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Ovarian Cancer
A serious threat to women
Ovarian cancer is the most lethal form of cancer in women. It is the leading cause of death from gynecological cancers. Ovarian cancer's high mortality rate is due to the fact that the disease is usually in an advanced stage by the time it is detected. Why? The disease rarely produces any signs in its early stages, so by the time symptoms are apparent, the cancer has usually spread to other parts of the body. Only one-fourth of ovarian cancers are found before they have spread.
No definite cause has been identified. The greatest known risk factor is a family history of ovarian cancer, particularly in a first-degree relative (a mother, sister, or daughter). A history of infertility or breast cancer seems to increase risk, while using birth control pills for at least five years reduces risk.
Surgery to remove cancerous tissue is the first line of treatment. Chemotherapy may be given, too, with radiation therapy used to a lesser degree. Your chances of recovery (prognosis) depends on the stage and extent of the cancer at the time of diagnosis.
Pronunciation
o-VAR-ee-an KAN-ser
Synonyms
- Ovarian carcinoma
- Cancer of the ovaries
Detailed Description
Every woman has two ovaries, located on either side of the uterus. Each month, one ovary releases an egg. The attached fallopian tube carries the egg from the ovary to the uterus. Eggs are either fertilized or expelled from the body along with the monthly menstrual flow.
Nearly all ovarian cancers begin on the epithelium, the outer covering of the ovary. About 15% of epithelial ovarian cancers occur as borderline tumors on the epithelium. Women with these borderline tumors have a better outlook because the tumors are less aggressive. Another 75% are classified as ovarian invasive epithelial carcinoma. The remaining 10% of ovarian cancers occur equally in the germ cells (where eggs are produced) and the stroma, a fibrous network of tissue within the ovary.
If a cancerous tumor begins to form on an ovary, it is likely to spread fairly quickly. Malignant cells are shed in early phases of the disease, setting the stage for new growths to form on nearby tissue. Both ovaries may be affected, as well as such nearby organs as the uterus, bowel, and bladder. All this usually occurs without any noticeable symptoms.
If cancer is discovered, it is staged according to the degree of its severity. The following stages are commonly used:
- Stage I: Cancer is limited to one or both ovaries.
- Stage II: Cancer is found in one or both ovaries and has spread to other tissues or organs in the pelvic cavity.
- Stage III: Cancer is found in one or both ovaries and has spread to abdominal tissues and organs such as the regional lymph nodes and/or the lining of the liver (superficial metastases).
- Stage IV: Cancer is found in one or both ovaries, has invaded distant lymph nodes, and has spread to distant sites in the body, such as the inside of the liver (parenchymal metastases).
While the cause of ovarian cancer remains unknown, a family history of the disease is thought to be the greatest risk factor, particularly when it has occurred in a first-degree relative (a mother, sister, or daughter). Environmental exposure to asbestos or high-level radiation may contribute to the disease, and reproductive history and past use of oral contraceptives and fertility drugs may also play a role in determining risk. Also, women who have had breast cancer are at twice the average risk for ovarian cancer.
Surgery is a standard form of treatment, and chemotherapy and radiation therapy may be recommended as well. If both ovaries are removed, bearing children will not be possible, but the chances of having the cancer recur are minimized. Overall prognosis depends on the stage of the cancer at the time of diagnosis and the course of therapy used to treat the disease.
Characteristics of Ovarian Cancer
- Fifth most common cause of cancer in women
- Most lethal form of cancer in women; causes the most deaths of all gynecological cancers
- Usually detected in advanced stage
- Few or no early warning signs or symptoms
- Family history is greatest risk factor (however, fewer than 10% of women with ovarian cancer have a family history)
How Common Is Ovarian Cancer?
