Ovarian cancer accounts for 4% of all cancers among women, and is the fifth deadliest cancer in women. Unfortunately, almost 70% of women with the common epithelial ovarian cancer fail to get diagnosed until the disease has spread to the upper abdomen or beyond. Five-year survival rates for ovarian cancer diagnosed late is only 15-20%, where it is close to 90% for women whose cancer is caught early on.
Many types of tumors can develop in the ovaries. Benign (non-cancerous) tumors can be surgically removed. Treatment for malignant (cancerous) tumors varies depending on the type of the cancer and how much it has spread. The main types of ovarian tumors are (from the National Ovarian Cancer Coalition):
Epithelial Tumors: These develop from the cells that cover the outer surface of the ovary and most are benign. Malignant epithelial tumors are carcinomas and are the deadliest of all ovarian cancers. Epithelial ovarian carcinomas (EOC's) account for 85-90% of all ovarian cancers. They occur in the following stages:
- Stage I: Cancer growth is limited to the ovary or ovaries.
- Stage IA: Growth is limited to one ovary and the tumor is confined to the inside of the ovary.
- Stage IB: Growth is limited to both ovaries without any tumor on their outer surfaces.
- Stage IC: The tumor is classified as either Stage IA or IB and one or more of the following are present: tumor is present on the outer surface of one or both ovaries; the capsule has ruptured; and there are ascites containing malignant cells or with positive peritoneal washings.
- Stage II: Cancer growth involves one or both ovaries with pelvic extension.
- Stage IIA: The cancer has extended to and/or involves the uterus or the fallopian tubes or both.
- Stage IIB: The cancer has extended to other pelvic organs.
- Stage IIC: The tumor is classified as either Stage IIA or IIB and one or more of the following are present: tumor is present on the outer surface of one or both ovaries; the capsule has ruptured; and there are ascites containing malignant cells or with positive peritoneal washings.
- Stage III: Cancer growth involves one or both ovaries, and one or both of the following are present: the cancer has spread beyond the pelvis to the lining of the abdomen; and the cancer has spread to lymph nodes. The tumor is limited to the true pelvis but with histologically proven malignant extension to the small bowel or omentum.
- Stage IIIA: During the staging operation, the practitioner can see cancer involving one or both of the ovaries, but no cancer is grossly visible in the abdomen and it has not spread to lymph nodes. However, when biopsies are checked under a microscope, very small deposits of cancer are found in the abdominal peritoneal surfaces.
- Stage IIIB: The tumor is in one or both ovaries, and deposits of cancer are present in the abdomen that are large enough for the surgeon to see but not exceeding 2cm in diameter. The cancer has not spread to the lymph nodes.
- Stage IIIC: The tumor is in one or both ovaries, and one or both of the following is present: the cancer has spread to lymph nodes; and/or the deposits of cancer exceed 2cm in diameter and are found in the abdomen.
- Stage IV: This is the most advanced stage of ovarian cancer. Growth of the cancer involves one or both ovaries and organs located outside of the peritoneal cavity. Finding ovarian cancer cells in pleural fluid (from the cavity which surrounds the lungs) is also evidence of stage IV disease.
Germ Cell Tumors: Ovarian germ cell tumors develop from the cells that produce the ova or eggs. Most germ cell tumors are benign, although some are cancerous and may be life threatening. The most common germ cell malignancies are maturing teratomas, dysgerminomas and endodermal sinus tumors. Germ cell malignancies occur most often in teenagers and women in their twenties.
Prior to the modern era of combination chemotherapy, the most aggressive of these tumors, the GNP abnormal sinus tumor, was associated with a 1-year disease-free survival of only 10-19%. This occurred despite the fact that 70% of these tumors were diagnosed as stage I disease. Today, 90% of patients with ovarian germ cell malignancies can be cured and fertility preserved. We hope, ultimately, to achieve similar results in our strategic research planning for epithelial ovarian cancer.
