Overview
Ovaries produce eggs for reproduction and are the main source of the female hormones estrogen and progesterone. They are located on either side of the uterus. There are typically three types of ovarian cancer: epithelial tumors, found in the outer surface of the ovary and the most common form of ovarian cancer; germ cell tumors, and stromal tumors.
Nearly 22,000 women in the U.S. are diagnosed annually with ovarian cancer. In the absence of a strong family or personal history with the disease, a woman's chances of developing ovarian cancer are about 1 in 72 over the course of her lifetime, by the age of 70.
Ovarian cancer mainly occurs in older women. About half of those diagnosed are 63 years or older. It is more common in Caucasians than in African-American women.
Symptoms
Long known as the "silent killer", ovarian cancer was thought to cause no symptoms during early stages of the disease. Studies have shown, however, that women with ovarian cancer frequently have repetitive and frequent symptoms but often feel the signs are caused by other illnesses or aren't serious enough to warrant testing. Anyone with the following repetitive symptoms should speak to her health care provider:
- Bloating
- Pelvic or abdominal pain
- Difficulty eating or feeling full too quickly
- Urinary symptoms such as having to go urgently or frequently
- Fatigue
- Upset stomach or constipation
- Back pain
- Pain during sex
- Menstrual changes
- Abdominal swelling with weight loss
Causes
The causes of ovarian cancer are still unknown. Pregnancy and taking birth control pills lower the risk of the disease, so there may be a link between ovulation and ovarian cancer.
Risk Factors
Women with a mother, sister or daughter who had ovarian cancer.
Obese women, which means those with a body mass index of at least 30.
Women who have had breast cancer, particularly those who had it before they were 50 years old.
Women with certain mutated genes, for example, BRCA1 and BRCA2, as well as the damaged genes associated with Lynch Syndrome, among others. These mutated genes don't help suppress cell growth, making it easier for cancer to develop.
Women who took estrogen, without progesterone, after menopause for 10 or more years.
Infertile women
Women who are middle-aged or older
Talc
Asbestos
Tests and Diagnoses
Screenings are not typically effective for detecting ovarian cancer and should only be used for high-risk women until they have completed childbearing and are ready to have their fallopian tubes and ovaries removed.
A transvaginal ultrasound, performed with a wand in the vagina, uses sound waves to look at the uterus, fallopian tubes and ovaries. It typically finds masses but cannot distinguish between cancer and benign tumors.
A blood test to determine the level of CA-125, a protein found in the blood, can be used when a woman has already been diagnosed with ovarian cancer. The level is typically higher in women with the disease and the test can be effective in analyzing whether treatment is working. It is not used as a screening tool because other conditions can also raise the CA-125 level. In addition, not all women who have ovarian cancer have an elevated CA-125 level.
CT and MRI scans can detect a mass but cannot confirm if it is cancerous.
A biopsy of tissue is necessary to confirm the diagnosis of ovarian cancer.
Treatment
Ovarian cancer is most commonly treated with a combination of surgery and chemotherapy. Radiation is rarely used.
Surgery: Depending on the type of ovarian cancer, the stage of the disease, and the age of the patient, surgery may range from a full hysterectomy – removing both ovaries, fallopian tubes, uterus and cervix - to taking out just one ovary, which is done for fertility preservation, only when appropriate. In addition, when the disease is in an early stage, lymph nodes and biopsies of the tissue lining the abdomen are also removed to fully stage the cancer. When the disease is advanced, all visible signs of cancer are removed from the abdomen and pelvis.
Chemotherapy: Giving chemotherapy medications by mouth or injecting them into a vein has been the standard in cancer treatment for decades and is still used most often. But studies have shown that intraperitoneal chemotherapy, when the medication is inserted through a catheter directly into the abdominal cavity, results in better outcomes for many eligible women when battling ovarian cancer. Holy Name has been at the forefront in using this type of treatment. Dr. Sharyn Lewin, Director of Gynecologic Oncology, is one of the nation's most skilled oncologists in advocating and utilizing intraperitoneal chemotherapy.
Targeted therapy is a treatment that uses drugs or other substances to alter the way a cancer cell grows, divides, repairs itself or interacts with other cells. Bevacizumab (Avastin) is one of these drugs and is often used to fight ovarian cancer. Personalized medicine allows such targeted therapy to treat cancer cells with the best chemotherapy drugs and new biologic agents available.
Precancerous Conditions
To treat precancers or dysplasia – a precancerous condition involving the growth of abnormal cells on the lining of the cervix or at the opening between the uterus and vagina – liquid nitrogen may be used to freeze abnormal cells, a procedure known as cryosurgery. Patients may experience a watery brown discharge for several weeks after the procedure. Laser surgery may also be performed to burn off the abnormal cells.
For severe dysplasia, also known as CIN 3, a conization to remove a cone-shaped piece of tissue, may be performed. This can be done several ways, with a surgical or laser knife or a thin heated wire, known as the loop electrosurgical (LEEP) procedure. A cone biopsy may be used for diagnosis or as treatment for women with early stage disease who want to preserve their fertility.
Prevention
Aside from removing the ovaries and fallopian tubes, there is no way to prevent or screen for ovarian cancer.
The best prevention starts with knowing your family history. Women who are at high risk for developing the disease should undergo genetic testing (make this a link to our genetic testing page) and counseling. Those with a genetic predisposition have the highest risk for ovarian cancer and may have their ovaries and fallopian tubes removed to prevent the disease.
Women who use oral contraceptives lower their risk of developing the disease. If birth control pills are taken for five or more years, the chances of developing ovarian cancer are 50 percent lower compared to women who never used oral contraceptives. Oral contraceptives have side-effects and should be taken only after a full discussion with your physician.