Ovarian cancer is the fifth most common type of cancer in women, with nearly 30,000 new cases diagnosed annually. One in 65 women will develop the disease by age 85. It most often affects women ages 50 to 70. The most common type of ovarian cancer, called epithelial carcinoma, usually affects postmenopausal women. Germ cell malignancies, a rarer and less deadly form of the disease, are found primarily in younger women; more than 50% of those afflicted are under age 20. Ovarian cancer only occurs in females.
What You Can Expect
Overall prognosis depends on the stage of the cancer at the time of diagnosis and the course of therapy used to treat the disease. But survival rates also vary widely because there are various types of ovarian cancers, some more aggressive than others. What's more, women differ in their immune responses against the cancer. If tumor cells have spread to distant sites in the body (metastasis), prognosis depends on the degree of regional spread, for example, to the peritoneum and regional lymph nodes, and the effects on vital organs.
Established Causes
The causes of ovarian cancer are unknown.
Theoretical Causes
Hereditary factors are suspected to play a role in the development of ovarian cancer.
Drugs That Can Cause or Aggravate Ovarian Cancer
Some fertility drugs, such as clomiphene, may increase risk for ovarian cancer.
Risk Factors
The following factors increase the risk of developing ovarian cancer:
- Family history of the disease: while most women only have a 1.5% chance of developing ovarian cancer, among those with familial ovarian carcinoma, the risk is higher
- Age: the most common type of ovarian cancer usually occurs in postmenopausal women
- Having had few or no children
- Delayed childbirth (after age 35)
- Use of fertility drugs to stimulate ovulation
- History of breast cancer or endometrial cancer
- Family history of Lynch II syndrome (marked by high rates of cancers of the colon and uterus)
- Exposure to asbestos or high levels of radiation
Use of oral contraceptives (birth control pills) seems to decrease the likelihood of ovarian cancer.
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
All women older than age 18 should get an annual pelvic exam with Pap smear (which screens for cervical cancer only) and palpation of the ovaries. Since screening tests are costly and yield a high rate of false positive results, no other screening tests are currently advised, except for women at high risk due to a family history of ovarian cancer. For these women, many physicians recommend undergoing additional screening procedures every year after age 35. The most valuable tests are a thorough pelvic exam, a transvaginal ultrasound, and a blood test for cancer antigen 125 (CA-125).
Symptoms
Ovarian cancer rarely produces early warning signs. Your doctor may check for ovarian cancer during a pelvic exam, but often, the disease is advanced by the time it's detected. Then you may notice the following symptoms:
- Discomfort or pain in abdomen; feeling of pressure in pelvis
- Abdominal swelling, bloating, gas, or indigestion
- Unusual vaginal discharge or bleeding
- Change in bowel or bladder function (constipation, frequent urination)
- Weight loss
- General ill health
- Nausea
- Anemia
- Palpable mass in the abdomen or pelvic area
- Rarely, enlarged breasts and increased hair growth
Conditions That May Be Mistaken for Ovarian Cancer
Ovarian cancer may be confused with other problems that cause pain, discomfort or swelling in the abdomen:
- Ovarian cysts and benign tumors
- Other gynecological tumors (benign or cancerous)
- Fibroids
- Endometriosis
- Pelvic inflammatory disease
- Gastrointestinal tumors (benign or cancerous)
- Colitis (inflamed colon)
- Inflammatory bowel disease
- Liver disease that causes excess fluid and swelling in the abdomen
How Ovarian Cancer Is Diagnosed
If you have symptoms, or if your doctor finds growths or enlarged ovaries during a pelvic exam, there are several tests to check for ovarian cancer. (The Pap test, used to spot cervical cancer, does not find ovarian tumors.)
- Ultrasound: An ultrasound scan is a painless procedure. A doctor or technician places a small probe against your abdomen and bounces high-frequency sound waves off the ovaries to create images of them. Your doctor may also choose to do a transvaginal ultrasound. In either method, the pictures are displayed on a video screen, then recorded on video film. Ultrasound can show abnormal areas on the ovaries, such as tumors.
