Hrush Achemyan is a celebrity makeup artist, best known for her close work with the Kardashian family. The 33-year-old, Armenian-born beauty-influencer has also designed two fashion lines and has over 2.4 million followers on Instagram. She recently posted a , "Putting Rumors to Rest: The Truth About My Silent Battle" in which she reveals that she has been diagnosed with stage 1 ovarian cancer.
The diagnosis was made after Achemyan was examined by her gynecologist during her annual pap smear. A mass was discovered in her left ovary. The mass was biopsied five times and was found to be cancerous. The mass had also caused noticeable abdominal swelling which many speculated might signify that she was pregnant. Hrush took to with a picture of her swollen belly to reveal the true cause and to share the video of her cancer journey.
The video also shows Achemyan heading to Cedars-Sinai Medical Center in Los Angeles, where she underwent removal of the mass by Thais Aliabadi, MD. Aliabadi happens to be the same doctor who delivered Kylie Jenner's daughter Stormi Webster and Khloé Kardashian's daughter True Thompson. Achemyan tells followers: "I can't stress enough for you guys to get checked out annually and be in tip-top shape. Ovarian cancer is a silent and deadly killer. It doesn't discriminate. When you find out it is a little too late but thank you Lord for having this amazing doctor in my life."
Postoperatively, although she is feeling a lot of pain, she says she is happy to have shared her story: "I never knew I could be this person that could even express this much emotionally with you all. Especially because I've been brought up to be very private. It's so crazy to me that I feel so free now."
The following day, she shared another image of how much smaller her abdomen looked. She then ended the video by saying "We have to check in a month if the mass grows back but for now I am ok."
Is Ovarian Cancer Actually Cancer of the Ovary?
In recent years, there has been a paradigm shift concerning what has classically been called ovarian cancer. Of course, the rare tumors that originate in germ cells (sex cells, oocytes), or the stromal tissues surrounding those cells are still "true" ovarian cancers. However, tumors that originate anatomically on or near the ovaries are now divided into three subgroups: ovarian epithelial cancer, fallopian tube cancer (FTC), and primary peritoneal cancer (PPC).
The inclusion of FTC and PPC within the ovarian epithelial cancer designation is generally accepted because of much evidence that now points to a common Müllerian epithelium derivation. The Müllerian epithelium are tissues of the female reproductive tract that are derived from Müllerian ducts found in embryos. This includes the epithelia of the fallopian tubes, endometrium, endocervix, ectocervix, and upper vagina. In 2013, reported their careful analysis of bilateral salpingo-oophorectomy specimens from BRCA1 or BRCA2 mutation carriers having their ovaries and fallopian tubes removed in risk-reduction surgery. "These studies showed that a significant majority of high-grade serous ovarian carcinomas, the most common subtype, arise from the fallopian tube fimbriae rather than the OSE [ovarian surface epithelium]." The fimbriae are small finger-like projections at the end of the fallopian tubes that engulf the ovary and through which eggs move from the ovaries into the uterus.
Thus, high-grade serous adenocarcinomas arising from the fallopian tube and elsewhere in the peritoneal cavity, together with most ovarian epithelial cancers, represent extrauterine adenocarcinomas of Müllerian epithelial origin and are staged and treated similarly to ovarian cancer. Since 2000, FTC and PPC have usually been included in ovarian cancer clinical trials.
Incidence and Mortality
Epithelial carcinoma of the ovary is one of the most common gynecologic malignancies, with 50% of all cases occurring in women older than 65 years. It is the fifth most frequent cause of cancer death in women.
Estimates of ovarian cancer incidence and mortality in the U.S. are 21,750 cases and 13,940 deaths.
Approximately 1.2% of women will be diagnosed with ovarian cancer at some point during their lifetime. In 2017, there were an estimated 233,364 women living with ovarian cancer in the U.S.
The overall 5-year relative survival rate is 48.6%, although it varies by stage at diagnosis. For women with localized disease, the 5-year relative survival is 92.6%. Those with regional disease, 74.8% and those with distant disease only 30.2%.
