The ovaries are small, almond-shaped organs located on either side of the uterus. They are where eggs are produced. Ovarian cancer can occur in several different parts of the ovary.
Ovarian cancer can start in the ovary’s germ, stromal, or epithelial cells. Germ cells are the cells which become eggs. Stromal cells function like connective tissue. They make up most of the ovary. Epithelial cells are the outer layer of the ovary.
The American Cancer Society estimates that 22,280 women will be diagnosed with ovarian cancer in the United States in 2016 and that 14,240 deaths will occur from this type of cancer in 2016. About half of all cases occur in women over the age of 63.
Symptoms of Ovarian Cancer
Early stage ovarian cancer may not have any symptoms. However, some symptoms may include:
- frequent bloating
- quickly feeling full when eating
- difficulty eating
- a frequent, urgent need to urinate
- pain or discomfort in the abdomen or pelvis
These symptoms have a sudden onset. They feel different from normal digestion or menstrual discomfort. They also don’t go away. If you have these symptoms for longer than two weeks, you should seek medical attention.
Other symptoms of ovarian cancer can include:
- lower back pain
- pain during intercourse
- a change in the menstrual cycle
- weight gain
- weight loss
- vaginal bleeding
- back pain that worsens
Types of Ovarian Cancer
Epithelial Carcinoma of the Ovary
This type often doesn’t have symptoms in the early stages. Most people aren’t diagnosed until they’re in the advanced stages of the disease.
This type of ovarian cancer can run in families and is more common in women who have a family history of:
- ovarian cancer and breast cancer
- ovarian cancer without breast cancer
- ovarian cancer and colon cancer
Women who have two or more first-degree relatives, such as a parent, sibling, or child, with ovarian cancer are at the highest risk. However, having even one first-degree relative with ovarian cancer increases the risk. The “breast cancer genes” BRCA1 and BRCA2 are also associated with ovarian cancer risk.
Factors That Are Linked to Increased Survival
Several factors are linked to increased survival in women who have epithelial carcinoma of the ovary:
- receiving a diagnosis at an earlier stage
- being a younger age
- having a well-differentiated tumor, or cancer cells that still closely resemble healthy cells
- having a smaller tumor at the time of removal
- having a cancer caused by BRCA1 and BRCA2 genes
Germ Cell Cancer of the Ovary
“Germ cell cancer of the ovary” is a name that describes several different types of cancer. These cancers develop from the cells that create eggs. They usually occur in young women and adolescents and are most common in women in their 20s.
These cancers can be large, and they tend to grow quickly. Sometimes, tumors produce human chorionic gonadotropin (HCG). This can cause a false-positive pregnancy test.
Germ cell cancers are often very treatable. Surgery is the first-line treatment. Chemotherapy after the surgery is highly recommended.
Stromal Cell Cancer of the Ovary
Stromal cell cancers develop from the cells of the ovaries. Some of these cells also produce ovarian hormones including estrogen, progesterone, and testosterone.
Stromal cell cancers of the ovaries are rare and grow slowly. They secrete estrogen and testosterone. Excess testosterone can cause acne and facial hair growth. Too much estrogen can cause uterine bleeding. These symptoms can be quite noticeable. This makes stromal cell cancer more likely to be diagnosed at an early stage. People who have stromal cell cancer often have a good outlook. This type of cancer is usually managed with surgery.
Diagnosing Ovarian Cancer
Diagnosing ovarian cancer starts with a medical history and physical exam. The physical exam should include a pelvic and rectal examination. One or more blood tests may also be used to diagnose this condition. They may include:
- a complete blood count
- a test for cancer antigen 125 levels, which may be elevated if you have ovarian cancer
- a test for HCG levels, which may be elevated if you have a germ cell tumor
- a test for alpha-fetoprotein, which may be produced by germ cell tumors
- a test for lactate dehydrogenase levels, which may be elevated if you have a germ cell tumor
- a test for inhibin, estrogen, and testosterone levels, which may be elevated if you have a stromal cell tumor
- liver function tests to determine if the cancer has spread
- kidney function tests to determine if the cancer has obstructed your urine flow or spread to the bladder and kidneys
Other diagnostic studies can also be used to check for signs of ovarian cancer:
A biopsy is essential for determining if cancer is present. A small sample is taken from the ovaries to look for cancer cells. This can be done with a needle that’s guided by a CT scan or by an ultrasound. It can also be done through a laparoscope. If fluid in the abdomen is present, a sample can be examined for cancer cells.
There are several types of imaging tests that can look for changes in the ovaries and other organs that are caused by cancer. These include a CT scan, MRI, or PET scan.
Checking for Metastasis
If your doctor suspects ovarian cancer, they may order other tests to see if the cancer has spread to other organs. These tests may include the following:
- A urinalysis can be done to look for signs of infection or blood in the urine. These can occur if cancer spreads to the bladder and kidneys.
- A chest X-ray can be done to detect when tumors have spread to the lungs.
- A barium enema can be done to see if the tumor has spread to the colon or rectum.
Stages of Ovarian Cancer
Cancer of the ovary is staged according to the following criteria:
- Stage 1 cancer is confined to one or both ovaries.
- Stage 2 cancer is confined to the pelvis.
- Stage 3 cancer has spread into the abdomen.
- Stage 4 cancer has spread outside of the abdomen or into other solid organs.
Treatment for Ovarian Cancer
Treatment of ovarian cancer depends on the type, stage, and whether you want to have children in the future. Surgery can be done to confirm the diagnosis, determine the stage of the cancer, and potentially remove the cancer.
During surgery, your surgeon will try to remove all tissue that contains cancer. They may also take a biopsy to see if the cancer has spread. The extent of the surgery may depend on whether you want to be pregnant in the future.
If you want to become pregnant in the future and you have stage 1 cancer, surgery can include:
- removal of the ovary that has cancer and a biopsy of the other ovary
- removal of the fatty tissue, or omentum attached to some of the abdominal organs
- removal of abdominal and pelvic lymph nodes
- biopsies of other tissues and collection of fluid inside of the abdomen
Surgery is more extensive if you don’t want to have children. You also may need more surgery if you have stage 2, 3, or 4 cancer. Complete removal of all areas involved with cancer may prevent you from becoming pregnant in the future. This includes:
- removal of the uterus
- removal of both ovaries and fallopian tubes
- removal of the omentum
- removal of as much tissue that has cancer cells as possible
- biopsies of any tissue that might be cancerous
Surgery is usually followed by chemotherapy. Medications can be given intravenously or through the abdomen. This is called intraperitoneal treatment. Side effects of chemotherapy can include:
- hair loss
- problems sleeping
Can Ovarian Cancer Be Prevented?
Ovarian cancer rarely shows symptoms in the early stages. As a result, it’s often not discovered until it has progressed into advanced stages. There’s currently no way to prevent ovarian cancer, but doctors know of factors that lower your risk of developing ovarian cancer. They include taking birth control pills, having given birth, and breast-feeding.
You should talk to your doctor about early screening for ovarian cancer if you have a family history of it.