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Reviewed by the Faculty of Harvard Medical School

Ovarian Cancer

What Is It?

Ovarian cancer is the uncontrolled growth of abnormal cells in the ovaries, the female reproductive organs that produce eggs. Ovarian cancer cells come from one of three areas in the ovary. Cancer cells forming in the surface layer of the ovary (epithelial carcinoma) are the most common. Cancer cells forming from the egg-producing cells (germ cell tumors) and from the supportive tissues within the ovaries (stromal tumors) are less common.

The disease often does not cause any symptoms until it has spread beyond the ovaries, the late stage of ovarian cancer. It is difficult for a physician to detect ovarian cancer during a pelvic exam before this late stage. This helps to explain why ovarian cancer leads to death more often than some other cancers. Ovarian cancer accounts for more deaths than any other cancer of the female reproductive system. An estimated 15,520 women are expected to die of ovarian cancer in the United States during 2008, according to the latest statistics from the American Cancer Society.

Symptoms of ovarian cancer may be mild and imitate less serious problems even though the disease has spread to other organs. Symptoms can be vague and include frequent urination and bloating. For these reasons, about 75% of ovarian cancer cases aren't identified until the later, more dangerous, stages of the disease. Researchers are trying to develop screening tests that can detect ovarian cancer during its early stage because it's more likely the disease can be cured or controlled when it is treated in the early stage.

The exact causes of ovarian cancer are unknown, but a number of risk factors have been identified. The disease has a strong genetic (inherited) component, and women who have had a first-degree relative (sister, mother or daughter) diagnosed with ovarian cancer are at a high risk of developing the disease, as are women who have a relative who has had breast or colon cancer. The likelihood of developing ovarian cancer also increases with age. Most ovarian cancers occur in women over age 50, and the highest risk is in women over 60. Women who have never had children are more likely to develop ovarian cancer.

Ovarian cancer accounts for 4% of all cancers in women. An estimated 20,650 new cases of ovarian cancer are expected to be diagnosed in the United States during 2008, according to the latest statistics.

Symptoms

Ovarian cancer usually doesn't cause obvious symptoms until late in its development. Even then, the symptoms can be mistaken as signs of a minor disorder. Symptoms of ovarian cancer can include:

  • Abdominal discomfort and pain
  • Bloating
  • Nausea
  • Diarrhea
  • Frequent urination
  • Sudden weight gain or loss
  • Abnormal bleeding from the vagina
Diagnosis

Occasionally, a doctor may find signs of early stage ovarian cancer, such as a firm, enlarged ovary when abnormal cells are confined to the ovary. A pelvic ultrasound may help diagnose the disease at an early stage. However, the ovaries often appear normal during early stages of ovarian cancer.

Besides an ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) also can be used to identify misshapen or enlarged ovaries and other features that may point to or strongly suggest the presence of cancerous changes.

Blood tests can help confirm ovarian cancer by identifying high blood levels of CA-125, a protein commonly found in elevated levels in women who have ovarian cancer. The usefulness of this test is limited, however, because CA-125 can be elevated in many conditions that are not cancerous. The only way to be certain that cancer is present is to obtain a sample of ovarian tissue and have it examined for cancerous changes.

Prevention

Women who take birth control pills have half the risk of developing ovarian cancer, possibly because these drugs prevent ovulation. The protective effect of the Pill is greatest in women who use it for four or more years. It is thought that breast-feeding, which also reduces the number of times a woman ovulates, can reduce the risk of ovarian cancer. Reducing the amount of fat in the diet also is thought to help reduce the risk of developing ovarian cancer.

Treatment

Surgery is the usual treatment for ovarian cancer. In most cases, the ovaries, the fallopian tubes, the uterus and the cervix are removed, as well as the thin tissue covering the stomach and intestine (called the omentum) and surrounding lymph nodes.

Chemotherapy also may be necessary to kill remaining cancer cells. Radiation therapy is used less often. Both treatments also kill healthy cells, which can cause side effects, depending on the type, route, total dose and length of use. Examples of side effects include fever, chills, rash, difficulty breathing, nausea, vomiting, diarrhea, anemia, fatigue, irregular heart rate patterns, clotting disorders, blood pressure changes, phlebitis, nerve damage, muscle weakness and pain.

When To Call A Professional

It is important to check with a doctor if you notice any of the following symptoms:
  • Persistent or worsening abdominal discomfort and pain
  • Abdominal bloating
  • Unexplained, persistent or worsening nausea or diarrhea
  • Frequent urination
  • Sudden weight gain or loss
  • Abnormal vaginal bleeding

Remember, the symptoms of ovarian cancer are vague and often mimic other less serious problems. It is even more important to have regular pelvic exams, and to be particularly wary of these symptoms if you are at high risk of ovarian cancer. Women at high risk of developing ovarian cancer include those who:

  • Are known to be genetic carriers of specific forms of the BRCA1 or BRCA2 genes
  • Have had a first-degree relative (sister, mother or daughter) diagnosed with ovarian cancer
  • Have a relative who has had breast or colon cancer
  • Are over age 60
  • Have never had children
Prognosis

The likelihood of surviving ovarian cancer depends on how far it has spread when treatment begins. If ovarian cancer is identified and treated before it spreads beyond the ovary, the five-year survival rate is 95%. Only 25% of all ovarian cancers are found at this early stage.

About 78% of all patients with ovarian cancer survive one year after diagnosis. More than 50% survive longer than five years after diagnosis. In general, older women with ovarian cancer tend to have a poorer outlook than younger women.

Additional Info

National Ovarian Cancer Coalition, Inc.
2501 Oak Lawn Ave., Suite 435
Dallas, TX 75219
Phone: 214-273-4200
Toll-Free: 1-888-682-7426
http:.www.ovarian.org/

American Cancer Society (ACS)
1599 Clifton Rd., NE
Atlanta, GA 30329-4251
Toll-Free: 1-800-227-2345
http://www.cancer.org/

National Cancer Institute (NCI)
Public Inquiries Office
6116 Executive Blvd.
Room 3036A
Bethesda, MD 20892-8322
Phone: 301-435-3848
Toll-Free: 1-800-422-6237
http://www.nci.nih.gov/

National Women's Health Information Center (NWHIC)
8270 Willow Oaks Corporate Dr.
Fairfax, VA 22031
Toll-Free: 1-800-994-9662
TTY: 1-888-220-5446
http://www.4woman.org/

Last updated November 24, 2008




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