- CT Scanning (also called computed tomography scanning): A CT scan can yield more detailed images of your ovaries than a regular X-ray. You'll need to lie still on a movable table that is guided into the center opening of a large machine, a CT scanner, that sends a narrow X-ray beam through your body. The X-ray beam, along with computer analysis, creates fine images of your ovaries, including abnormal areas, for your doctor to evaluate.
If a pelvic mass is found on through the ultrasound or CT scan, your doctor will do a surgery called a laparotomy. If no definite mass is found, your doctor may perform a diagnostic laparoscopy. - Laparoscopy: In this method, your doctor makes a tiny cut in your abdomen and inserts a laparoscope, a small viewing instrument that allows for a direct look at your ovaries. During the procedure, the doctor may take a sample of tissue and fluid (biopsy). A pathologist checks these samples under a microscope for cancer.
- Laparotomy: During this form of abdominal surgery, your doctor looks at the ovaries and other nearby organs for signs of cancer. A laparotomy not only helps with diagnosis, but also can show how far cancer has spread. If cancer is found, both ovaries and as much of the tumor as possible are removed.
Also, your doctor may conduct the following laboratory tests:
- Blood tests for elevated cancer antigen 125 (CA 125).
- Lysophosphatidic acid (LPA) is a new blood test. Early studies suggest it may be very useful.
You may feel reassured after being tested; three out of four ovarian tumors turn out not to be cancerous. If your doctor diagnoses ovarian cancer, though, he or she will need to gather more information.
Staging ovarian cancer
If you have ovarian cancer, your doctor will conduct staging tests to try to find out whether the cancer has spread to other parts of the body (metastasis). If the cancer has spread to vital organs, such as the brain, lungs, or liver, it is less likely to be cured. Staging helps your doctor not only to assess your chances for recovery (prognosis), but also to plan your treatment. Because laparotomy findings are such a large part of the staging, it's wise to find an oncological gynecologic surgeon who can perform all the steps of the staging laparotomy.
For ovarian cancer, other staging tests include:
- Barium enemas
- Mammograms
- Chest X-rays
- CT scans
- Magnetic resonance imaging tests (MRIs)
- Bone scans
- X-rays of the urinary system
Goals of Treatment
When ovarian cancer is found before it has a chance to spread to other organs, it can often be cured. Among women whose cancer is found and treated in the early stages, 60% to 80% are still alive five years after diagnosis. Overall, though, the survival rate at five years is 30 to 40 percent. The reason: ovarian cancer is found early in only one quarter of cases.
But today, even if a woman can't be cured, aggressive surgery and chemotherapy can help her to survive longer than she would have before such treatments existed. Therapies for ovarian cancer aim to remove the tumor and destroy all remaining cancer cells in the body, as well as lessen the chances of the disease recurring. Younger women often worry that treatment will take away their ability to bear children. In some cases, that's true. But sometimes surgeons can treat the cancer and still preserve a woman's fertility.
Treatment Overview
Ovarian cancer is treated with surgery, chemotherapy, and less often, radiation. At least 10 different types of ovarian cancer have been identified. Treatment and chances of recovery depend on the type of cancer and how far it has progressed.
Surgery
Often, ovarian cancer surgery involves removing both ovaries, the fallopian tubes, and the uterus. This surgery is called total abdominal hysterectomy with bilateral salpingo-oophorectomy. By cutting away these organs, your surgeon hopes to ensure that no cancer is left to grow and spread to other parts of the body. Sometimes, the surgeon also removes nearby lymph glands and a fold of tissue called the omentum because ovarian cancer often spreads to these areas. If the cancer has spread to distant parts of the body, you may need surgery in those areas as well.