Risk Factors
Increasing age is the most important risk factor for most cancers. Other risk factors for ovarian (epithelial) cancer include the following:
- Family history of ovarian cancer: A first-degree relative (e.g., mother, daughter, or sister) with the disease. This is the most important risk factor as approximately 20% of ovarian cancers are familial (mostly through BRCA1 or BRCA2 gene mutations)
- Inherited risk: BRCA1 or BRCA2 gene mutations
- Other hereditary conditions such as hereditary nonpolyposis colorectal cancer (HNPCC; also called Lynch syndrome)
- Endometriosis
- Hormone therapy: Postmenopausal hormone replacement therapy
- Obesity: High body mass index
Histopathology
Based on histopathology, immunohistochemistry, and molecular genetic analysis, there are five main subtypes of epithelial, fallopian tube, and peritoneal carcinomas. These are:
Although both HGSC and LGSC both arise from fallopian tube precursors, they appear to arise from different precursors: serous tubal intraepithelial neoplasia/carcinoma in the case of HGSC and endosalpingiosis/Müllerian rests in the case of LGSC. This accounts for differences in their molecular pathogenesis. HGSCs typically have TP53 and BRCA mutations, while LGSCs often carry KRAS and BRAF mutations.
Clinical Presentation
Ovarian, fallopian tube, or peritoneal cancer may not cause early signs or symptoms. When signs or symptoms do appear, the cancer is often advanced. Signs and symptoms include the following:
- Pain, swelling, or a feeling of pressure in the abdomen or pelvis
- Urinary urgency or frequency
- Difficulty eating or feeling full
- A lump in the pelvic area
- Gastrointestinal problems such as gas, bloating, or constipation
These symptoms often go unrecognized, leading to delays in diagnosis. Efforts have been made to enhance physician and patient awareness of the occurrence of these nonspecific symptoms.
Screening procedures such as gynecologic assessment, vaginal ultrasound, and cancer antigen 125 (CA-125) assay have had low predictive value in detecting ovarian cancer in women without special risk factors. As a result of these confounding factors, annual mortality in ovarian cancer is approximately 65% of the incidence rate.
Most patients with ovarian cancer have widespread disease at presentation. Early peritoneal spread of the most common subtype of high-grade serous cancers may relate to serous cancers starting in the fimbriae of the fallopian tubes or in the peritoneum, readily explaining why such cancers are detected at an advanced stage. Conversely, high-grade serous cancers are underrepresented among stage I cancers of the ovary.
Other types of ovarian cancers are, in fact, overrepresented in cancers detected in stages I and II. This type of ovarian cancer usually spreads via local shedding into the peritoneal cavity followed by implantation on the peritoneum and via local invasion of the bowel and bladder. The incidence of positive nodes at primary surgery has been reported to be as high as 24% in patients with stage I disease, 50% in patients with stage II disease, 74% in patients with stage III disease, and 73% in patients with stage IV disease. The pelvic nodes were involved as often as the para-aortic nodes. Tumor cells may also block diaphragmatic lymphatics. The resulting impairment of lymphatic drainage of the peritoneum is thought to play a role in the development of ascites in ovarian cancer. Transdiaphragmatic spread to the pleura is common.
Prognostic Factors
Certain factors affect treatment options and prognosis. These include:
- The type of tumor and its size
- The stage and grade of the tumor
- The existence of peritoneal fluid (ascites)
- The ability to surgically resect the tumor
- The presence of BRCA1 or BRCA2 mutations
- The patient's age and general health
- Whether the cancer is primary or recurrent
Favorable prognostic factors include diagnosis at a younger age, a well-differentiated tumor, early-stage disease, absence of ascites, smaller tumor size before surgery and small residual tumor after primary surgery, and being a BRCA1 or BRCA2 mutation carrier.
Treatment of "ovarian" cancers depends upon the exact type and is beyond the scope of this article. More information may be found at the National Cancer Institute's link below.
Sources: , ,
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.