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1 in 78 women will face ovarian cancer
in their lifetime
Learn more about ovarian cancer and the potential risk and treatment options available.
What is Ovarian Cancer?
The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries make eggs and female hormones. The fallopian tubes are a pair of tubes through which eggs travel from the ovaries to the uterus. The peritoneum is the membrane lining the cavity of the abdomen and covering the abdominal organs.
There are several types of ovarian cancer. While these diseases are all called “ovarian” because they affect the ovaries, they are actually unique in terms of their origin, how they look under a microscope, treatment and prognosis. Ovarian tumors can be benign (noncancerous) or malignant (cancerous). Although abnormal, cells of benign tumors do not metastasize (spread to other parts of the body). Not all ovarian tumors are cancer. Some ovarian tumors may be abnormal, but not necessarily cancerous. Ovarian cancer does present symptoms, but they can be commonly associated with other conditions,.
Causes of Ovarian Cancer
While the causes of ovarian cancer are still unknown, scientists have some theories:
Genetic errors may occur during one’s life known as acquired (somatic) gene mutations;
A person can be born with gene mutations (hereditary gene mutations also known as germline mutations);
Because being pregnant and taking birth control pills can lower risk of ovarian cancer, ovarian cancer may be related to ovulation
Though thought of as male hormones, androgens are found in women at lower levels, and may play a role in ovarian cancer;
And because tubal litigation and hysterectomy seem to lower risk, others have hypothesized that external substances that can cause cancer may enter the body through the vagina and pass through the uterus and fallopian tubes to the ovaries.
Additionally, based on research, it is believed that many if not almost all high-grade serous ovarian cancers (the most common subtype) previously thought to originate in the ovaries, actually arise from precursor lesions that begin in the fallopian tubes. Primary Peritoneal Carcinoma (PPC) is thought to develop from cells in the lining of the abdomen and pelvis, called the peritoneum. Since 2000, FTC and PPC have generally been included in ovarian cancer clinical trials. Regardless of the site of origin, the hallmark of these cancers is their early peritoneal spread or metastases.
Types of Ovarian Cancers
Ovarian cancers are now known to be several distinct diseases, which are named after the type of cell they come from: epithelial, germ cell, and stromal. These are the three main cell types that make up the ovary. Each cell type can develop into a different type of tumor, and each type differs in how it spreads, how it’s treated and its prognosis.
Epithelial ovarian cancer, which arise from the surface of the ovary (the epithelium), is the most common ovarian cancer. Fallopian Tube Cancer and Primary Peritoneal Cancer are also included within this designation.
Germ Cell ovarian cancer arises from the reproductive cells of the ovaries, and is rare.
Stromal cell ovarian cancer, which arises from connective tissue cells, is very rare.
Small cell carcinoma (SCCO) of the ovary is an extremely rare ovarian cancer and it is not certain whether the cells in SCCO are from ovarian epithelial cells, sex-cord stromal cells or germ cells.
Ovarian cancer is the fifth leading cause
of cancer-related death among women
Ovarian cancer accounts for 2.5 percent of cancers in women. While the 11th most common cancer among women, ovarian cancer is the 5th leading cause of cancer-related death among women, and is the deadliest of gynecologic cancers.
Ovarian cancer survival rates are much lower than other cancers that affect women. Five-year survival rates are commonly used to compare different cancers. The relative five-year survival rate for ovarian cancer is 46.5 percent. Survival rates vary greatly depending on the stage of diagnosis.
Symptoms of Ovarian Cancer
Ovarian cancer does have symptoms, but they are often very subtle and easily mistaken for other, more common problems. In some rare cases, early stage ovarian cancers may produce symptoms, but in the majority of women these don’t show up until the cancer has advanced (when the growth of the tumor triggers symptoms). Several studies show that ovarian cancer can produce these symptoms:
Pelvic or abdominal pain
Difficulty eating or feeling full quickly
Urinary symptoms (urgency or frequency)
Several other symptoms have been commonly reported by women with ovarian cancer. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities. However, these other symptoms are not as useful in identifying ovarian cancer because they are also found in equal frequency in women in the general population who do not have ovarian cancer.
Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer. See your doctor, preferably a gynecologist, if you have these symptoms for more than two weeks, and the symptoms are new or unusual for you.
