Your Health - Ovarian Cancer

Ovarian Cancer

(Cancer of the Ovaries; Cancer, Ovarian)

Definition

Ovarian cancer is the growth of cancer cells in the ovaries. The ovaries make eggs for reproduction and female hormones. The most common type of ovarian cancer is epithelial.

Cancer occurs when cells in the body divide without control or order. If cells keep dividing uncontrollably, a mass of tissue forms. This is called a growth or tumor. The term cancer refers to malignant tumors. They can invade nearby tissue and spread to other parts of the body.

Many of these tumors may grow to be very large without showing symptoms. These tumors can be hard to find during a physical exam. As a result, about 70% of patients are found with advanced disease.

Germ cell tumors come from the reproductive tissue. They account for 20% of tumors. More rare are stromal cancers. These come from the connective cells of the ovary. They typically make hormones which cause symptoms.

Cancerous Mass in the Left Ovary

Causes

The causes of ovarian cancer are not known. However, research shows that certain risk factors are associated with the disease.

Risk Factors

Factors that increase your chance for ovarian cancer include:

Family history of ovarian cancer, especially in mother, sister, or daughter
Age: 50 or older
Menstrual history—first period before age 12, no childbirth or first childbirth after age 30, and late menopause
Personal history of breast cancer or colon cancer
Certain gene mutations, including BRCA1, BRCA2

Use of birth control pills for more than five years appears to decrease risk.

Symptoms

Symptoms often only appear in the later stages.

Symptoms include:

Abdominal discomfort and/or pain
Gas, indigestion , pressure, swelling, bloating, or cramps
Ascites
Nausea, diarrhea , constipation , or frequent urination
Loss of appetite
Feeling of fullness even after only a light meal
Unexplained weight gain or loss
Abnormal bleeding from the vagina
Hair growth, voice deepening, acne , loss of menstrual periods in some rare stromal tumors

These may also be caused by other, less serious health conditions. Anyone with these symptoms should see a doctor.

Diagnosis

Your doctor will ask you about your symptoms and medical history. A physical exam will be done.

Tests may include:

Pelvic Exam

Your doctor will use her gloved finger to check your:

Uterus
Vagina
Ovaries
Fallopian tubes
Bladder
Rectum

She will check for lumps or a change in size or shape.

Diagnostic Tests

Your doctor will use a combination of tests to help diagnose your condition:

Ultrasound —a test that uses radiation to take a picture of structures inside the body
CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
Lower GI series or barium enema —injection of fluid into the rectum that makes the colon show up on an x-ray so the doctor can see abnormal spots
CA-125 assay —a blood test to measure the level of CA-125, a substance in the blood that may be elevated if ovarian cancer is present
OVA1 test—a blood test done after a pelvic mass is found; certain protein levels in the blood can indicate whether a pelvic mass is cancerous

Treatment

Treatment depends on the extent of the cancer and your general health.

General Approach

If ovarian cancer is found, staging tests are done. They will help to find out if the cancer has spread and, if so, to what extent.

The more advanced the tumor, the poorer the prognosis. About, 75% of all epithelial tumors are in an advanced when they are found. The overall five-year survival rate is about 50%.

Surgery is often the first step. Afterwards, you will receive chemotherapy . Sometimes, radiation therapy of the abdomen is given.

Treatments include:

Surgery

The cancerous tumor and nearby tissue will be removed. Nearby lymph nodes may also be removed.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, and via a catheter. The drugs enter the bloodstream. They travel through the body killing mostly cancer cells. Some healthy cells are killed as well.

Radiation Therapy (Radiotherapy)

This therapy uses radiation to kill cancer cells and shrink tumors. Radiation may be:

External radiation therapy—radiation directed at the abdomen from a source outside the body
Intra-abdominal P32—sometimes a radioactive solution may be introduced into the abdomen as part of treatment

The more advanced the tumor at diagnosis, the poorer the prognosis. Unfortunately, 75% of all epithelial tumors are stage 3 or 4 at the time of diagnosis. The overall five-year survival rate is about 50%.

Prevention

There are no guidelines for preventing ovarian cancer because the cause is unknown. Symptoms also are not present in the early stages. If you think you are at risk for ovarian cancer, talk to your doctor. Schedule check-ups with your doctor if needed. All women should have regular physical exams. These should include vaginal exams and palpation of the ovaries.

RESOURCES:

American Cancer Society
http://www.cancer.org/

CancerCare
http://www.cancercare.org/

Gynecologic Cancer Foundation
http://www.wcn.org/gcf/

National Cancer Institute
National Institutes of Health
http://www.cancer.gov/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/

References:

Ovarian cancer. National Cancer Institute, National Institutes of Health (NIH) website. Available at: http://www.cancer.gov/ . Accessed June 10, 2008.

What is ovarian cancer? American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_ovarian_cancer_33.asp?sitearea= . Updated February 6, 2008. Accessed June 10, 2008.

¹9/18/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA clears a test for ovarian cancer. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm182057.htm . Published September 11, 2009. Accessed September 18, 2009.

Last reviewed September 2009 by Mohei Abouzied, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.