Ovarian Cancer

Most ovarian cancers develop from the cells that cover the outer surface of the ovary, called the epithelial cells. Less frequently, ovarian cancer arises in the “germ cells” of the ovary which develop from the cells that produce the ova (eggs). Germ cell tumors may occur in teenagers and in women in there twenties. A third type of ovarian tumor develops from connective tissue cells that hold the ovary together and produce the female hormones, estrogen and progesterone. These rare tumors are generally much less aggressive than the other tumors.

Risk factors for ovarian cancer

• Family history of cancer (mother, daughter, sister). Women who have had or have a family history of breast, uterine, colon or rectal cancer may also have an increased risk.
• Age over 55
• Women who have never been pregnant
• Menopausal hormone therapy – some studies suggest that women who have had estrogen only products for 10 or more years may have increased risk of ovarian cancer

Symptoms

Usually there are no obvious symptoms of ovarian cancer. However, as the cancer grows symptoms may include:

• Pressure or abdominal swelling or bloating
• Abdominal discomfort
• Nausea, lack of appetite, indigestion, constipation
• Marked fatigue

Less common signs:

• urinary frequency
• shortness of breath

Prevention and Screening for Ovarian Cancer

There are no known methods to guarantee prevention of ovarian cancer. Most ovarian cancers are random and not inherited. However, 5–10% of individuals who develop ovarian cancer have an inherited genetic susceptibility to the disease.

Routine screening is not recommended for women with no risk factors as they are  considered to be at average risk. For those with an increased risk, evaluation of hereditary cancer pattern such as BRCA screening is recommended to determine if you have a low or high risk for ovarian cancer.

For women considered to be genetically at higher risk, your provider will discuss a management plan of regular screenings which may include pelvic exams, pelvic ultrasound with Doppler imaging and blood work to screen for tumor markers such as CA-125.  Not all women who have BRCA positive genes will go on to develop ovarian cancer. If you are BRCA positive, your provider will assist you in making decisions with a genetic counselor to consider risk reducing strategies such as use of oral contraceptives, surgery to remove the ovaries or increased monitoring.

Diagnosis

Your health care provider may use several tests to see if you have ovarian cancer, usually beginning with an internal (pelvic) examination. During the exam, your clinician will feel for any lumps or changes in the size or shape of the uterus, and if the ovaries have changed in size. A Pap test (microscopic evaluation of cervical and vaginal cells) may be performed to evaluate the cervix (opening of the uterus) and vagina.

Your clinician may order pelvic ultrasound or CT scan to visualize changes felt on exam. If these are positive, your physician will work with you and other specialists to determine next steps, including surgery.

Surgery for ovarian cancer has two objectives. First, to remove any cancer that exists (or as much as possible), including removing the ovaries, the uterus and the omentum (membrane in the abdominal cavity that connects and supports internal organs). The second objective is to take samples of the tissue and surrounding nodes to determine if and where the tumor has spread; this determines the stage of the disease. Depending upon the cell type of the tumor in pre-menopausal women, a more limited surgery may be appropriate.

Treatment options for ovarian cancer

If you are diagnosed with ovarian cancer, your healthcare provider will work you and a team of cancer care providers including a gynecology oncologist to provide you with the best treatment options. After a more definitive diagnosis is established at surgery, additional therapy will depend on several factors, including the cell type, the stage and extent of the cancer, and if there is any residual tumor remaining after completion of that initial surgery. Treatment typically includes chemotherapy (usually a combination of drugs), radiation and/or immunotherapy.

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