While knowing the symptoms is important, inasmuch as it may hasten a diagnosis, research has shown that symptom recognition alone is not useful in detecting ovarian cancer early and that earlier symptom recognition may not alter the course of the disease or outcome.
Ovarian Cancer Risk Factors
Research has shown that certain risk factors increase the likelihood a woman may get ovarian cancer. Other factors may actually decrease a woman’s probability of getting the disease. Having risk factors does not predict you will get ovarian cancer. Some women who get the disease have no known risk factors, and most women with the risk factors will not get ovarian cancer. However, if you think you may be at risk for ovarian cancer, you should speak with your doctor.
Factors that may increase the risk of ovarian cancer:
Genetics: BRCA1 and BRCA2
About 20 to 25 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease. The most significant risk factor for ovarian cancer is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). These genes are responsible for about 10 to 15 percent of all ovarian cancers. Eastern European women and women of Ashkenazi Jewish descent are at a higher risk of carrying BRCA1 and BRCA2 mutations.
Genetics: Lynch Syndrome
Personal or Family History
Women with a grandmother, mother, daughter or sister with ovarian cancer but no known genetic mutation still have an increased risk of developing ovarian cancer. The lifetime risk of a woman who has a first degree relative with ovarian cancer is five percent (the average woman’s lifetime risk is 1.4 percent). Family history of any of the following cancers may indicate an increased risk: Breast cancer, Ovarian cancer, Colon cancer, Uterine cancer, Rectal cancer.
Having endometriosis increases the risk of clear cell and endometrioid ovarian cancers 2-3 fold.
All women are at risk of developing ovarian cancer regardless of age; however ovarian cancer rates are highest in women aged 55-64 years. The median age at which women are diagnosed is 63.
Reproductive History and Infertility
Research suggests a relationship between the number of menstrual cycles in a woman’s lifetime and her risk of developing ovarian cancer. Infertility, regardless of whether or not a woman uses fertility drugs, also increases the risk of ovarian cancer. A woman is at an increased risk if she started menstruating at an early age (before 12), has not given birth to any children, had her first child after 30, experienced menopause after 50, or has never taken oral contraceptives.
Hormone Replacement Therapy
Various studies have found a link between obesity and ovarian cancer. A 2009 study found that obesity was associated with an almost 80 percent higher risk of ovarian cancer in women 50 to 71 who had not taken hormones after menopause.
Factors that may reduce the risk of ovarian cancer:
Women can reduce the risk of developing ovarian cancer in many ways; however, there is no prevention method for the disease.
Ovarian cancer may be related to ovulation, meaning occurrences that result in less frequent ovulation may reduce your risk of ovarian cancer, including oral contraceptive use, pregnancy and breastfeeding. Removal of the ovaries, fallopian tubes, a hysterectomy, or tubal ligation also reduce your risk, but do not complete remove the chance or ovarian cancer. Removal or tubal ligation that occurs before 35 further reduces your risk.
The importance of a GYN oncologist
A gynecologic oncologist is a specialist in treating women’s reproductive cancers. Women with ovarian cancer are strongly encouraged to seek care from one of these specialists.
Multiple studies conducted over the past decade have shown that an ovarian cancer patient’s chance of survival is significantly improved when her surgery is performed by a gynecologic oncologist. One analysis of multiple studies found that women whose surgeries were performed by gynecologic oncologists had a median survival time that was 50 percent greater than women whose surgeries were done by general gynecologists or other surgeons inexperienced in optimal debulking procedures.
Sometimes referred to as cytoreductive surgery, debulking involves removal of as much of the tumor as possible. As part of the debulking procedure, doctors try to stage the disease definitively and identify the optimal treatment for the cancer. Proper staging and optimal debulking translate into improved overall survival for women at any stage of ovarian cancer.
Gynecologic oncologists have greater success in treating ovarian cancer as a result of their tendency to perform more aggressive surgery. Women whose tumors have been reduced to less than one centimeter have a better response to chemotherapy and improved survival rate. Gynecologic oncologists also are more likely to perform the multiple peritoneal and lymph node biopsies necessary to ensure adequate surgical staging.
