Women’s Health Q&A with Scripps Gynecological Cancer Program Director Jo Marie Tran Janco

Tennis star Chris Evert’s recently publicized diagnosis of stage 1C ovarian cancer underscored the dangers of a disease that can strike silently with seemingly harmless symptoms in the early stages.

Dr Jo Marie Tran Janco


Carmel Valley resident Dr. Jo Marie Tran Janco is director of the gynecologic cancer program at Scripps MD Anderson Cancer Center and physician at the Scripps Clinic. In a Q&A, she talked about ovarian cancer awareness, signs and symptoms to look out for, and treatment options.

This interview has been lightly edited for clarity and conciseness.

Q: What is your background and how did you end up at Scripps?

A: I’m the director of the gynecologic cancer program at Scripps MD Anderson Cancer Center. I joined the Scripps Clinic medical group when I returned to Southern California after completing my stock market training in Minnesota about six years ago. I was really looking for a program that would provide evidence-based comprehensive care that was truly individualized and with colleagues I could trust.

Q: Given recent news about Chris Evert sharing his diagnosis of ovarian cancer, how important is it to raise awareness about ovarian cancer?

A: I think with gynecological cancer in general, especially ovarian cancer, there could be a lot more awareness. Many of the women I treat have fairly vague symptoms when leading up to their diagnosis, and because the symptoms are abdominal, things like bloating can be confused with other things like bowel symptoms. So sometimes there may be a delay in its recognition. So I think it’s very important for women to be more aware of the signs and symptoms of ovarian cancer, and also empowered to think about their medical history, family history, learn about genetic testing – that’s how Chris Evert got his diagnosis.

Q: Are there any misconceptions about ovarian cancer or anything that people would be surprised to learn about it?

A: I think there is a misconception that it is a silent cancer. Most women, when they are diagnosed, if they look back, they had symptoms for several months before their diagnosis. But they tend to be vague so I think awareness of increased frequency of symptoms – like bloating, pelvic and abdominal pain, changes in urinary habits like frequency or urgency that are different and more frequent is pretty typical of what we study and what we hear from patients – I think that would lead to earlier diagnosis and more patient awareness.

And then I think the other thing that’s important to know is how important it is to consider family history and genetic testing. Most ovarian cancers are not associated with genetic mutations, but probably between 20 and 25% are. If women know their mutation status, if they have had genetic counseling and testing and have this information, it can empower them to do things to prevent cancer and also for their family members to get test.

Q: Are there any other key risk factors people should be aware of?

A: Age is a risk, so as women age they are at greater risk for ovarian cancer. But there is a whole structure and different types of ovarian cancer. Younger women should also pay attention to symptoms. Some subtypes of ovarian cancer are associated with other conditions, such as endometriosis. The reproductive history is important. Women who have not had children or who have not been pregnant are at increased risk when dealing with large populations. Anyone with a family history of ovarian cancer, whether a direct close relative or even a great-aunt or grandparent, could be at increased risk.

When you read about risk factors for ovarian cancer, one thing that sometimes comes up is race or ethnicity. It’s true that most white women are at higher risk, but anyone, regardless of background, can potentially be at risk. I have patients from all walks of life. It is therefore important to know the signs and symptoms and to really be in communication with your doctor to have these symptoms examined.

Q: What treatment options are available for women with ovarian cancer?

A: It really depends on what stage, what subtype. That’s why I think it’s important to be treated at a comprehensive cancer center like the Scripps MD Anderson Cancer Center. Usually, treatment involves surgery. This should be done with a gynecological oncologist. I think what a lot of people don’t know is that gynecologic oncology is also a subspecialty. We are cancer oncology surgeons who are trained to treat and manage gynecological cancers, as well as very comprehensively support women throughout their cancer journey, and beyond.

Often treatment begins with surgery, sometimes that’s all women need. Often, chemotherapy is involved. We have more targeted treatments available. There is a whole new class of drugs called PARP inhibitors that we are increasingly incorporating into cancer treatments. So there have been a lot of exciting new developments.

For more information, visit scripps.org/cancer.

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