If you don't plan to have children in the future, removal of the ovaries, fallopian tubes and uterus is recommended. But if you do want children, this type of surgery renders you infertile. If your ovarian cancer is caught early, your surgeon may be able preserve your fertility by removing only the affected ovary, along with the fallopian tube. Your surgeon will check the remaining ovary carefully, including taking a small piece of tissue to make sure the ovary can be left in place without causing harm.
Chemotherapy
After surgery, your doctor may prescribe chemotherapy to kill any remaining cancer cells that may have spread. Chemotherapy may also be used to shrink tumors before surgery, to make them easier to remove. Chemotherapy drugs are most often given in combination. The following drugs are most often used:
- Cytoxan (Cyclophosphamide)
- Paraplatin (Carboplatin)
- Platinol (Cisplatin)
- Taxol (Paclitaxel)
Second choices
- 5-FU (Fluorouracil)
- Adriamycin (Doxorubicin)
- Alkeran (Melphalan)
- Cytosar-U (Cytarabine)
- Doxil (Doxorubicin)
- Hexalen (Altretamine)
- Ifosfamide
- Taxotere (Docetaxel)
- Topotecan
- VePesid (Etoposide)
New drugs in development
Researchers have made much recent progress in the field of cancer treatment, so be sure to ask your oncologist (cancer specialist) about the latest therapies. Gemcitabine and oxaliplatin are among the agents that have been in trials recently for ovarian cancer. Monoclonal antibodies, such as herceptin, are also being developed. New drug combinations are always being tested, and chemotherapy in combination with bone marrow transplantation is also under investigation. Hormonal therapy (such as tamoxifen) may also help.
Radiation
Radiation uses high-energy X-rays, delivered from outside the body, to kill cancer cells. Or radiation can be given from within the body through an implant near the tumor. In this country, though, radiation therapy is rarely used to treat ovarian cancer. Despite radiation's effectiveness, its long-term side effects seem to be greater than with chemotherapy.
Considerations When Selecting Treatment
If you have been diagnosed with ovarian cancer and you still want to have children, talk to your doctor about treatment options that might preserve your fertility. Depending on your individual case, your surgeon may be able to take a conservative approach and remove only one ovary and fallopian tube so that you still have a chance to become pregnant later.
All women with ovarian cancer should be aware that every treatment has advantages and drawbacks. Make sure you weigh the risks and benefits of each route with your doctor before you select a therapy. Your age, overall health, and stage of cancer are all factors to take into account. Treatment has side effects, too, that range from mild to severe. As you decide on therapies, talk to your doctor about how to deal with these unwanted effects. Sometimes, remedies exist. For instance, anti-nausea drugs can make you feel much better if you're going through chemotherapy.
Appropriate Healthcare Settings
Treatments for ovarian cancer can occur on both an inpatient and outpatient basis, depending on the level of care required.
Healthcare Professionals Who May Be Involved
Many healthcare professionals work together to treat and manage this condition:
- Family practitioners
- Internists
- Gynecologists
- Radiologists
- General surgeons
- Pathologists
- Medical oncologists
- Gynecologic oncologists
- Surgical oncologists
- Radiation oncologists
Monitoring the Condition
As with all cancers, ovarian cancer can come back. Talk to your doctor about a schedule of follow-up exams to monitor your general health and to check for possible recurrence of the disease in the years following diagnosis.
Possible Complications
Surgery
- Wound infection (To lessen the risk of infection, keep the incision site clean and dry. Your doctor may also prescribe an antibiotic ointment.)
- Scarring
- Abdominal adhesions
- Blood clots
Chemotherapy
- Nausea
- Vomiting
- Low blood cell counts
- Hair loss
- Toxic effects on the kidneys or nerve tissue
Radiation therapy
- Nausea and vomiting
- Diarrhea
- Acute or chronic enteritis (inflamed intestine)
- Ovaries may stop functioning (leading to disrupted menstrual cycle and hot flashes)
- Low blood counts
Quality of Life
A diagnosis of ovarian cancer alters your quality of life in major ways. Your health and well-being understandably may be your first concern. If the disease is advanced, invasive treatments may be required and side effects from therapy can be substantial. Living with pain is difficult, and you may find it hard to carry on with normal daily activities. Also, emotional stress is a natural consequence of living with a serious illness. For many cancer patients, counseling or a support group is a huge help in learning about the disease and gathering emotional support. If you're interested, your doctor or hospital will be able to refer you to these sources of help.
