Ovarian Cancer


Fact: There are no reliable screening tests for ovarian cancer

Definition
Ovarian cancer is a type of cancer that begins in the ovaries. Women have two ovaries, one on each side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen and progesterone.

Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Most commonly, tumors arise from the epithelium, or lining cells, of the ovary. These include epithelial ovarian (from the cells on the surface of the ovary), fallopian tube, and primary peritoneal (the lining inside the abdomen that coats many abdominal structures) cancer. These are all considered to be one disease process. There is also an entity called ovarian low malignant potential tumor; these tumores have some of the microscopic features of a cancer, but tend not to spread like typical cancers.

There are also less common forms of ovarian cancer that come from within the ovary itself, including germ cell tumors and sex cord-stromal tumors. All of these diseases as well as their treatment will be discussed.

Symptoms
Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel.
Signs and symptoms of ovarian cancer may include:

  • Abdominal bloating or swelling
  • Quickly feeling full when eating
  • Weight loss
  • Discomfort in the pelvis area
  • Changes in bowel habits, such as constipation
  • A frequent need to urinate


When to see a doctor:

Make an appointment with your doctor if you have any signs or symptoms that worry you.

If you have a family history of ovarian cancer or breast cancer, talk to your doctor about your risk of ovarian cancer. Your doctor may refer you to a genetic counselor to discuss testing for certain gene mutations that increase your risk of breast and ovarian cancers. Only a small number of women are found to have genetic mutations that can lead to ovarian cancer.

Causes
It's not clear what causes ovarian cancer.
In general, cancer begins when a genetic mutation turns normal cells into abnormal cancer cells. 

​Cancer cells quickly multiply, forming a mass (tumor). They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize).

Types of ovarian cancer
The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:

  • Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.
  • Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal.
  • Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.


Risk factors
Certain factors may increase your risk of ovarian cancer:

  • Age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.
  • Inherited gene mutation. A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer.
    The gene mutations that cause Lynch syndrome, which is associated with colon cancer, also increase a woman's risk of ovarian cancer.
  • Estrogen hormone replacement therapy, especially with long-term use and in large doses.
  • Age when menstruation started and ended. If you began menstruating before age 12 or underwent menopause after age 52, or both, your risk of ovarian cancer may be higher.
  • Never being pregnant.
  • Fertility treatment.
  • Smoking.
  • Use of an intrauterine device.
  • Polycystic ovary syndrome.

If you have a genetic predisposition to ovarian cancer, your doctor may recommend regular pelvic imaging and blood tests to screen for the disease.

Prevention
There's no sure way to prevent ovarian cancer. But certain factors are associated with lower risk:

  • Use of oral contraceptives, especially for more than 10 years
  • Previous pregnancy
  • History of breast-feeding
  • Daily use of aspirin

Diagnosis
Sometimes the doctor may feel a lump in or on an ovary during a pelvic exam. Often a lump may be seen during an ultrasound. Most lumps aren't cancer.

If your doctor thinks you may have ovarian cancer, you may have a blood test called CA-125 (cancer antigen 125). Too much CA-125 in your blood can be a sign of ovarian cancer. But too much CA-125 in the blood can be caused by many things, such as the menstrual cycle, endometriosis, and uterine fibroids. 

The only way to know for sure that a woman has ovarian cancer is with biopsies taken during surgery. Tissue samples will be sent to a lab to see if they contain cancer.

Treatments and drugs
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Surgery
Treatment generally involves removing both ovaries, the fallopian tubes, the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue (omentum) where ovarian cancer often spreads. Your surgeon also will remove as much cancer as possible from your abdomen.

Less extensive surgery may be possible if your ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children.

Chemotherapy
After surgery, you'll likely be treated with chemotherapy to kill any remaining cancer cells. Chemotherapy drugs can be injected into a vein or directly into the abdominal cavity or both.
Chemotherapy may be used as the initial treatment in some women with advanced ovarian cancer.

Coping and support
A diagnosis of ovarian cancer can be extremely challenging. Here are some suggestions that may make dealing with cancer easier:

  • Find someone to talk with. You may feel comfortable discussing your feelings with a friend or family member, or you might prefer meeting with a formal support group. Support groups for the families of cancer survivors also are available.
  • Let people help. Cancer treatments can be exhausting. Let people know what would be most useful for you.
  • Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But choose goals that you can reach.
  • Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer.


Want to learn more?
The following are organizations and/or websites dedicated to providing information and education surrounding Ovarian Cancer. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.

American Cancer Society
Mayo Clinic
Medicine Net
WebMD



Information on this page taken directly from:
Mayo Clinic
Medicine Net
WebMD