Cancer - ovaries

Definition

Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs.

Alternative Names

Causes

A woman has a 1 in 67 chance of developing ovarian cancer. Ovarian cancer is the fifth most common cancer among women, and it causes more deaths than any other type of female reproductive cancer.

The cause is unknown.

The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has and the earlier in life she gives birth, the lower her risk of ovarian cancer. Certain genes (BRCA1 and BRCA2) are responsible for a small number of ovarian cancer cases. Women with a personal history of breast cancer or a family history of breast or ovarian cancer have an increased risk for ovarian cancer.

The use of fertility drugs may be associated with an increased chance of developing ovarian cancer, although this is a subject of ongoing debate.

The links between ovarian cancer and talc use, asbestos exposure, a high-fat diet, and childhood mumps infection are controversial and have not been definitively proven.

Older women are at highest risk. About two-thirds of the deaths from ovarian cancer occur in women age 55 and older. About 25% of ovarian cancer deaths occur in women between 35 and 54 years of age.

Ovarian cancer symptoms are often vague and non-specific, so women and doctors often blame the symptoms on other, more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries.

Symptoms

• Sense of pelvic heaviness
• Vague lower abdominal discomfort
• Vaginal bleeding
• Weight gain or loss
• Abnormal menstrual cycles
• Unexplained back pain that worsens over time
• Increased abdominal girth
• Non-specific gastrointestinal symptoms:
  • Increased gas
  • Indigestion
  • Lack of appetite
  • Nausea and vomiting
  • Inability to ingest usual volumes of food
  • Bloating

• Increased urinary frequency or urgency
• Excessive hair growth

Exams and Tests

A physical examination may reveal increased abdominal girth and ascites

Tests include:

• CBC
• Blood chemistry
• CA125
• Quantitative serum HCG (blood pregnancy test)
• Alpha fetoprotein
• Urinalysis
• GI series
• Exploratory laparotomy
• Ultrasound
• Abdominal CT scan or MRI of abdomen

Treatment

Surgery is the preferred treatment and is often needed to diagnose ovarian cancer.

Studies have shown that surgery performed by a specialist in gynecologic oncology results in a higher cure rate.

Chemotherapy is used as after surgery to treat any remaining disease. Chemotherapy can also be used if the cancer comes back.

Radiation therapy is rarely used in ovarian cancer in the United States.

Support Groups

For additional information and resources, cancer support group.

Outlook (Prognosis)

Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made. The outcome is often poor.

• About 76% of women with ovarian cancer survive 1 year after diagnosis.
• About 45% live longer than 5 years after diagnosis.
• If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the 5-year survival rate is about 94%.

Possible Complications

• Spread of the cancer to other organs
• Loss of organ function
• Fluid in the abdomen (ascites)
• Blockage of the intestines

When to Contact a Medical Professional

Call for an appointment with your health care provider if you are a woman over 40 years old who has not recently had a Pap smear and pelvic examination. Routine Pap smears and pelvic examinations are recommended for all women over 20 years old.

Call for an appointment with your provider if you have symptoms of ovarian cancer.

Prevention

Having regular pelvic examinations may decrease the overall risk. Screening tests for ovarian cancer remains a very active research area. To date, there is no cost-effective screening test for ovarian cancer, so more than 50% of women with ovarian cancer are diagnosed in the late stages of the disease.

Recent research has shown that surgery to remove the ovaries in women with mutation in the BRCA1 and BRCA2 genes can dramatically reduce their risk of developing ovarian cancer.

American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society; 2006.

Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:2317.