If you are a young woman who hasn't started (or finished) having children, fertility issues may also weigh heavily on your mind. While some forms of surgery can preserve fertility, many treatments will cause a woman to be unable to become pregnant. It may help to seek counseling, discuss options, and consider alternatives down the road, such as adoption.
If both your ovaries have been removed, your levels of estrogen will drop and you'll have an onset of menopause. Natural menopause normally occurs gradually, but when it is surgically induced, symptoms like hot flashes and vaginal dryness may be more troublesome. Menopause also puts you at greater risk of heart disease and thinning of the bones (osteoporosis). To help keep these problems at bay, ask your doctor about hormone replacement therapy, also called estrogen replacement therapy. You may also want to ask about cholesterol-lowering drugs to prevent heart disease, and bisphosphonates for osteoporosis.
Considerations for Women
Pregnancy
Pregnant women who are diagnosed with ovarian cancer have fewer treatment options. Chemotherapy and radiation therapy are not recommended, unless an abortion is performed first. Surgery is possible in the second and third trimesters, however. Fortunately, ovarian cancer during pregnancy is rare.
Nursing mothers
Avoid nursing during chemotherapy because your infant will swallow the chemicals through your breast milk. If you need chemotherapy, wean your baby onto formula first.
Considerations for Children and Adolescents
Germ cell malignancies, a less common form of ovarian cancer, are found mainly in younger females-- more than 50% of those affected are under age 20. (In contrast, the most common type of ovarian cancer, epithelial carcinoma, most often affects postmenopausal women.) If an adolescent girl is diagnosed with a germ cell cancer, cure is often achieved through limited surgery and chemotherapy. If one ovary and fallopian tube are left, she may still be able to have children.
Preventing Ovarian Cancer
Though no general steps for preventing ovarian cancers are known, the following measures are thought by some to help protect against this condition or minimize its effects:
- Eat a healthful diet. Much research has been performed recently about the relationship between diet and cancer, and some doctors believe that a healthful diet rich in fruits and vegetables can help prevent all forms of cancer, including ovarian cancer. A diet rich in fruits and vegetables and low in fat (particularly saturated fat) may provide a protective effect. Bright-colored fruits like cantaloupes, strawberries, and red grapefruits, and green, leafy vegetables like spinach, kale, and cabbage may be especially helpful.
- Avoid contaminants. Some studies have shown that occupational exposure to asbestos and high levels of radiation may contribute to ovarian cancer, so do everything possible to limit contact with these substances. Also, avoiding the use of talcum powder in the genital area may also help.
- Consider hormone treatment. Prolonged use of oral contraceptives has been linked to decreased rates of hereditary ovarian cancer.
- Avoid alcohol. Since heavy alcohol consumption may be linked to cancer, experts recommend drinking moderately, if at all.
- Ask your doctor about oophorectomy. At the time of hysterectomy or pelvic surgery for other reasons, the ovaries may be removed. However, this procedure causes early onset of menopause and bring its own risks.
- Get examined regularly. Early detection is crucial for preventing ovarian cancer from becoming more serious. Women over age 18 should have regular pelvic exams that include palpation of the ovaries. Those with a family history of ovarian cancer should be screened after age 35. Screening should include a thorough pelvic exam, a transvaginal ultrasound, and a blood test for elevated levels of cancer antigen 125 (CA-125).
