Ovarian Cancer

Cancer happens when cells in the body begin changing and multiplying out of control. These cells can form lumps of tissue called tumors. Cancer that starts in the ovaries is called ovarian cancer. Ovarian cancer can spread from the ovaries to other parts of the body. This spread is called metastasis. In general, the more cancer spreads, the harder it is to treat.

Since only women have ovaries, only women can get this kind of cancer.

The ovaries are a pair of walnut-sized organs in a woman's pelvic area. They are located on either side of the uterus (the organ that holds the baby when a woman is pregnant). Ovaries keep and release the eggs that, when combined with a man's sperm, can grow into a baby. The ovaries also make the female hormones progesterone and estrogen.

When a woman reaches menopause (the "change of life"), her ovaries stop releasing eggs and stop making certain hormones.

There are three different types of ovarian tumors:

• Epithelial tumors form in the cells that cover the outer surface of the ovaries. This is the most common type of ovarian cancer.

• Germ cell tumors form in the cells inside the ovary that produce eggs. These rare tumors are most common in women in their teens and early twenties. There are different subtypes of germ cell tumors. 

• Stromal tumors grow from the support cells that hold the ovaries together and make female hormones. This is a rare form of ovarian cancer.

Ovarian cancer often doesn’t cause any symptoms until after it has spread outside the ovary. Even then, it often causes vague symptoms. These are similar to those of many other more common diseases. These symptoms can include the following:

• Indigestion, heartburn, nausea, or gas.

• Belly swelling or discomfort.

• Pelvic pain or cramping.

• Bloating or a sense of fullness, especially after eating.

• Backache.

• Painful, frequent, or burning during urination with no infection.

• Diarrhea or constipation.

• Tiredness and lack of energy (fatigue).

• Loss of appetite or unplanned weight loss or weight gain.

• Vaginal bleeding or irregular periods.

• Pain during sex.

• Enlarged lymph nodes in the neck or groin.

Many of these symptoms may be caused by other health problems. It’s important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

If your healthcare provider thinks you might have ovarian cancer, you will need certain exams and tests to be sure. Diagnosing ovarian cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, reproductive history (such as if you've ever been pregnant), and family history of disease. Your healthcare provider will also give you a physical exam.

You may have one or more of the following tests:

• Pelvic exam.

• Ultrasound.

• CT scan.

• CA-125 blood test.

• Biopsy.

Pelvic exam

This is often the first exam done. It allows your healthcare provider to feel for any abnormal lumps (masses) or other problems. During a pelvic exam, you lie on your back on an exam table, with your feet in stirrups and your legs apart. Your healthcare provider puts one or two fingers of a gloved hand inside your vagina. He or she uses the other hand to press on your lower belly (abdomen) to feel for masses. Your healthcare provider may also put a finger in your rectum to feel for anything abnormal that might suggest that the cancer has spread.

Ultrasound

This test allows your healthcare provider to see if there's a cyst or tumor on your ovary, or if there is fluid in your abdomen Your healthcare provider aims sound waves at your ovaries. He or she does this either by putting a small probe into your vagina (transvaginal ultrasound) or aiming them through the skin of your abdomen (abdominal ultrasound). The pattern of the echoes makes a picture on a video screen. This is called a sonogram. The echoes are different for healthy tissues, fluid-filled cysts, and tumors. The test can be uncomfortable, but it isn’t painful. It doesn’t use X-rays. You don’t need to be sedated.

CT scan

This test makes detailed 3D pictures of organs and tissues in your pelvis or abdomen. An X-ray machine linked to a computer takes several pictures. You may get contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly.

CA-125 blood test

This blood test shows how much of a protein called CA-125 is in your blood. A high (elevated) CA-125 may be a sign of tumor cells. But it also can be elevated in many noncancer conditions. This is called a false positive result. After a diagnosis of ovarian cancer, your healthcare provider may use this blood test to see if you’re responding to treatment. Or the test can be used to check if the cancer has come back.

Biopsy

Unlike many other types of cancer, a biopsy is rarely used to diagnose ovarian cancer before surgery. If cancer is present and just in the ovary, doing a biopsy breaks the covering of the ovary. This may allow the cancer to spread. Sometimes your healthcare provider may recommend a biopsy of a tumor or lymph node that is not near the ovary. This is done to see if the cancer has spread to another area. A diagnosis of ovarian cancer is often confirmed at the time of surgery. At that time, the surgeon removes the tumor or tumors and takes samples of nearby tissues to find out if the cancer has spread. In a lab, a pathologist looks at the removed tissues to see if cancer is present.

When your healthcare provider has the results of your tests, he or she will contact you with the results. Your provider will talk with you about other tests you may need if ovarian cancer is strongly suspected. Make sure you understand the results and what follow-up you need.

You and your healthcare provider will discuss a treatment plan that's best for your needs. Treatment choices may include:

• Surgery to remove the ovary with cancer or both ovaries as well as nearby tissue and organs.

• Chemotherapy, which uses strong medicines to kill cancer cells. This treatment is often used along with surgery.

• Radiation therapy, which uses directed rays of energy to kill cancer cells, is sometimes used in the treatment of ovarian cancer. Radiation therapy is not a common main treatment for ovarian cancer.

