Ovarian Cancer

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What are the ovaries?

The ovaries are female reproductive organs located in the pelvis. There are two of them—one on each side of the uterus. The ovaries produce eggs and the female hormones estrogen and progesterone. Estrogen and progesterone control the development of female body characteristics (i.e., breasts, body shape and body hair) and regulate the menstrual cycle and pregnancy.

What is ovarian cancer?

Ovarian cancer is a disease in which malignant cells are found in an ovary. There are three types of ovarian tumors, named for the tissue in which they are found:

• Epithelial cell. These are cells that cover the surface of the ovary. Most of these tumors are benign (noncancerous). However, epithelial ovarian cancer accounts for most ovarian cancer cases.

• Germ cell. These are cells that form the eggs in the ovary.

• Stromal cell. These cells form the ovary and produce female hormones.

What is extra-ovarian primary peritoneal carcinoma (EOPPC)?

Extra-ovarian primary peritoneal carcinoma (EOPPC) is a rare cancer closely related to epithelial ovarian cancer. It occurs outside the ovary in the peritoneum, which is the lining of the abdomen. Because it occurs outside the ovary, women who have had their ovaries removed can still develop this type of cancer.

EOPPC can mimic ovarian cancer in terms of symptoms and can also cause an increase in the CA-125 tumor marker. Treatment is similar to that for ovarian cancer and includes surgery and chemotherapy.

What causes ovarian cancer?

The cause of ovarian cancer is not yet known. An estimated 22,280 new cases of ovarian cancer are expected in the U.S. in 2012. Ovarian cancer is the ninth most common form of cancer among women.

What are risk factors for ovarian cancer?

The cause of ovarian cancer is unknown, but there are certain risk factors that indicate an increase in a woman's chance of developing ovarian cancer. The following have been suggested as risk factors for ovarian cancer:

• Age (over the age of 55)

• Obesity

• Hormone replacement therapy
  Some studies have suggested that women who use hormone replacement therapy after menopause may have a slightly increased risk of ovarian cancer.

• Personal history of breast or colon cancer

• Family history
  First-degree relatives (such as mother, daughter, sister) of a woman who has had ovarian cancer are at risk for developing the disease. The risk increases if two or more first-degree relatives have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.

How can ovarian cancer be prevented?

Suggested preventive measures include the following:

• Healthy diet (high in fruits, vegetables, grains, and low in saturated fat)

• Pregnancy and breastfeeding

• Hysterectomy. Surgical removal of the uterus.

• Oophorectomy. Surgical removal of ovaries.

Research studies have shown that certain genes are responsible for increasing the risk of ovarian and breast cancer. Genetic counseling can predict whether you are likely to have one of these gene mutations. If your family history suggests that you may have one of these gene mutations, you might want to talk to your physician about genetic testing.

What are the symptoms of ovarian cancer?

The following are the most common symptoms of ovarian cancer. However, each individual may experience symptoms differently. Symptoms may include:

• General discomfort in the lower abdomen, including any/all of the following:

  • Feeling swollen or bloated

  • A loss of appetite or a feeling of fullness - even after a light meal

  • Gas, indigestion, and nausea

• Weight loss

• Diarrhea or constipation, or frequent urination caused by the growing tumor, which may press on nearby organs, such as the bowel or bladder

• Feeling very tired all the time

• Bleeding from the vagina

• Build up of fluid around the lungs, which may cause shortness of breath

The American Cancer Society (ACS) recommends that if any of these symptoms occur almost daily or last a few weeks and are new, the woman should seek the attention of her physician. In many cases, symptoms do not occur until the ovarian cancer is in an advanced stage. The symptoms of ovarian cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is ovarian cancer diagnosed?

Diagnosis includes a medical history and physical examination, including a pelvic examination to feel the vagina, rectum, and lower abdomen for masses or growths. A Pap test may be requested as part of the pelvic examination. The physician may also order other tests, including:

• Ultrasound. An imaging technique that uses sound waves to produce an image on a monitor of the abdominal organs, such as the uterus, liver, and kidneys.

• Computed tomography (CT or CAT scan). A noninvasive procedure that takes cross-sectional images of the internal organs to detect any abnormalities that may not show up on an ordinary X-ray. The CT scan may indicate enlarged lymph nodes - a possible sign of a spreading cancer or of an infection.

• Lower gastrointestinal (GI) series. X-rays of the colon and rectum using a contrast dye called barium.

• Intravenous pyelogram (IVP). X-rays of the kidneys and ureters, taken after the injection of a dye.

• Blood test. To measure a substance in the blood called CA-125 (a tumor marker that is found to be elevated in the blood of women with ovarian cancer). This test is more often used to monitor the progress of treatment than as a screening test since non-cancer problems can cause it to be elevated.

• Biopsy. A procedure in which tissue samples are removed from the body for examination under a microscope; to determine if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.

Treatment for ovarian cancer

Specific treatment for ovarian cancer will be determined by your physician based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Ovarian cancer may be treated with surgery, chemotherapy, radiation therapy, or a combination of treatments.

• Surgery. Surgery for ovarian cancer may include:

  • Salpingo-oophorectomy. Surgery to remove the fallopian tubes and ovaries.

  • Hysterectomy. Surgical removal of the uterus.

  • Pelvic lymph node dissection. Removal of some lymph nodes from the pelvis.

• Chemotherapy. The use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.

• Radiation therapy. The use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:

  • External radiation (external beam therapy). A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.

  • Internal radiation (brachytherapy, implant radiation). Radiation is given inside the body as close to the cancer as possible. In some cases, a treatment called intraperitoneal radiation therapy is used. A radioactive liquid is given through a catheter into the abdomen. (Internal radiation is very rarely used to treat ovarian cancer.)

Another treatment for ovarian cancer is intraperitoneal (IP) chemotherapy. This type of chemotherapy is given directly into the abdomen through a catheter (a long, thin tube). While several clinical trials have shown a benefit for this type of chemotherapy treatment for women with advanced ovarian cancer, it is not widely used.