Stromal Tumors: Ovarian stromal tumors develop from connective tissue cells that hold the ovary together and those that produce the female hormones, estrogen and progesterone. The most common types among this rare class of ovarian tumors are granulosa-theca tumors and Sertoli-Leydig cell tumors. These tumors are quite rare and are usually considered low-grade cancers, with approximately 70% presenting as stage I disease.
Symptoms of Ovarian Cancer
Ovarian cancer often shows no obvious signs or symptoms until late in its development. Signs and symptoms of ovarian cancer may include:
- General abdominal discomfort and/or pain (gas, indigestion, pressure, swelling, bloating, cramps)
- Nausea, diarrhea, constipation, or frequent urination
- Unexplained weight gain or weight loss, particularly weight gain in the abdominal region
- Pelvic and/or abdominal swelling, bloating, and/or feeling of fullness
- Pain during intercourse
- Ongoing fatigue
- Abnormal postmenopausal bleeding (this symptom is rare)
Risk Factors
An increased risk of developing ovarian cancer can be inherited from both your mother and your father's side of the family. Women with a strong family history of ovarian cancer are more likely to develop the disease at an early age (younger than 50). Other risk factors include:
- Personal or family history of breast cancer, ovarian cancer, endometrial cancer, prostate cancer, or colon cancer
- Hereditary nonpolyposis colorectal cancer or syndrome
- Age. The likelihood of developing ovarian cancer increases as a woman gets older. Most ovarian cancers occur in women over the age of 50, with the highest risk in women over 60.
- Childbearing. Women who have never had children are more likely to develop ovarian cancer than women who have had children. In fact, the more children a woman has had, the less likely she is to develop ovarian cancer.
- Unexplained infertility and no history of birth control pill usage
- North American or Northern European heritage and/or Ashkenazi Jewish population
- Living in an industrialized country
- Fertility drugs may slightly increase a woman's chance of developing ovarian cancer.
- Talc. Some studies suggest that women who have used talc in the genital area for many years may be at increased risk of developing ovarian cancer.
- Hormone replacement therapy (HRT). Some evidence suggests that women who use HRT after menopause may have a slightly increased risk of developing ovarian cancer.
Treatment
Women should always discuss treatment options with a physician, because optimal treatment will vary depending on the stage of disease, the woman's age, and the overall condition of her health.
Surgery to remove the cancerous growth is the primary method for diagnosis and therapy for ovarian cancer. Your surgeon will usually remove the ovaries, fallopian tubes, uterus and cervix. (This operation is called a hysterectomy with bilateral salpingo-oophorectomy. Often, the surgeon also removes the omentum (the thin tissue covering the stomach and large intestine) and lymph nodes in the abdomen.
Chemotherapy uses drugs to kill cancer cells both in and outside of the ovaries. This treatment is used to destroy any cancerous cells that may remain after surgery, to control tumor growth or to relieve symptoms of the disease. After chemotherapy is done, your doctor may perform a second-look surgery, removing samples of fluid and tissue to see if the chemotherapy was successful.
Radiation Therapy (Radiotherapy) uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area.
Clinical Trials
Click here for information from the National Cancer Institute on clinical trials.
Click here for the National Cancer Institute's publication, Taking Part in Clinical Trials: What Cancer Patients Need To Know.
Body1 Resources
Ovarian Cancer Forums
Stories:
Blood Test May Spot Ovarian Cancer
No Link Between Cancer, Pill
Related Conditions:
Ovarian Cancer: An Overview
Ovarian Cysts
Phlebitis
Diagnostic Tools:
CA-125 Blood Test
Amylase
Bone Mineral Density Tests
Serum Progesterone
Transvaginal Ultrasound
Procedures:
Hysterectomy
Sources & More Information
National Ovarian Cancer Coalition
National Institutes of Health
Cancer Information Service (CIS)
1-800-4-CANCER
Gilda Radner Website