There are many risk factors for ovarian cancer.

Age

A woman's risk for ovarian cancer rises with age. 

Obesity

Being obese means having a body mass index greater than 30. Obesity increases risk for ovarian cancer and many other cancers. It also increases the risk of dying from it.

Pregnancy history

Women who have never given birth have a slightly higher risk for ovarian cancer.

Use of estrogen replacement therapy

Women who have used estrogen replacement therapy for menopause for more than 10 years may have a slightly higher risk for ovarian cancer. This therapy means taking estrogen alone, without progesterone.

Family history and genetic syndromes

A mother or sister is considered a first-degree relative. If you have two or more first-degree relatives who have had ovarian cancer, this suggests that heredity may be a cause. If you have a family history of breast, ovarian, endometrial, or colon cancer, or genetic cancer syndromes such as Lynch syndrome, your family may have certain genetic mutations (such as BRCA genes) that increase the risk for ovarian cancer. These types of ovarian cancer account for about 1 in 20 to 1 in 10 ovarian cancer cases. Syndromes passed in families and linked to increased risk include:

• Lynch syndrome or hereditary nonpolyposis colon cancer (HNPCC). This increases a woman's risk of having ovarian, uterine, colon, and other cancers at a much younger age than usual.

• Peutz-Jeghers syndrome (PJS). This is caused by a certain genetic mutation (gene STK11). It’s linked with a higher risk for ovarian, breast, uterine, and lung cancer.

• Gorlin syndrome or nevoid basal cell carcinoma syndrome (NBCCS). Women with NBCCS have an increased risk for noncancerous fibrous tumors of the ovaries called fibromas. There is a slight risk that these fibromas could turn into ovarian cancer.

• Li-Fraumeni syndrome. This is linked with a slightly higher risk for ovarian cancer.

• Ataxia-telangiectasia. This may put women at a slightly higher risk for ovarian cancer.

• Cowden disease or PTEN tumor hamartoma syndrome. This is caused by inherited changes in the PTEN gene. It mostly causes thyroid problems, thyroid cancer, and breast cancer. But it also increases the risk for ovarian cancer.

• MUTYH-associated polyposis. This causes polyps in the colon and small intestine. It’s also linked with a high risk for colon cancer. It also puts people at a higher risk for other cancers, including cancers of the ovary and bladder.

Personal cancer history

A personal history of breast, uterine, rectum, or colon cancer puts you at a higher risk for ovarian cancer.

Use of talcum powder

It’s not clear if using talcum powder on the genital area raises the risk for ovarian cancer. Talk with your healthcare provider if you decide that you want to use talcum powder.

Use of fertility medicines

If you've used fertility medicine for more than a year, you may be at increased risk for ovarian cancer. But studies don't agree on this link. It may be the infertility problem and not the medicine that increases this risk.

Endometriosis

If you have endometriosis, you may have a higher risk for ovarian cancer.

Talk with your healthcare provider about your risk factors for ovarian cancer and what you can do about them.

If you’re concerned about your family's history of breast or ovarian cancer, talk with your healthcare provider about genetic counseling. If you have gene changes that put you at higher risk, you may want to discuss surgery. Having surgery to remove your ovaries and fallopian tubes may help lower your risk.

Ovarian cancer screening tests aren’t recommended. This is because current screening tests are not accurate enough to find ovarian cancer in most women. But regular pelvic exams are important. You can talk with your healthcare provider about using ultrasound to check your ovaries for changes if you’re at higher risk.

Regular blood tests for antigen CA-125 may also be an option. CA-125 is a protein found in the cells of some kinds of ovarian cancer. This isn’t a perfect screening test because it’s not higher (elevated) in all women with ovarian cancer. If it is a lot high, it doesn’t necessarily mean you have ovarian cancer.

Birth control pills (oral contraceptives) may help lower the risk for some types of ovarian cancer. Women who take birth control pills for 5 years or more have about half the risk for ovarian cancer as women who never used them. But birth control pills can increase the risk for blood clots and stroke. They can also cause other side effects. Talk with your healthcare provider about birth control pills.

Being told you have ovarian cancer can be scary, and you may have many questions. You have people on your healthcare team to help. Learning about your cancer and about the treatment options available to you can make you feel less afraid.

Your healthcare team will likely include:

• Gynecologic oncologist. This is an obstetrician/gynecologist (OB/GYN) who is specially trained in treating cancers of the female reproductive system. This doctor does the surgery to treat ovarian cancer and can also treat cancer with medicines

• Medical oncologist. This is a doctor who specializes in treating cancer with medicines.

• Radiation oncologist. This is a doctor who specializes in treating cancer with radiation.

• Oncology nurse. This is a nurse who specializes in caring for people with cancer.

They will answer any questions you may have. They’ll help you through each of the steps you take before, during, and after treatment. Your team will let you know what tests you need and the results of those tests. They’ll guide you in making treatment decisions and help prepare you and your loved ones for what’s ahead.

Coping with cancer can be very stressful. Talk with your healthcare team about seeing a counselor. They can refer you to someone who can help. You can also visit support groups to talk with other people coping with cancer. Ask your healthcare team about local support groups.