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Ovarian Cancer

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(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. Stromal cancers are more rare. These come from the connective cells of the ovary. They typically make hormones that cause symptoms.
Cancerous Mass in the Left Ovary
Ovarian Cancer
Copyright © Nucleus Medical Media, Inc.

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 endometrial 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 sound waves to examine the body
  • Biopsy of tissue or cells
  • Computed tomography (CT) scan—a type of x-ray that uses a computer to make pictures of structures inside the body
  • Magnetic resonance imaging (MRI) scan—a test that uses magnetic waves to make pictures of structures inside the body
  • Lower gastrointestinal (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
Other tests may also be done to analyze the blood.

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:
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/

Foundation for Women's Cancer http://www.foundationforwomenscancer.org/

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

Cashen AF, Wildes TM. The Washington Manual; Hematology and Oncology Subspeciality Consult. Wolter Kluwers; 2008.

Ovarian cancer. National Cancer Institute, National Institutes of Health (NIH) website. Available at: http://www.cancer.gov/ . Accessed September 20, 2011.

What is ovarian cancer? American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F2%5F1X%5FWhat%5Fis%5Fovarian%5Fcancer%5F33.asp?sitearea= . Updated February 6, 2008. Accessed June 10, 2008.

9/18/2009 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.

Revision Information

  • Reviewer: Igor Puzanov, MD
  • Review Date: 09/2012 -
  • Update Date: 00/92/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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