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Ovarian Cancer

Ovarian cancer is a disease in which cancer cells develop in the tissue covering the ovaries, which produce eggs and the hormones estrogen and progesterone. Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in cells that line the ovary) or malignant germ cell tumors (cancer that begins in egg cells).

Ovarian cancer is the second most common gynecologic cancer and the ninth most common cancer in women (not counting skin cancer). It ranks fifth as the cause of cancer death in women. About half of women who are diagnosed with ovarian cancer are 60 or older and it is more common in white women than African-American women. Because it produces no distinctive symptoms, ovarian cancer may not be discovered until an advanced stage.

The highly skilled and knowledgeable multidisciplinary Gynecologic Oncology team at Beaumont offers surgery, radiation and chemotherapy, or a combination of these therapies. They can also direct eligible patients to clinical trials designed to evaluate the most effective treatments.

What are the ovaries?

The ovaries are female reproductive organs located in the pelvis. There are two of them - one on each side of the uterus. The ovaries produce eggs and the female hormones estrogen and progesterone. Estrogen and progesterone control the development of female body characteristics (i.e., breasts, body shape and body hair) and regulate the menstrual cycle and pregnancy.

What is ovarian cancer?

Ovarian cancer is a disease in which malignant cells are found in an ovary. There are three types of ovarian tumors, named for the tissue in which they are found:

  • epithelial cell - cells that cover the surface of the ovary. Most of these tumors are benign (noncancerous). However, epithelial ovarian cancer accounts for 85 percent to 90 percent of ovarian cancer cases.
  • germ cell - cells that form the eggs in the ovary.
  • stromal cell - cells that form the ovary and produce female hormones.

What is extra-ovarian primary peritoneal carcinoma (EOPPC)?

Extra-ovarian primary peritoneal carcinoma (EOPPC) is a cancer closely related to epithelial ovarian cancer. It occurs outside the ovary in the peritoneum, which is the lining of the abdomen. Because it occurs outside the ovary, women who have had their ovaries removed can still develop this type of cancer.

EOPPC can mimic ovarian cancer in terms of symptoms and can also cause an increase in the CA-125 tumor marker. Treatment is similar to that for ovarian cancer and includes surgery and chemotherapy.

Causes of Ovarian Cancer

The cause of ovarian cancer is not yet known. An estimated 22,440 new cases of ovarian cancer are expected in the US in 2017. Ovarian cancer is the eight most common form of cancer among women.

Risk Factors for Ovarian Cancer

The cause of ovarian cancer is unknown, but there are certain risk factors that indicate an increase in a woman's chance of developing ovarian cancer. The following have been suggested as risk factors for ovarian cancer:

  • early menarche - starting monthly periods early - before the age of 12
  • late menopause (after the age of 52)
  • age - over the age of 50
  • hormone replacement therapy
  • Some studies have suggested that women who use hormone replacement therapy after menopause may have a slightly increased risk of ovarian cancer.
  • infertility (inability to become pregnant)
  • having a first child after the age of 30
  • personal history of breast or colon cancer
  • family history
  • First-degree relatives (such as mother, daughter, sister) of a woman who has had ovarian cancer are at risk for developing the disease. The risk increases if two or more first-degree relatives have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.
  • certain fertility drugs

Prevention of Ovarian Cancer

Suggested preventive measures include the following:

  • healthy diet (high in fruits, vegetables, grains, and low in saturated fat)
  • birth control pills
  • pregnancy and breastfeeding
  • hysterectomy - surgical removal of the uterus.
  • tubal ligation - surgery to block the fallopian tubes to prevent conception.
  • oophorectomy - surgical removal of ovaries.

Research studies have shown that certain genes are responsible for increasing the risk of ovarian and breast cancer.

Symptoms of Ovarian Cancer

The following are the most common symptoms of ovarian cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • general discomfort in the lower abdomen, including any/all of the following:
    • feeling swollen or bloated
    • a loss of appetite or a feeling of fullness - even after a light meal
    • gas, indigestion, and nausea
  • weight loss
  • diarrhea or constipation, or frequent urination caused by the growing tumor, which may press on nearby organs, such as the bowel or bladder
  • bleeding from the vagina
  • build up of fluid around the lungs, which may cause shortness of breath

The American Cancer Society (ACS) recommends that if any of these symptoms occur almost daily or last a few weeks and are new, the woman should seek the attention of her physician. In many cases, symptoms do not occur until the ovarian cancer is in an advanced stage. The symptoms of ovarian cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnosis of Ovarian Cancer

Diagnosis includes a medical history and physical examination, including a pelvic examination to feel the vagina, rectum, and lower abdomen for masses or growths. A Pap test may be requested as part of the pelvic examination. The physician may also order other tests, including:

  • ultrasound - an imaging technique that uses sound waves to produce an image on a monitor of the abdominal organs, such as the uterus, liver, and kidneys.
  • computed tomography (CT or CAT scan) - a noninvasive procedure that takes cross-sectional images of the brain or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray. The CT scan may indicate enlarged lymph nodes - a possible sign of a spreading cancer or of an infection.
  • lower gastrointestinal (GI) series - x-rays of the colon and rectum using a contrast dye called barium.
  • intravenous pyelogram (IVP) - x-ray of the kidneys and ureters, taken after the injection of a dye.
  • blood test - to measure a substance in the blood called CA-125 (a tumor marker that is found to be elevated in the blood of women with ovarian cancer). This test is more often used to monitor the progress of treatment than as a screening test since non-cancer problems can cause it to be elevated.
  • biopsy - a procedure in which tissue samples are removed from the body for examination under a microscope; to determine if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.

Treatment for Ovarian Cancer

Specific treatment for ovarian cancer will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Ovarian cancer may be treated with surgery, chemotherapy, radiation therapy, or a combination of treatments.

  • Surgery
    • salpingo-oophorectomy - surgery to remove the fallopian tubes and ovaries.
    • hysterectomy - surgical removal of the uterus.
    • pelvic lymph node dissection - removal of some lymph nodes from the pelvis.
  • Chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.
  • Radiation therapy - the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:
    • external radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
    • internal radiation (brachytherapy, implant radiation) - radiation is given inside the body as close to the cancer as possible. In some cases, a treatment called intraperitoneal radiation therapy is used. A radioactive liquid is given through a catheter into the abdomen.
Another treatment for ovarian cancer is intraperitoneal (IP) chemotherapy. This type of chemotherapy is given directly into the abdomen through a catheter (a long, thin tube). While several clinical trials have shown a benefit for this type of chemotherapy treatment, it is not widely used.