Ovarian Cancer

What is ovarian cancer?

Summary

Ovarian cancer is an abnormal growth of cells in the ovaries, the reproductive organ in women responsible for producing eggs. Risk factors for developing ovarian cancer include familial genetic syndromes, increasing age, obesity or weight gain, starting menses at an early age, undergoing menopause at a later age and using prolonged postmenopausal hormone replacement therapy.

Early-stage ovarian cancer is usually asymptomatic. Late-stage ovarian cancer may cause abdominal, pelvic, or back pain, fatigue, abdominal bloating, constipation, urinary symptoms, or difficulty breathing.

The diagnosis is made by laboratory studies, imaging, and tissue biopsy. Treatment consists of surgery and adjuvant chemotherapy.

Recommended care

You schedule a visit with your primary care physician (PCP). It is likely an ultrasound will be performed as well as blood tests.

Ovarian cancer symptoms

Ovarian cancer can be classified based on the histological findings. Different types of ovarian cancer can present at different ages and with different symptoms.

Types

Types of ovarian cancer include epithelial ovarian cancers (90 percent of cases), which usually occur in postmenopausal women; germ cell tumors (five percent), which usually occur in women in their early 20s; and sex cord stromal tumors (five percent), which usually occur in women in their 50s.

Asymptomatic cancer

Early-stage ovarian cancer usually does not cause any symptoms, which can lead to missed diagnoses.

Main symptoms

Symptoms of ovarian cancer usually develop with late-stage disease, when cancer may have spread to other parts of the body. Possible symptoms include:

• Abdominal or pelvic pain: This pain usually develops gradually and persists for months. In one study, 72 percent of women reported symptoms for three months or more and 35 percent reported symptoms for six months or more prior to diagnosis
• Early puberty or abnormal uterine bleeding: Those with germ cell tumors specifically may develop early puberty or abnormal uterine bleeding. These symptoms can occur because germ cell tumors can release sex hormones such as estrogen and testosterone.
• Fatigue: Manifesting as persistent tiredness.

Other symptoms

Other symptoms that may be present due to cancer spreading or affecting other body systems include:

• Back pain: This can occur if the cancer spreads to the spine. Similar to abdominal or pelvic pain, the pain is usually gradual in onset and chronic.
• Abdominal bloating, difficulty eating, early satiety, nausea, vomiting, or constipation: These symptoms may be due to the cancer-causing obstruction of the gastrointestinal tract.
• Decreased urination, bladder fullness, or leakage of urine: Urinary symptoms may develop due to the cancer-causing obstruction of the urinary tract.
• Difficulty breathing: This can be due to fluid in the abdomen pushing up on the diaphragm (the muscle responsible for breathing), fluid in the lining of the lungs, or a clot in the blood vessels of the lungs.

Ovarian cancer causes

Causes and risks of ovarian cancer vary but have significant links to genetics, age, weight, and hormone levels throughout a woman's life.

Genetic mutations

Approximately 10 to 12 percent of ovarian cancers are caused by familial genetic syndromes, which are genetic mutations that run in families and predispose to the development of certain types of cancers.

• BRCA mutation: About 10 percent of ovarian cancers are caused by mutations in the BRCA gene, which also increases the risk of developing breast and pancreatic cancers.
• Lynch syndrome: About two to three percent of ovarian cancers are caused by the condition hereditary nonpolyposis colorectal cancer, or Lynch syndrome, which increases the risk of developing colon cancer and cancer of the uterus.

Increased age

Increased age is a risk factor for developing most types of ovarian cancers. The most common type of ovarian cancer, epithelial ovarian cancer, usually affects women who are postmenopausal.

Obesity or weight gain

Obesity or weight gain is associated with an increased risk of developing ovarian cancer. This is thought to be because fat tissue can convert male sex hormones into estrogens, which stimulates the growth of cells in the ovaries. One analysis found that overweight or obese women had a 20 to 30 percent increased relative risk of developing ovarian cancer compared to women who were not overweight or obese.

Abnormal start of menses or menopause

Starting menses at an early age or undergoing menopause at a later age have been associated with an increased risk of developing ovarian cancer. This is thought to be due to experiencing an increased number of cycles of ovulation over the course of a lifetime.

Using hormone replacement therapy

Using hormone replacement therapy to treat symptoms of menopause is associated with an increased risk of developing ovarian cancer. This is especially true with estrogen-only hormone replacement therapy since the unopposed estrogen can stimulate the growth of cells in the ovaries. The risk is particularly higher for prolonged use of hormone replacement therapy.

Ways that risks are reduced

Having one or more children is associated with a decreased risk of developing ovarian cancer, since being pregnant stops ovulatory cycles. Taking hormonal contraceptives, including oral contraceptive pills, for a long period of time has also been associated with a decreased risk of developing ovarian cancer since hormonal contraceptives can reduce ovulatory cycles.

Treatment options and prevention for ovarian cancer

Treatment for ovarian cancer involves surgery to remove the cancer cells followed by adjuvant chemotherapy. More information about these two components of treatment is provided below.

Surgery

The primary treatment for ovarian cancer is surgery to remove the cancer. The extent of surgery will depend on how far the cancer has spread. People with low-risk stage 1 cancer who wish to preserve fertility may undergo surgery to remove the affected ovary and fallopian tube (a structure adjacent to the ovary) only. However, because ovarian cancer has usually spread by the time of diagnosis, surgery may involve removing multiple organs, including both ovaries and fallopian tubes, the uterus, and organs in the abdominal cavity. Surgery has the best outcomes when all visible cancer is removed, a technique called "primary surgical cytoreduction".

Adjuvant chemotherapy

Most people with ovarian cancer will benefit from adjuvant chemotherapy, or chemotherapy given after surgery, to further improve outcomes. Chemotherapy for ovarian cancer usually includes platinum-based drugs such as cisplatin or carboplatin, as well as other drugs that may include paclitaxel, docetaxel, bevacizumab, or others. Multiple rounds of chemotherapy are usually required.

Prognosis

More than 80 percent of people with advanced-stage ovarian cancer will experience a recurrence of their cancer. Therefore, those who have been treated for ovarian cancer are usually monitored with regular follow-up visits and checking levels of CA125, which can help detect recurrent cancer.

Screening

Currently, the U.S. Preventive Services Task Force (USPSTF) recommends against screening for ovarian cancer in women without symptoms and without a known genetic syndrome that predisposes to developing ovarian cancer.

Prevention

Methods of reducing the risk of developing ovarian cancer include maintaining a healthy lifestyle and avoiding long-term postmenopausal hormone replacement therapy. In addition, individuals with the BRCA mutation may consider getting undergoing a prophylactic surgery to remove their ovaries and fallopian tubes, which can reduce the risk of developing ovarian cancer by 69 to 100 percent.

When to seek further consultation for ovarian cancer

If you develop symptoms of ovarian cancer you should go see your physician. He or she can evaluate you to determine if your symptoms are due to ovarian cancer.

If you or a family member have a genetic mutation that increases the risk of developing ovarian cancer

If you or a family member have a genetic mutation such as a BRCA mutation, you should go see your physician. Your physician can order genetic testing and connect you with a genetic counselor to understand your risks and prevention options.