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Symptoms, Treatments and Diet for Ovarian Cancer

Dec 9, 2020

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Highlights

A diet containing cruciferous vegetables such as broccoli, kale and cauliflower, dietary fiber rich foods such as whole grains and legumes, and green tea containing EGCG (Epigallocatechin-3-gallate) may help in reducing the risk of ovarian cancer. Studies have also found the benefits of using key bio-actives such as Delta-tocotrienol, Vitamin C, Indole-3-carbinol, EGCG, Neem extracts, Silibinin and Curcumin in Ovarian Cancer patients along with specific chemotherapies to improve their efficacy, reduce the specific treatment related side-effects or relieve the aggravated symptoms/signs. However, obesity as well as dietary intake of acrylamide may be associated with an increased risk of this Cancer.


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Ovarian Cancer Incidence

Ovarian cancer is the eighth most commonly occurring cancer in women worldwide. In 2018, approximately 300,000 cases were estimated. (World Cancer Research Fund) Around 1.2% of women will be diagnosed with ovarian cancer at some point during their lifetime. (SEER., Cancer Stat Facts, National Cancer Institute) With the recent medical advancements, even though the 5-year survival rate for this cancer has improved in the past 30 years, overall, the prognosis still remains poor.

Symptoms, Treatment and Diet of Ovarian Cancer

The 5-year relative survival rate of advanced ovarian cancers varies between 12-42%. 60–80% of the ovarian cancer patients undergo treatment with the standard of care chemotherapies and relapse in 6 to 24 months resulting in further chemotherapy, ultimately making the cancer chemo-resistant.

Following are the different factors that can increase the risk of ovarian cancer:

  • Increasing age
  • Inherited gene mutations which can lead to ovarian cancer
  • Family history of ovarian cancer
  • Being overweight or obese
  • Smoking 
  • Exposure to asbestos
  • Estrogen hormone replacement therapy
  • Menstruation at an early age and menopause at a later age

Signs and Symptoms of Ovarian Cancer

Most of the signs and symptoms of ovarian cancer are similar to those of many other health conditions such as irritable bowel syndrome (IBS). Following are some of the most common signs and symptoms of ovarian cancer:

  • Discomfort in the tummy or pelvic area
  • Abdominal bloating
  • Swelling of the tummy
  • Loss of appetite or feeling full quickly when eating 
  • Changes in bowel habits, such as constipation
  • Needing to urinate more often

It is not necessary that having any of these signs/symptoms indicate that you have ovarian cancer.  However, if you experience any of these signs/symptoms of ovarian cancer, do ensure that you consult a healthcare practitioner.

Treatment for Ovarian Cancer

The treatment for ovarian cancer depends on the stage or extent the cancer has spread, the general health of the patient and whether the patient is still able to have children. In most cases, the treatment of ovarian cancer involves a combination of surgery and chemotherapy. Surgery, Chemotherapy, Radiotherapy, Targeted Therapies and Palliative care are the common treatment options for ovarian cancer. The treatment is aimed to cure the cancer, if possible. If ovarian cancer is too advanced, treatment used will be aimed at relieving symptoms and controlling the cancer for as long as possible.

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Studies associated with the Impact of Different Foods/Diet in Ovarian Cancer Patients

Researchers across the world have been studying the impact of the intake of different foods and diet in ovarian cancer patients as well as the association of various foods with the risk of ovarian cancer. Based on few in vitro, preclinical, observational and clinical studies, here are the examples of some foods which have been shown to be good or bad, when it comes to Ovarian Cancer.

Intake of Delta-tocotrienols may Improve the response of a Targeted therapy (anti-VEGF monoclonal antibody) Used in Ovarian Cancer Patients

In a phase II clinical study conducted by the researchers from Vejle Hospital in Denmark which involved 23 multi-resistant ovarian cancer patients, the researchers found that delta-tocotrienols, a specific group of chemicals found in Vitamin E, when taken along with one of the most common targeted therapies used for ovarian cancer, a humanized anti-VEGF monoclonal antibody, almost doubled the survival rate of the patients, maintaining the rate of disease stabilization at 70% with minimal toxicity. The patients had a mean progression free survival of 6.9 months and a mean overall survival of 10.9 months. (Thomsen CB et al, PharmacolRes., 2019)

Hence, a diet including foods such as grape fruit seed oil, oats, hazelnuts, maize and palm oil may be beneficial for ovarian cancer patient taking anti-VEGF monoclonal antibody therapy.

Decreased Magnesium levels in the body may be associated with Shorter Survival of Ovarian Cancer Patients treated with Platinum Based Chemotherapy

Decrease in the levels of Magnesium in the body is one of the most common side-effects seen in cancer patients who are treated with platinum based regimens. 

