Ovarian cancer is rare in the general population, but if it runs in your family, you may be at risk. In this Blum Center presentation from August 3, 2020, Kathleen Steinberg, MS, LCGC, discusses ovarian cancer-causing genes and what you can do if you have familial risk.
What is Ovarian Cancer?
Cancer is caused by malignant (cancerous) cells that grow and multiply without control. When cancer begins in the tissues of an ovary, it is called ovarian cancer.
The ovaries are female reproductive organs located in the pelvis. There is one on each side of the uterus (womb). Ovaries produce eggs and the female hormones estrogen and progesterone, which control the development of certain female body characteristics and regulate the menstrual cycle and pregnancy.
The American Cancer Society estimated that about 21,290 women in the United States would receive a new diagnosis of ovarian cancer in 2015, and that the disease would cause about 14,180 deaths.
Types of Ovarian Cancer
There are three main types of ovarian cancer. Each is named for the tissue in which the tumor (abnormal growth) starts.
- Epithelial ovarian cancer forms in the cells covering the surface of an ovary. While these tumors are usually benign, they account for most cases of ovarian cancer
- Germ cell cancer forms in the cells of an ovary that produce eggs
- Stromal cell cancer forms in the cells that hold the ovary together and produce female hormones
Extra-ovarian primary peritoneal carcinoma (EOPPC) is a cancer closely related to epithelial ovarian cancer. It occurs outside of the ovary in the peritoneum (lining of the abdomen, or belly). As a result, women who have had their ovaries removed can still develop EOPPC.
Ovarian Cancer Symptoms
Ovarian cancer symptoms may look like symptoms associated with other medical conditions. Talk to you doctor if you notice any:
- General discomfort in the lower abdomen (stomach), such as:
- Feeling swollen or bloated
- A loss of appetite (you do not feel hungry)
- A feeling of fullness, even after a light meal
- Gas, indigestion or nausea
- Diarrhea (loose bowel movements)
- Constipation (trouble having a bowel movement)
- Frequent urination
- Feeling very tired all the time
- Bleeding from the vagina
- Shortness of breath, which may be due to buildup of fluid around the lungs
- Pelvic pain
- Pain during intercourse
Diagnosing Ovarian Cancer
The first step in diagnosing any disease is to complete a medical history and physical examination. In diagnosing ovarian cancer, your doctor will also perform an internal pelvic exam to check the vagina, rectum and lower abdomen for masses or tumors. A Pap test, which involves the microscopic examination of cells collected from the cervix (lower part of the uterus), may also be done during the pelvic exam.
In addition, your doctor may order tests and procedures such as:
- Ultrasound: High-frequency sound waves are used to create images of organs in the pelvic area, including the ovaries, and to locate lumps in the tissues
- Computed tomography (CT) scan: A series of X-ray images of inside the body are combined to produce cross-sectional views of the pelvic area. This test may detect enlarged lymph nodes, a possible sign of a spreading cancer or infection
- CA 125 assay: This test measures a substance in the blood called CA-125, which is often found in higher levels when ovarian cancer is present
- Biopsy: A sample of ovarian tissue is removed during surgery and then viewed under a microscope to check for cancer or other abnormal cells. A diagnosis of ovarian cancer is confirmed only by a biopsy
Treating Ovarian Cancer
If you are diagnosed with ovarian cancer, your care team will work with you to develop a treatment plan. This individualized plan will depend on factors such as type and stage (extent) of ovarian cancer, your general health, and your treatment preferences.
The most common treatment for ovarian cancer (epithelial) is surgery. Types of surgery include:
- Unilateral salpingo-oophorectomy: Removal of an ovary and fallopian tube (known as bilateral salpingo-oophorectomy if both ovaries and both fallopian tubes are removed). Nearby lymph nodes and part of the vagina may also be removed
- Hysterectomy: Removal of the uterus, including the cervix. Cutting-edge approaches to this procedure include:
- Robotic-assisted hysterectomy
- Laparoscopic hysterectomy (in which a narrow viewing tube is inserted through a small incision in the belly to remove the uterus)
- Pelvic lymph node dissection: Lymph nodes are removed from the pelvis and then dissected (cut up) to identify the microscopic spread of cancer that imaging tests such as a CT scan might miss
- Omentectomy: removal of the omentum
- Debulking surgery: removal of all visible tumor
Nonsurgical treatment options (treatments other than surgery) for ovarian cancer include:
- Radiation therapy uses high-energy radiation beams to kill or shrink tumors while sparing healthy tissue. The radiation source can come from outside the body (external radiation therapy) or from implants inside the body (internal radiation therapy)
- Chemotherapy kills cancer cells through the use of intravenous (IV) or oral drugs. Another way to treat ovarian cancer is intraperitoneal (IP) chemotherapy. Here, the medicine is given directly into the abdomen through a long, thin tube called a catheter. IP chemotherapy may help improve outcomes and reduce side effects for women with advanced ovarian cancer
- Targeted therapy uses drugs that attack specific parts of cancer cells. These drugs work differently from standard chemotherapy drugs
Some hospitals also offer clinical trials that may provide access to new and promising therapies for ovarian cancer.
Ovarian Cancer Related Factsheets:
- Intraperitoneal Chemotherapy
- Guide to Radiation Oncology
- Maintain Your Sexual Health During and After Cancer Treatment
- La salud sexual durante y después del tratamiento contra el cáncer
The National Cancer Institute has more information on Ovarian cancer: