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Ovarian Cancer
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Ovarian Cancer

(Cancer of the Ovaries; Cancer, Ovarian)

En Español (Spanish Version)More InDepth Information on This Condition

Definition

Ovarian cancer is when cancer cells grow in the ovaries. The ovaries make eggs for reproduction and female hormones.

Cancer occurs when cells in the body (in this case ovarian cells) 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 tumors, which can invade nearby tissue and can spread to other parts of the body. A benign tumor does not invade or spread.

The most common type of ovarian cancer is epithelial. Many of these tumors are cystic. They may grow to be very large without showing symptoms. Because of this, and because these tumors can be hard to find during a physical exam, about 70% of patients are found with advanced disease.

Germ cell tumors come from the reproductive tissue. They account for 20% of tumors. More rare are stromal cancers. These come from the connective cells of the ovary and typically make hormones which cause symptoms (such as male patterns of hair growth, no menstrual periods, or increased menstrual bleeding).

Cancerous Mass in the Left Ovary

ovarian tumor

© 2008 Nucleus Medical Art, Inc.

Causes

The causes of ovarian cancer are not known. However, research shows that certain risk factors are associated with the disease.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Family history of ovarian cancer, especially in mother, sister, or daughter
  • Age: 50 or older
  • Menstrual history—first period before age 12, no childbirth or first childbirth after age 30, and late menopause
  • Personal history of breast cancer or colon cancer
  • Certain gene mutations, including BRCA1, BRCA2

Use of birth control pills for more than five years appears to decrease risk.

Symptoms

Ovarian cancer generally doesn't cause symptoms until the later stages.

Symptoms include:

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

These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor.

Diagnosis

Your doctor will ask you about your symptoms and medical history, and perform a physical examination.

Tests may include:

Pelvic Exam

Your doctor will use her gloved finger to check your uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. She will check for lumps or a change in size or shape.

Imaging Tests

Tests that create pictures of the ovaries and surrounding tissues that will show if there is a tumor include:

  • Ultrasound—a test that uses radiation to take a picture of structures inside the body
  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the body
  • MRI scan—a test that uses magnetic waves to make pictures of structures inside the body
  • Lower GI series or barium enema—injection of fluid into the rectum that makes your colon show up on an x-ray so the doctor can see abnormal spots
  • CA-125 assay—a blood test to measure the level of CA-125, a substance in the blood that may be elevated if ovarian cancer is present

Treatment

General Approach

The general approach with ovarian cancer is to first undergo a complete surgical procedure. This must be done by a qualified gynecologic oncologist.

During this first surgery, if ovarian cancer is found, staging tests are done to find out if the cancer has spread and, if so, to what extent. Treatment for ovarian cancer depends on the extent of the cancer and your general health. Afterwards, you will receive chemotherapy. Sometimes, radiation therapy of the abdomen is given.

Treatments include:

Surgery

Your surgeon will remove the cancerous tumor and nearby tissue. Nearby lymph nodes may also be removed.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Radiation Therapy (Radiotherapy)

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

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

The more advanced the tumor at diagnosis, the poorer the prognosis. Unfortunately, 75% of all epithelial tumors are stage 3 or 4 at the time of diagnosis, and the overall five-year survival rate is about 50%.

Prevention

There are no guidelines for preventing ovarian cancer because the cause is unknown. Symptoms also are not present in the early stages. 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 examinations, including vaginal examination and palpation of the ovaries, as part of their routine medical care.

RESOURCES:

American Cancer Society
http://www.cancer.org/

CancerCare
http://www.cancercare.org/

Gynecologic Cancer Foundation
http://www.wcn.org/gcf/

National Cancer Institute
National Institutes of Health
http://www.cancer.gov/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/

References:

Ovarian cancer. National Cancer Institute, National Institutes of Health (NIH) website. Available at: http://www.cancer.gov/. Accessed June 10, 2008.

What is ovarian cancer? American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_ovarian_cancer_33.asp?sitearea=. Updated February 6, 2008. Accessed June 10, 2008.



Last reviewed February 2008 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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