The ovaries are the parts of the female reproductive system that produce a woman’s eggs and female hormones.
Cancer of the ovary is not common, but it is the deadliest of female reproductive cancers. Women with ovarian cancer rarely experience the symptoms until cancer has reached an advanced stage.
At stage 1 of ovarian cancer, the cancer is present only in the ovaries i.e. it has not spread in any other organs. Signs and symptoms at this stage may include
- Mass felt in the abdomen
- Distension or swelling of abdomen
- Abnormal vaginal bleeding (between menstrual periods or after menopause)
- Pain or discomfort in the lower abdomen
- Back pain
- Bloating.
- Feeling full even with small portions of food
- Loss of appetite
- More frequent or urgent need to urinate and/or constipation.
How do you get ovarian cancer?
There is no sure way to know if you will get ovarian cancer. But, there are several factors that put you at risk. These include:
- Having a close family member with a history of ovarian cancer
- Having a genetic mutation (abnormality) called BRCA1 or BRCA
- Having a gene connected with Lynch syndrome
- History of breast, uterine, or colon cancer
- Middle-age or older age
- Having an Eastern European or Ashkenazi Jewish background
- Having endometriosis (a condition in which tissue from the lining of the uterus grows elsewhere in the body).
- Nulliparity (describes a woman who has not given birth)
- Fertility treatments
- Being overweight has been linked to increased incidence of ovarian cancer.
- Being on hormone replacement therapy
What are the stages of ovarian cancer?
After a woman is diagnosed with ovarian cancer, doctors will try to find out the cancer’s stage. This helps them to know about how far the cancer has spread so that they can treat it accordingly.
The stages of ovarian cancer range from stage I (1) through IV (4). The lower the number, the less the cancer has spread.
- Stage 1: Cancer is limited to one or both ovaries.
- Stage 2: Cancer has spread outside of ovaries but limited to the pelvis.
- Stage 3: Cancer has spread outside of the pelvis, but limited to the abdomen, or lymph node involvement, but not including the inside of the liver and spleen
- Stage 4: Cancer has spread to the liver or outside of the abdomen like to lungs.
Where does ovarian cancer occur?
Can Ovarian Cancer Be Found Early?
Only about 20% of ovarian cancers are diagnosed at an early stage. About 94% of patients live longer than 5 years after diagnosis when they find the cancer early.
Ovarian cancer can be found early by
- Regular checkup of women’s health: A regular pelvic examination can help detect ovarian cancers early by careful palpation (the doctor feels for abnormalities with their hands).
- Consulting a doctor in case of ovarian cancer symptoms: Prompt attention to symptoms may improve the chances of early diagnosis and successful treatment.
Screening tests are used to detect cancer in people with no symptoms. There is not enough research yet that has found a screening test to accurately detect ovarian cancer at an early stage. However, doctors have been using tests such as transvaginal ultrasound (TVUS) and the CA-125 blood test to gain some early insight into potential ovarian cancer.
TVUS (transvaginal ultrasound): A probe inserted into the vagina and images are cast on the sonography screen to check if there is an ovarian tumor. The shortcoming of TVUS is that it cannot distinguish between a cancerous ovarian mass and a noncancerous ovarian mass.
CA-125 blood test: This test measures the amount of a protein called CA-125 in the blood. High CA-125 levels are suggestive of ovarian cancer. But, the problem with using this test for ovarian cancer screening is that an increased level of CA-125 is also found in other common conditions such as endometriosis and pelvic inflammatory disease. Also, not everyone who has ovarian cancer has a high CA-125 level.
A CT Scan is further used to confirm the diagnosis of ovarian tumor in case of abnormal CA-125 level or abnormal TVUS.
Some organizations advocate the use of the tests, TVUS and CA-125 test to identify those women who have a high risk of ovarian cancer due to a hereditary genetic syndrome such as Lynch syndrome, BRCA gene mutations or a strong family history of breast and ovarian cancer.
A Pap test or HPV (human papillomavirus) test is the most widely used screening test for cervical cancer, but it is not a very effective test for ovarian cancer. Even if ovarian cancers are found through Pap tests, they usually are already at an advanced stage.
Ovarian Cancer Symptoms, Signs, Stages
What Is Ovarian Cancer?
Ovarian cancer is a malignancy of the ovaries, the female sex organs that produce eggs and make the hormones estrogen and progesterone. Treatments for ovarian cancer are improving, and the best outcomes are always seen when the cancer is found early.
Symptoms of Ovarian Cancer
There may not be any early symptoms of ovarian cancer. However, when symptoms do occur, they include abdominal bloating or a feeling of pressure, abdominal or pelvic pain, frequent urination, and feeling full quickly when eating. These symptoms, of course, occur with many different conditions and are not specific to cancer. You should discuss these symptoms with your doctor if they occur frequently and persist for more than a few weeks.
Risk Factor: Family History
Family history of ovarian cancer is a risk factor; a woman has a higher chance of developing it if a close relative has had ovarian, breast, or colon cancer. Inherited gene mutations, including the BRCA1 and BRCA2 mutations linked to breast cancer, are responsible for about 10% of ovarian cancers. Talk to you doctor if you have a strong family history of these cancers to determine if closer medical observation may be helpful.