In a study done by the researchers from The University of Texas MD Anderson Cancer Center in the United States, they evaluated whether decreased magnesium levels (a condition called hypomagnesemia) affected the survival of 229 patients with advanced stage ovarian cancer who had undergone surgery and received chemotherapy containing platinum based regimens. between January 2004 to December 2014. Based on the findings from this study, the researchers concluded that the frequent occurrence of low magnesium levels in the body during the course of the platinum based chemotherapy and tumor reductive surgery was strongly predictive of the shorter survival in these advanced stage cancer patients.  (Liu W et al, Oncologist, 2019)

Hence, taking Magnesium as part of the diet in the right quantities may be beneficial for ovarian cancer patients.

High Dose Vitamin C/Ascorbate Enhanced Chemosensitivity of Ovarian Cancer and may Reduce Chemo-Induced Toxicity

In a study done by the researchers from the University of Kansas Medical Center, they found that parenteral ascorbate/Vitamin C along with the conventional chemotherapeutic agents (CIS/PTX) synergistically inhibited ovarian cancer in animal models and also reduced chemo-induced toxicity in ovarian cancer patients. (Ma Y et al, Sci. Transl. Med., 2014)

Indole-3-carbinol and Epigallocatechin-3-gallate May be a Potential Maintenance Therapy in Advanced Ovarian Cancer Patients

Indole-3-carbinol (I3C) is a key active ingredient found in cruciferous vegetables and Epigallocatechin-3-gallate (EGCG) is the key active ingredient found in green tea.

Researchers from the Peoples’ Friendship University of Russia, Russian Scientific Center of Roentgenoradiology and MiraxBioPharma in Russia and Wayne State University in the United States conducted a сomparative clinical trial to assess the efficacy of long-term maintenance therapy with I3C (with or without EGCG) in advanced ovarian cancer patients and found that long-term usage of I3C alone or with EGCG may improve treatment outcomes in these cancer patients and can be a potential maintenance therapy for these patients.(Vsevolod I Kiselev et al, BMC Cancer., 2018)

Hence, taking I3C and EGCG rich foods as part of the diet in the right quantities may be beneficial for ovarian cancer patients.

Neem Supplementation may Support a Specific Platinum Based Chemo Drug in Ovarian Cancer: Preclinical/In vitro Studies

Different laboratory studies have evaluated the impact of neem supplementation in gynaecological cancer cells such as ovarian, breast and cervical cancer cells and found that neem supplementation may reduce the proliferation of these cancer cells as well as improve the  the cytotoxicity of a commonly used chemotherapy in these cancers. (Kamath SG et al, Int. J Gynecol. Cancer, 2009; Sharma C et al, J Oncol. 2014)

Few studies in animal models of these gynaecological cancers also found that neem supplementation may reduce the treatment induced kidney and liver toxicities. (Moneim, AEA et al, Biol. Med. Res. Int., 2014; Shareef M et al, Matrix Sci. Med., 2018)

Silibinin May improve the Cytotoxicity of a Specific Chemo Treatment in Ovarian Cancer : Preclinical/In vitro Studies

Experimental studies have shown that Milk Thistle active, Silibinin can inhibit the growth of human ovarian cancer cells, and may also induce apoptosis (cell death) of these cells. Few other studies had also found that Silibinin may improve the cytotoxicity of a common ovarian cancer drug named PTX (Onxal). Silibinin in combination with PTX (Onxal) may also increase the apoptosis/cell death of ovarian cancer cells. (Prabha Tiwari and Kaushala Prasad Mishra, Cancer Research Frontiers., 2015)

These findings suggest that silibinin may be used as part of combinatorial therapies against this cancer.

Curcumin may Improve the Efficacy of a Platinum Based Chemotherapy in Ovarian Cancer : Preclinical/In vitro Studies 

Curcumin is the key active ingredient present in a common curry spice,Turmeric. An experimental study done by the researchers from The Ohio State University in the United States found that Curcumin experimentally enhanced the effectiveness of a Platinum-based Chemotherapy (CIS) in Ovarian cancer Cells suggesting that Curcumin may be an effective adjuvant for the treatment of this cancer. (Karuppaiyah Selvendiran et al, Cancer Biol Ther., 2011)

Obesity before Diagnosis may be associated with Poor Survival in Epithelial Ovarian Cancer Patients

A meta-analysis done by the researchers from the Korea University College of Medicine based on 17 population-based studies obtained through literature search in MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials databases found that obesity in early adulthood and obesity 5 years before the cancer diagnosis were associated with poor survival in Epithelial Ovarian Cancer Patients. (Hyo Sook Bae et al, J Ovarian Res., 2014)

