Ovarian Cancer

Ovarian cancer is cancer that begins in the cells of the ovary. The ovaries are part of the female reproductive system. They produce a woman's eggs and female hormones. There is one ovary on each side of a woman’s uterus and each ovary is about the size and shape of an almond.

Ovarian cancer is not common, but it causes more deaths than other female reproductive cancers. A woman’s lifetime risk of getting ovarian cancer is 1 in 75 and her lifetime risk of dying from ovarian cancer is 1 in 100. It is difficult to detect and diagnose in early stages due to the fact that it may not cause symptoms in early stages and there are no good screening tests for ovarian cancer. Most ovarian cancers are diagnosed in women over 60 years of age.

Treatment for ovarian cancer usually includes surgery followed by chemotherapy.

In the early stages, ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and non-specific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel.

Signs and symptoms of ovarian cancer may include:

• abdominal bloating or swelling
• quickly feeling full when eating
• weight loss
• discomfort or feeling of heaviness in the pelvis area
• changes in bowel habits, such as constipation
• frequent or urgent needs to urinate
• fatigue
• upset stomach
• loss of appetite
• back pain
• pain during sex
• constipation
• menstrual changes or unexplained vaginal bleeding

The cause of ovarian cancer is not entirely clear. Cancer occurs when some ovarian cells begin growing abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. The cells may spread (metastasize) through your pelvis and abdomen or to other parts of your body.

Hormonal, lifestyle, and environmental factors may increase the risk of getting ovarian cancer, but it is not clear why some women who have no risk factors develop cancer and other women with risk factors never do. Ovarian cancer is likely caused by a complex interaction of genetic makeup and environment.

Factors that are associated with an increased risk of ovarian cancer include:

• age. Ovarian cancer is most common in women aged 50 to 60 years.
• inherited gene mutations. A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). (These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer.)
• long-term use of estrogen hormone replacement therapy
• age when menstruation started and ended. If a woman began menstruating before age 12 or underwent menopause after age 52, or both, the risk of ovarian cancer may be higher.
• never being pregnant
• receiving fertility treatment
• smoking
• using an intrauterine device
• having polycystic ovary syndrome

If ovarian cancer is suspected, your doctor will likely begin with a pelvic examination to examine the outer part of the genitals, the vagina, and the uterus and ovaries.

Your doctor also may recommend:

• imaging tests, such as ultrasound or CT scans, of your abdomen and pelvis to help determine the size, shape, and structure of your ovaries
• blood tests, which can detect a protein found on the surface of ovarian cancer cells
• surgery to remove a tissue sample and abdominal fluid to confirm a diagnosis of ovarian cancer.

If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible.

The results of the surgery will be used to define the extent — or stage — of your cancer. The cancer's stage helps determine the prognosis and treatment options.

Stages of ovarian cancer include:

• Stage I. The cancer is found in one or both ovaries.
• Stage II. The cancer has spread to other parts of the pelvis.
• Stage III. The cancer has spread to the abdomen.
• Stage IV. The cancer is found outside the abdomen.

If you have or have had ovarian cancer, you can take steps to manage the stress that accompanies the diagnosis.

• Learn about ovarian cancer so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends.
• Talk with other cancer survivors or attend support groups.

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Hormone therapy, targeted therapy, and radiation therapy are sometimes used, depending on the type, stage, and location of the cancer.

Surgery. Surgery for ovarian cancer generally involves removing both ovaries, the fallopian tubes, the uterus, and nearby lymph nodes and a fold of fatty abdominal tissue where ovarian cancer often spreads. The surgeon also will remove as much cancer as possible from your abdomen.

Less extensive surgery may be possible if your ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children.

Chemotherapy. After surgery, patients will likely be treated with chemotherapy to kill any remaining cancer cells. Chemotherapy drugs can be injected into a vein or directly into the abdominal cavity or both.

Chemotherapy may be used as the initial treatment in some women with advanced ovarian cancer.

Chemotherapy drugs that are commonly used in treating ovarian cancer include:

• albumin bound paclitaxel (nab-paclitaxel, Abraxane)
• altretamine (Hexalen)
• capecitabine (Xeloda)
• carboplatin
• cisplatin (Platinol-AQ)
• cyclophosphamide (Cytoxan)
• docetaxel (Taxotere)
• etoposide (VP-16)
• gemcitabine (Gemzar)
• ifosfamide (Ifex)
• irinotecan (CPT-11, Camptosar)
• liposomal doxorubicin (Doxil)
• melphalan (Alkeran, Novaplus Melphalan Hydrochloride, Alkeran IV)
• paclitaxel (Taxol)
• pemetrexed (Alimta)
• topotecan (Hycamtin)
• vinorelbine (Navelbine)

Targeted therapy. Targeted therapy for cancer targets the changes in cells that cause cancer. Bevacizumab (Avastin) and olaparib (Lynparza) are targeted therapies that have some effectiveness in advanced ovarian cancer.

Hormone therapy. Hormone therapy uses hormones or hormone blocking agents to kill cancer cells. Agents used to treat certain types of ovarian cancer include:

• goserelin (Zoladex)
• leuprolide (Lupron)
• tamoxifen
• letrozole (Femara)
• anastrozole (Arimidex)
• exemestane (Aromasin)

Radiation. Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation) or radiation can be placed inside your body near the cancer (brachytherapy).