Risk Factor: Age
Age is the strongest risk factor for ovarian cancer. It is much more common after menopause, and using hormone therapy may increase a woman's risk. This risk appears strongest in those who take estrogen therapy without progesterone for at least 5-10 years. It is not known whether taking estrogen and progesterone in combination also increases risk.
Risk Factor: Obesity
Obesity is also a risk factor for ovarian cancer; obese women have both a higher risk of developing ovarian cancer and higher death rates from this cancer than non-obese women. The risk seems to correlate with weight, so the heaviest women have the highest risk.
Screening Tests
Two ways to screen for ovarian cancer in its early stages are ultrasound of the ovaries and measurement of levels of a protein called CA-125 in the blood. Neither of these methods has been shown to save lives when used to test women of average risk. Therefore, screening is currently recommended only for women at higher risk.
Diagnosing Ovarian Cancer
Imaging tests like CT, MRI, or ultrasound can reveal an ovarian mass, but only a sampling of the tissue (biopsy) can determine whether the mass is cancerous. A biopsy is analyzed by a pathologist to determine whether or not the ovarian mass biopsied is due to cancer.
Stages of Ovarian Cancer
Staging of ovarian cancer refers to the extent to which it has spread to other organs or tissues. This is typically evaluated during surgery. Stages of ovarian cancer are as follows:
Stage I: The cancer is limited to the ovaries
Stage II: The cancer has spread to the uterus or other pelvic organs
Stage III: The cancer has spread to lymph nodes or lining tissues of the abdomen
Stage IV: The cancer has spread to distant sites, like the liver or lungs.
Types of Ovarian Cancer
There are different kinds of ovarian cancer, depending on the type of cell within the ovary that gave rise to the cancer. The large majority of ovarian cancers are epithelial cancers, or carcinomas. These cancers begin in the cells that line the surface of the ovary. Sometimes, tumors of these cells are not clearly cancerous but still display some suspicious features. These are called tumors of low malignant potential (LMP) and are less dangerous than other kinds of ovarian cancer.
Ovarian Cancer Survival Rates
Five-year survival rates for ovarian cancer range widely, from 18% to 89%, depending on the stage of the cancer when it was diagnosed. However, these odds were based on women diagnosed from 1988 to 2001, and treatments are constantly improving, so the odds may be better for women diagnosed today. For LMP tumors, five-year survival rates range from 77 to 99%.
Ovarian Cancer Surgery
Surgery is not only used to diagnose and stage ovarian cancer, but it is also used as a first step in treatment. Surgery to remove as much of the tumor as possible is typically carried out. It is usually necessary to remove the uterus as well as the fallopian tubes, the unaffected ovary, the omentum, and any other deposits visible and over 2 cm in size if possible to thereby both debulk and stage the ovarian cancer. Biopsies are also usually also done of sites where ovarian cancer is likely to be spread even if it is not visible.
Chemotherapy
Chemotherapy is typically given after surgery for all stages of ovarian cancer. Chemotherapy drugs are usually given intravenously, or administered directly into the abdominal cavity (intraperitoneal chemotherapy). Newer medications have made such treatment more tolerable than in the past. It is often highly effective, especially if the ovarian cancer has been well debulked. Women with LMP tumors often do not require chemotherapy after surgery unless the surgical findings were initially of concern or tumors grow back.
Targeted Therapies
New therapies for ovarian cancer may be directed at blocking tumor growth by interfering with the formation of blood vessels to supply the tumor. The process of blood vessel formation is known as angiogenesis. The drug Avastin works by blocking angiogenesis, causing tumors to shrink or stop growing. Avastin is used in some other cancers, and it is currently being tested in ovarian cancer.
After Treatment: Early Menopause
If women have both ovaries removed, this triggers menopause if they are still menstruating. The resultant drop in hormone production when the ovaries are removed can elevate a woman’s risk for other conditions like osteoporosis. Regular follow-up care is important after all treatment for ovarian cancer.
After Treatment: Moving On
After treatment, women may find that it takes a long time to regain their energy. Fatigue is common after cancer treatment. A gentle exercise program is a very effective way to restore energy and well-being. Your doctor can help you determine what activities are best for you.
Risk Reducer: Pregnancy
Women who have never given birth are more likely to develop ovarian cancer than those who have biological children. The risk seems to decrease with every pregnancy. Breastfeeding may also decrease risk.
Risk Reducer: 'The Pill'
Women who have taken birth control pills have a lower risk of ovarian cancer. Taking the pill for at least five years reduces a women’s risk by about 50%. Birth control pills and pregnancy both stop ovulation, and some researchers think that less frequent ovulation lowers the risk of ovarian cancer.
Risk Reducer: Tubal Ligation
Tubal ligation (having your tubes tied) or having a hysterectomy while leaving the ovaries intact may both offer some protection against ovarian cancer.
Risk Reducer: Removing the Ovaries
Removal of the ovaries is an option for women with genetic mutations that increase their cancer risk. This option can also be considered for women over 40 who are undergoing a hysterectomy.
Risk Reducer: Low-Fat Diet
No definitive dietary changes have been shown to prevent ovarian cancer. Nevertheless, a study showed that women who consumed a low-fat diet for at least 4 years had a lower risk of ovarian cancer. Other studies showed that ovarian cancer may be less common in women who consume a lot of vegetables. More studies are needed to clarify any relationship between diet and ovarian cancer.
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