Studies associated with Different Foods/Diet and the Risk of Ovarian Cancer

Cruciferous Vegetable Intake may Reduce the Risk

A study done by Horace Greeley High School and Roswell Park Cancer Institute in New York did a hospital-based, case-control analysis of self reported dietary data from 675 ovarian cancer patients and 1275 people without cancer, collected between 1981 and 1998 at Roswell Park Cancer Institute, New York, to evaluate the association between cruciferous vegetable (broccoli, spinach, kale etc) intake and this cancer. The study found that compared to low intake, high intakes of total vegetables, cooked cauliflower and cooked greens reduced the risk of this cancer by 35%, 18% and 37%, respectively. The dose-dependent analysis also found that for every additional ten servings of cruciferous vegetables per month, the risk reduced by 15%. (Hallie McManus et al, utr Cancer., May-Jun 2018)

Hence, a diet including cruciferous vegetables may help reduce the risk of ovarian cancer. 

Dietary Fiber Intake may Reduce the Risk

Dietary fiber is high in foods such as whole grains and legumes such as peas, beans etc.

In a meta-analysis done by the researchers from the Second Hospital of Lanzhou University and Second Military Medical University in Shanghai, China, based on data obtained from 13 studies, involving 5777 ovarian cancer cases and 1,42189 participants, obtained through literature search in PubMed, EMBASE, and the Cochrane Library databases till August 2017, they evaluated the association between dietary fiber intake and the risk of this cancer. (Bowen Zheng et al, Nutr J., 2018)

Based on the findings from the meta-analysis, they concluded that a diet including foods high in dietary fiber may significantly reduce the risk of ovarian cancer.

Unlike Black Tea, Green Tea Intake may Reduce the Risk

A meta-analysis done by the researchers from the University of North Carolina at Chapel Hill Gillings School of Global Public Health, University of Illinois at Chicago School of Public Health and Brown University School of Public Health in the United States, based on data from 14 studies obtained through literature search in PubMed, EMBASE, Web of Science and Scopus databases until 14 May 2017, found that, Green tea intake may be associated with a reduced risk of ovarian cancer. However, the study found that black tea consumption did not have any significant benefit on this cancer risk. (Zhang D et al, Carcinogenesis., 2018)

Hence, a diet including green tea may help to stay away from ovarian cancer.

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Coffee Intake may not be associated with the Risk

A meta-analysis done by the researchers from the Tehran University of Medical Sciences in Iran which included 14 cohort/population-based studies obtained through literature search in PubMed/Medline, ISI Web of Science, Scopus, and EMBASE databases till October 2018 found that there was no significant association between caffeine intake or different types of coffee intake and the risk of ovarian cancer. (Salari-Moghaddam A et al, J Clin Endocrinol Metab., 2019)

Hence, drinking coffee may not increase ovarian cancer risk.

Dietary Intake of Acrylamide may Increase the Risk

Acrylamide is a carcinogenic chemical produced by starchy foods such as potatoes which are fried, roasted or baked at a very high temperature, over 120oC. 

A meta-analysis done by the researchers from various Universities in Italy, Denmark, United States, Iceland and Czech Republic evaluated the association between estimated dietary intake of acrylamide and the risk of breast, endometrial, and ovarian cancers in 16 population-based and 2 case-control studies published through February 25, 2020. The researchers found that a high intake of acrylamide may be associated with an increased risk of ovarian and endometrial cancers, specifically in those who never smoked. (Giorgia Adani et al, Cancer Epidemiol Biomarkers Prev., 2020)

Hence, dietary intake of acrylamide through fried foods and potatoes included in the diet may increase ovarian cancer risk.

High Intake of Eggs may Increase the Risk

A meta-analysis done by the researchers from the Hebei Medical University in China based on data from 12 studies involving 629,453 subjects and 3728 ovarian cancer cases, obtained through literature search in PUBMED, EMBASE, and Cochrane Library Central databases till August 2013, found that compared to those with low intake of eggs, people with high egg consumption may be associated with an increased risk of this cancer, especially in case-control studies. (Sai-tian Zeng et al, Clin Nutr., 2015)

Conclusion

Based on these studies, a diet containing foods such as cruciferous vegetables, dietary fiber rich foods such as whole grains and legumes, and green tea may help reduce the risk of ovarian cancer. In addition to these foods, different studies have also found the benefits of including key actives such as Delta-tocotrienol, Vitamin C, Indole-3-carbinol, EGCG, neem, Silibinin and Curcumin in the diet for Ovarian Cancer patients, when taken along with specific chemo to improve their efficacy or to reduce the treatment related side-effects and relieve aggravated symptoms/signs. However, obesity due to high intake of red meat or processed meat and fried foods as well as dietary intake of acrylamide may be associated with an increased risk of this Cancer.

“What should I eat?” is the most frequently asked question to cancer dieticians and physicians. The right answer depends upon cancer type, underlying genomics, current treatments, any allergies, lifestyle information, and factors like BMI.

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