Self-Care Measures
- Join a support group. Research has shown that for women with breast cancer, joining a support group can be comforting and may even increase longevity. The same may be true for women with ovarian cancer. A support group can be a setting to exchange information about ovarian cancer, learn about the latest research, and share coping strategies. It may also be comforting to find that you're not alone. For those not comfortable with the idea of a support group, talking to a trusted friend or family member or an experienced therapist may be helpful.
- Treat menopause symptoms. If both of your ovaries are removed as part of your cancer treatment, you will undergo menopause abruptly. If you are bothered by hot flashes, hormone replacement therapy may be recommended, but you can also take some steps at home to soothe your symptoms. Wear light, layered clothing during the day, and try taking a lukewarm shower before bed and using light covers to prevent night sweats.
Websites & Organizations
American Cancer Society
625 North Court
Palatine, IL 60067
Phone: 800-ACS-2345 (227-2345)
American College of Obstetricians & Gynecologists
409 12th Street, SW
Washington, DC 20024-2188
Phone: 800-762-ACOG (2264)
Cancer AnswerLine
800-865-1125
Cancer Care Inc.
Gilda Radner Familial Ovarian Cancer Registry
Rosewell Park Cancer Institute
Elm and Carlton Streets
Buffalo, NY 14263
Phone: 800-OVARIAN (682-7426)
National Coalition for Cancer Survivorship
1010 Wayne Avenue, 5th Floor
Silver Springs, MD 20910
Phone: 888-837-6227 or 301-650-8868
National Ovarian Cancer Coalition, Inc.
P.O. Box 4472
Boca Raton, FL 33429-4472
Phone: 561-393-3220 or 888-OVARIAN (682-7426)
Fax: 561-361-8804
Email: NOCC@Ovarian.org
National Women's Health Resource Center, Inc.
120 Albany Street, Suite 820
New Brunswick, New Jersey 08901
Toll Free Phone: 877-98-NWHRC or 877-986-9472
Email: NatlWHRC@aol.com
Office of Cancer Communications
National Cancer Institute (NCI)
Bldg. 31, room 101-18
9000 Rockville Pike
Bethesda, MD 20205
Phone: 800-638-6694 or 800-4-CANCER
Sources for This Article
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw Hill, 1996.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Baker, TR, Piver, MS. "Etiology, Biology, and Epidemiology of Ovarian Cancer." Semin Surg Oncol. 242-8. Jul-Aug 1994.
Dorum, A, Kristensen, GB, Abeler, VM, Trope, CG, Moller, P. "Early Detection of Familial Ovarian Cancer." Eur J Cancer. 1645-51. Sep 1996.
Hamilton, TC. "Ovarian Cancer, Part I: Biology." Curr Probl Cancer. 1-57. Jan-Feb 1992.
Hoskins, WJ. "Prospective on Ovarian Cancer: Why Prevent?" J Cell Biochem Suppl. 189-99. 1995.
Houlston, R, Bourne, TH, Davies, A, Whitehead, MI, Campbell, S, Collins, WP, Slack, J. "Use of Family History in a Screening Clinic for Familial Ovarian Cancer." Gynecol Oncol. 247-52. Nov 1992.
Langston, AA, Ostrander, EA. "Hereditary Ovarian Cancer." Curr Opin Obstet Gynecol. 3-7. Feb 1997.
Ozols, RF. "Ovarian Cancer, Part II: Treatment." Curr Probl Cancer. 61-126. Mar-Apr 1992.
Runowicz, CD, Fields, AL, Goldberg, GL. "Promising New Therapies in the Treatment of Advanced Ovarian Cancer." Cancer. 2028-33. Nov 15, 1995.
Tortolero-Luna, G, Mitchell, MF. "The Epidemiology of Ovarian Cancer." J Cell Biochem Suppl. 200-7. 1995.
Trimble, EL, Arbuck, SG, McGuire, WP. "Options for Primary Chemotherapy of Epithelial Ovarian Cancer: Taxanes." Gynecol Oncol. S114-21. Dec 1994.