Testing & Treatment
No reliable screening or early detection tests exist for ovarian cancer. The Pap test does not test for ovarian cancer; it screens for cervical cancer. If a woman has the signs and symptoms of ovarian cancer, her doctor will probably perform a complete pelvic exam, a transvaginal or pelvic ultrasound, radiological tests, such as a transvaginal ultrasound or CT scan, and a CA-125 blood test. Used individually, these tests are not definitive; they are most effective when used in combination with each other. If a woman has a strong family history or a genetic predisposition such as a BRCA mutation, doctors may use some of these tests to monitor a woman.
Testing: know what to ask for
Blood tests: CA-125, OVA1, Inhibin B, Inhibin B
Blood tests for ovarian cancer combined with other testing can be helpful in diagnosing ovarian cancer. These blood tests are often conducted at the presence of symptoms. Because of the nature of these tests, they are not endorsed for general screening of ovarian cancer, and should be conducted in conjunction with additional exam resources.
Among the blood tests your doctor could order is the CA-125 blood test. CA-125 is a substance in the blood that may increase when a cancerous tumor is present; this protein is produced by ovarian cancer cells and is elevated in more than 80 percent of women with advanced ovarian cancers and in 50 percent of those with early-stage cancers. The OVA1 test measures the levels of five proteins in blood that change when ovarian cancer is present. Granulosa cell tumors are most often detected and/or monitored via the following blood indicators: Inhibin B and Inhibin A.
Further Examination: Transvaginal Ultrasound, Pelvic Exam, Recto-vaginal Pelvic Examination
A pelvic exam may be included as part of a woman’s regular female health exam. This exam requires the doctor to place one or two fingers into a woman’s vagina and another over her abdomen to feel the size, shape, and position of the ovaries and uterus. Ovarian cancer is rarely detected in a pelvic exam and usually in an advanced stage if it is.
A transvaginal ultrasound is a test used to examine a woman’s reproductive organs and bladder, and can often reveal if there are masses or irregularities on the surface of the ovaries and within cysts that form within the ovaries.
A recto-vaginal pelvic exam allows your doctor to examine the ovaries for lumps or changes in shape or size. Every woman should undergo a rectal and vaginal pelvic examination at her annual check-up with her gynecologist. A Pap test is routine in a pelvic exam but it detects cervical cancer, not ovarian cancer.
The only definitive way to determine if a patient has ovarian cancer is through surgery and biopsy. Doctors will perform surgery after they obtain enough evidence from their exam and test results. If there is a suspicion from these tests that ovarian cancer might be present, the patient should seek a referral to a gynecologic oncologist before surgery occurs. Research shows that women treated by gynecologic oncologists live longer than those treated by other physicians.
Navigating and understanding treatment options are critical for an ovarian cancer patient’s survival. All treatment decisions should be made by a patient in consultation with her medical professional. Treatment may include:
Additional Drugs, such as targeted therapies and angiogenesis inhibitors
Radiation Therapy or Radiotherapeutic Procedures
Complementary Therapies (such as massage therapy, special diets or acupuncture)
Early detection is key
Women diagnosed at an early stage—before the cancer has spread—have a much higher five-year survival rate than those diagnosed at a later stage. However, only approximately 15 percent of ovarian cancer patients are diagnosed early with early stage disease.
When cancer returns after a period of remission, it is considered a recurrence. Around 70 percent of patients diagnosed with ovarian cancer will have a recurrence.
One of the factors in determining a patient’s risk of recurrence is the stage of the cancer at diagnosis:
Patients diagnosed in stage I have a 10 percent chance of recurrence.
Patients diagnosed in stage II have a 30 percent chance of recurrence.
Patients diagnosed in stage III have a 70 to 90 percent chance of recurrence.
Patients diagnosed in stage IV have a 90 to 95 percent chance of recurrence.
Women with recurrent ovarian cancer may have to undergo another surgery. The effectiveness and type of treatment for recurrent ovarian cancer depends on what kind of treatment the patient received in the past, the side effects associated with previous treatments, the extent of the recurrent cancer and the length of time since the last treatment was finished called the “time to recurrence,” which researchers often call “progression-free survival.”
During treatment for recurrence, it is very important to have a continual dialogue with your doctor about the benefits of treatment, with respect to remission and survival, versus the risks of the side effects that hurt the quality of your life. If you do choose treatment in recurrence, there are several options based on your previous treatments.