancer cases, it has a very high death rate, making it the sixth most common cause of death from cancer in women in the UK.

It is essential to recognise the risk factors and early indicators of ovarian cancer, as it is frequently referred to as a “silent killer.” In its initial stages, the disease typically presents very subtle or ambiguous symptoms, making it challenging to diagnose on time. Early symptoms include, but are not specific:

• Bloating
• Indigestion
• Feeling full with a lack of hunger
• Diarrhoea or constipation
• Stomach, back, and pelvic pains

Cytoreductive surgery and medication are the main methods of treatment.^1,2,3

Factors that cause a female's ovulation period to increase throughout her lifetime, such as nulliparity, early menarche, and late menopause, put you at risk of developing OC. Ovarian cancer can also be developed secondary to other conditions, the most common being endometriosis and excessive fat buildup (obesity). Though inconsistent, some studies have shown that obesity predisposes one to OC, while weight and dietary fat reduction reduce this risk by 40%.⁴

Here we will focus on the relationship between ovarian cancer and weight, its risk, disease progression, treatment options, and prognosis.

Infographic from Biorender showing an obese individual and a cancerous ovary 

What is the link between weight and OC risk?

Weight in terms of obesity, overweight, and underweight has been explored in ovarian cancer.

Obesity and overweight

A lot of research has been done to study and find out if there is an actual link between obesity and the risk of developing ovarian cancer. According to the latest World Cancer Research Fund Continuous Update Project, the chance of ovarian cancer rose by 6% for every 5-unit rise in BMI, meaning that as weight changes over time in females, the higher the risk of OC. It has also been reported that there is a 30% and 16 % higher chance of ovarian cancer for people who are obese and overweight, respectively, compared to people with a normal weight.⁵

Some physiological processes that may cause OC due to obesity have also been suggested, including genetic mutations, chronic inflammation, insulin resistance, and hormonal imbalances. The fat cells also act as hormone-releasing organs. It is because of this that when there is a problem with fat storage, as in obesity, it causes the dysregulation of sex hormones (oestrogen), fat-hormones leptin and adiponectin, inflammatory processes, and even the regulation of sugar, increasing the risk of developing OC.⁶

Leptin release makes you feel full. If leptin regulation is imbalanced, your brain may not respond to it, leading to overeating even when full. This can cause obesity and hormonal imbalance, with high leptin levels raising the risk of ovarian cancer.

Additionally, those who inherit or develop a harmful change in their genes, like the BRCA1 (Breast Cancer gene 1) and BRCA2 (Breast Cancer gene 2) mutation, a >20kg increase in weight since the age of 18, is said to be suggestive of an increased risk of developing ovarian cancer.⁷

Underweight

Being classified as underweight in adulthood refers to having a body mass index (BMI) of less than 18.5 kg/m². Although the link between being underweight and ovarian cancer is not thoroughly understood, it is recognised that individuals diagnosed with gynaecological cancers often face malnutrition challenges that can exacerbate their condition. Therefore, maintaining a healthy diet is extremely important.⁸

How does weight affect OC progression and prognosis?

When you are overweight or obese, the progression and prognosis of OC can be affected in different ways.

Tumour growth and aggressiveness

Fat cells in obese individuals can create a suitable condition that allows cancer cells to thrive. It does this by:⁹

• Increasing the level of leptin, a hormone produced by the fat cells, will promote the growth of the cancerous cells, avoiding cell death 
• Reducing the level of adiponectin will reduce the cancer cell death; they keep growing and spreading
• Resistance to sugar-controlling hormone (insulin) can cause too much sugar in the body (hyperglycemia), because your body can no longer effectively store it. Hyperglycemia helps the growth of tumour cells
• An increase in female sex hormone oestrogen by the fat cells can also cause cancer cells to grow, increasing the speed and infiltration of the cancerous cells

Influence on treatment outcomes

Biochemical changes due to fat accumulation can cause the blood cells in charge of fighting against unwanted germs and invaders in the body to turn into tumour-associated macrophages (TMAs). They are responsible for making the tumour cells thrive in the body. This may cause:¹⁰

• Lack of response of the cancer cells to chemotherapy 
• Challenge in the administration of surgery and radiation 
• Reduction in treatment doses, thus the ineffectiveness of drugs

Weight loss during cancer progression

Most cancers are well known to induce muscle cell wasting, but in OC, although there is some evidence, it is still unclear because of bloating and inflammatory symptoms. 

Malnutrition 

The primary health issue faced by individuals with OC is insufficient nutrition. Those with OC struggle to obtain enough nutrients due to the metabolic impacts of large tumours and blocked intestines. Research indicates that over 50% of people with this condition are at risk for malnutrition.¹¹

How can you manage weight to prevent and treat OC?

To reduce OC risk and other cancers, as well as comorbidities, like hypertension and diabetes, maintaining a good, balanced diet early in life is crucial.

Healthy diet in OC treatment 

Studies have shown improved outcomes in nutritional interventions for ovarian cancer cases.^12,13

• The first type of nutritional support to preserve or enhance nutritional status in OC persons involves a personalised nutrition consultation by a dietitian, with or without oral nutritional supplements 
• Each treatment depends on the individual and their unique features
• Nutrition intervention during treatment with chemotherapy can manage the bad effects of the treatment, keep the patient from losing weight, and help them stick to the planned chemotherapy schedule

Physical activity and weight management

Although less calorie consumption is considered more significant than exercise in weight reduction, physical activity may be more important in the management of weight loss.

Cancer cells can use energy from calorie-dense diets rich in carbohydrates, fats, and ketones to support their proliferation and survival. Therefore, if the energy supply for these cancer cells is restricted, it can slow down or potentially halt their growth. This is one of the reasons why it is thought that a low-calorie diet may lead to positive outcomes.¹³

Medical interventions for weight control in OC

A series of medications and surgery may help to lessen the cancer symptoms. Treatment is not entirely curative in some cases, but reversal of the tumours is possible. Always seek professional medical consultation and advice.¹⁴ 

FAQs

How does one's nutritional status affect the prognosis of OC after medical treatment?

Optimal cytoreduction, which means having less than 1 cm of disease left after surgery, is the best predictor of long-term survival for women with ovarian cancer. To get this clinical outcome, aggressive and complicated surgeries are often needed. A good nutritional state affects a person's ability to handle the stress of surgery and reduces the risk of problems afterwards. So, good dietary status means a higher chance of a better prognosis.

Can a low-calorie diet prevent ovarian cancer from recurring?

It is not certain, however, studies show that a healthy diet and low carb intake can reduce the risk of recurrence in OC and other cancers, as well as breast cancer.^9,15

Summary

Weight contributes a lot to ovarian cancer risk, progression, and treatment outcomes in different ways. Lifestyle, gene mutations, and hormonal imbalances are the main causative factors. Obesity may lead to an increased risk, while weight loss due to cancer can worsen prognosis. Therefore:

• Weight management through lifestyle modifications is very important
• There is also a need for personalised medical and nutritional interventions in managing ovarian cancer
• It is important to get regular gynaecological check-ups, especially with advancing age, so that the ailment can be diagnosed earlier