Ovarian Cancer

 

Overview

Each year in the United States, more than 21,000 women are diagnosed with ovarian cancer.

The most common type of ovarian cancer is epithelial ovarian cancer. This is cancer that originates in the cells that cover the outer surface of the ovary. Less common types of ovarian cancer include germ cell tumors and sex cord-stromal tumors. This overview focuses only on epithelial ovarian cancer.

 

 

 

 

 

 

 

Ovarian cancer may not produce any symptoms until late in its development. Symptoms that have been associated with ovarian cancer include bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms such as urgency or frequency. These symptoms do not necessarily indicate ovarian cancer (they can be caused by many other conditions), but women with persistent symptoms are advised to seek care.

Evaluation of suspected ovarian cancer may involve imaging with tools such as computed tomography (CT) and ultrasound, blood tests, and surgery.

Prevention and Screening

The chance of an individual developing cancer depends on both genetic and non-genetic factors. A genetic factor is an inherited, unchangeable trait, whereas a non-genetic factor is a variable in a person’s environment, which can often be changed. Non-genetic factors may include diet, exercise, or exposure to other substances present in our surroundings.

Hereditary or Genetic Factors

Family History: Women with a family history of ovarian cancer have a greater risk of developing ovarian cancer themselves. In addition, some families are at particularly high risk of cancer due to hereditary cancer syndromes. These families often have multiple family members with cancer, and are more likely to develop cancer at a young age. In the case of breast and ovarian cancers, inherited mutations in two genes—BRCA1 and BRCA2—have been found to greatly increase the lifetime risk of developing breast and ovarian cancer. Mutations in these genes can be passed down through either the mother’s or the father’s side of the family.

Environmental or Non-Genetic Factors

Reproductive factors: Several aspects of a woman’s reproductive history appear to influence her risk of ovarian cancer. Behaviors that appear to reduce ovarian cancer risk include use of oral contraceptives, tubal sterilization (tubal ligation), and an increasing number of full-term pregnancies. Breastfeeding has also been linked with a reduced risk of ovarian cancer.

Postmenopausal hormone use: Estrogen, with or without progestin, is an effective treatment for many menopausal symptoms. Some studies, however, have suggested that postmenopausal hormone therapy may increase the risk of ovarian cancer.

Prevention

Removal of the Ovaries: In women with a strong family history of ovarian cancer or a BRCA1 or BRCA2 mutation, removal of the ovaries before cancer develops (prophylactic oophorectomy) can greatly reduce ovarian cancer risk. Surgery doesn’t completely eliminate ovarian cancer risk because some cells remain behind after surgery. It’s also important to be aware that removal of the ovaries often results in menopausal symptoms such as hot flashes, and makes a woman unable to have children.

Screening and Early Detection

For several types of cancer, progress in the area of cancer screening has led to earlier cancer detection and better outcomes. The term screening refers to the regular use of certain examinations or tests in persons who do not have any symptoms of a cancer but are at risk for that cancer.

There are currently no ovarian cancer screening tests that are routinely used in women at average risk of the disease. Potential screening tests such as the CA-125 blood test or transvaginal ultrasound have limited accuracy and have not been shown to reduce the risk of death from ovarian cancer. This is an active area of research, however, and there is still hope that a reliable marker or combination of markers for early ovarian cancer will be identified.

Women at high risk of ovarian cancer may be monitored using CA-125 and/or transvaginal ultrasound even though the benefit remains uncertain.

Pay Attention to Symptoms: According to a consensus statement developed by the American Cancer Society, the Gynecologic Cancer Foundation, and the Society of Gynecologic Oncologists, certain symptoms are more likely to occur in women with ovarian cancer than women in the general population:

  • Bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (urgency or frequency)

Women who experience these symptoms almost daily for more than a few weeks are encouraged to see a doctor, preferably a gynecologist.

Pelvic exam: A pelvic exam is often part of a routine gynecologic exam and may help to detect some ovarian cancers. Ovarian cancers that can be detected by pelvic exam tend to be at an advanced stage. A Pap test may also be performed during a gynecologic exam, but this test is used to detect cervical cancer, not ovarian cancer.

Learn More

Following surgical removal and staging of ovarian cancer, a final stage will be given. Treatment information for ovarian cancer is categorized and discussed by the stage. In order to learn more about the most recent information available concerning the treatment of ovarian cancer, click on the stage for which you are interested.

Stage I: Cancer is found only in one or both of the ovaries. Cancer cells may also be found in abdominal fluid, or ascites.

Stage II: Cancer is found in the ovaries and has spread to the uterus (womb), the fallopian tubes, or other areas within the pelvis. Cancer cells may also be found in abdominal fluid, or ascites.

Stage III: Cancer is found in the ovaries and has spread to other body locations within the abdomen, such as the surface of the liver, intestine or lymph nodes.

Stage IV: Cancer is found in the ovaries and has spread outside the abdomen or inside of the liver.
Recurrent or Refractory: Recurrent disease means that the cancer has returned (recurred) after it has been treated. Refractory disease means the cancer is no longer responding to treatment.

References

American Cancer Society. Cancer Facts & Figures 2009. Available at: http://www.cancer.org/docroot/STT/stt_0.asp (Accessed May 10, 2010).
American Cancer Society. Ovarian cancer has early symptoms. First national consensus on common warning signs. Available at: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Ovarian_Cancer_Symptoms_The_Silence_Is_Broken.asp (Accessed November 18, 2008).
Bertone-Johnson ER. Epidemiology of ovarian cancer: a status report. Lancet. 2005;365:101-102.
Danforth KN, Tworoger SS, Hecht JL, Rosner BA, Colditz GA, Hankinson SE. Breastfeeding and risk of ovarian cancer in two prospective cohorts. Cancer Causes and Control. 2007;18:517-23.
Steinrud Mørch L, Løkkegaard E, Halm Andreasen A, Krüger-Kjær S, Kidegaard Ø. Hormone therapy and ovarian cancer. Journal of the American Medical Association. 2009;302: 298-305.
Million Women Study Collaborators. Ovarian cancer and hormone replacement therapy in the Million Women Study. The Lancet. 2007;369:1703-10.
Rebbeck TR, Lynch HT, Neuhausen SL et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med. 2002;346:1616-1622.
National Cancer Institute. Ovarian Cancer Screening (PDQ®). Available at: http://www.cancer.gov/cancertopics/pdq/screening/ovarian/Patient/page3 (Accessed May 25, 2010).
American Cancer Society. Ovarian cancer has early symptoms. First national consensus on common warning signs. Available at: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Ovarian_Cancer_Symptoms_The_Silence_Is_Broken.asp (Accessed November 18, 2008).