Ovarian Cancer

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. 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

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Causes

Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but is probably a combination of genetics and environment.

Risk Factors

Ovarian cancer is most common in women age 50 or older. Other factors that may increase your chances of ovarian cancer:

• Family history of ovarian cancer, especially in mother, sister, or daughter
• Menstrual history—first period before age 12, no childbirth or first childbirth after age 30, and late menopause
• Personal history of breast cancer or uterine cancer
• Certain gene mutations, including BRCA1 or BRCA2
• Postmenopausal hormone replacement therapy
• Polycystic ovary syndrome or obesity
• Endometriosis

Use of birth control pills for more than 5 years appears to decrease the risk of ovarian cancer development.

Symptoms

Many ovarian tumors grow to be very large without showing symptoms. Symptoms often only appear in the later stages. These tumors can also be hard to find during a physical exam. As a result, the majority of tumors are found with advanced disease.

Symptoms include:

• Abdominal discomfort and/or pain
• Gas, indigestion , pressure, swelling, bloating, or cramps
• 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

Diagnosis

You will be asked about your symptoms and medical history. A physical exam and pelvic exam will be done.

Your bodily fluids and tissue may be tested. This can be done with:

• Blood tests
• Biopsy

Imaging tests include:

• Ultrasound
• CT scan
• MRI scan
• Lower GI series or barium enema

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, ovarian cancer is staged from 0-4. Stage 1 is a very localized cancer, while stage 4 indicates a spread to other parts of the body.

Treatment

Treatment for ovarian cancer depends on the stage of the cancer and your general health. Options may include:

Surgery

The cancerous tumor and nearby tissue will be removed. This usually includes the uterus, fallopian tubes, and lymph nodes.

Chemotherapy

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

Radiation Therapy

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

• External radiation therapy —radiation directed at the abdomen and pelvis from a source outside the body
• Internal radiation therapy (intra-abdominal P32)—sometimes a radioactive solution may be introduced into the abdomen as part of treatment

Prevention

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.

Genetic testing may help identify those who should consider having surgery to remove both ovaries and the fallopian tubes. In some cases, it may prevent ovarian cancer in high-risk women.

Eating a low-fat diet that includes lots of fruits and vegetables may also reduce your risk of ovarian cancer. It is also important to maintain a healthy weight.

Talk to your doctor about whether aspirin would help lower your risk of ovarian cancer.