Ovarian Cancer

Introduction

Ovarian cancer develops in a woman's ovary. In some cases, the cancer begins in the ovary. Other times, cancerous cells metastasize, or spread, to the ovary from another site in the body.

What is going on in the body?

The ovaries are inside the woman's pelvic area. From puberty to menopause, the ovaries produce female hormones. These hormones regulate the menstrual cycle, or menstruation. The ovary also contains eggs. The female hormones regulate the release of eggs during the cycle.
When an ovarian cell becomes cancerous, it will begin multiplying rapidly. A growth, or tumor, on the ovary forms as the cells multiply. This growth may or may not interfere with the function of the ovary. Cancer cells can break off from the tumor and spread directly to other areas inside the pelvis. Cancer cells can also metastasize through the bloodstream to other areas of the body.

What are the causes and risks of the disease?

No one knows what causes ovarian cancer. Women who have used oral contraceptives, or birth control pills, may be at lower risk than other women. The use of hormone replacement therapy at menopause has not been proven to increase risk. There is no proven link between diet and ovarian cancer.
Heredity may play a part. Our knowledge of the role of genetics in ovarian cancer is still being expanded. A genetic mutation called BRCA 1 results in increased risk of breast and ovarian cancer. BRCA 2, another genetic mutation, may result in increased risk for both female and male breast cancers, as well as ovarian cancer. Testing may be indicated when three or more closely related members of a family have had premenopausal breast cancer or ovarian cancer. Although it is much more common in women over 50 years of age, ovarian cancer can occur in childhood.
Genetic testing and genetic counseling may be helpful to women with a family history of ovarian cancer. The removal of ovaries to prevent the disease is controversial at this time. More needs to be learned about the reliability of testing and effectiveness of follow-up.
Other factors that might increase the risk of ovarian cancer include:

celibacy, or abstaining from sexual intercourse

a diet high in fat

exposure to asbestos, talc, and industrial toxins

having had no children

a history of uterine or breast cancer

infertility     

What are the signs and symptoms of the disease?

Ovarian cancer has a silent onset. The tumor may become quite large before it causes a problem. Ovarian tumors may be deep in the pelvis. They may be hard to detect, even with a pelvic exam.
When symptoms do occur, they are varied. They are related to the size and position of the tumor, as well as to the involvement of other organs. These symptoms may include:

bladder problems, such as stress incontinence and urinary frequency

a change in bowel habits, such as constipation

early menopause, or bleeding after menopause

gastrointestinal problems, such as indigestion, gas, and fullness after a light meal

heavy menstrual flow with breast tenderness

increasing abdominal size due to accumulation of fluid

irregular menstrual cycles

low back pain

pain and pressure in the pelvis and abdomen

weight loss

How is the disease diagnosed?

The discovery of a lump or mass during a pelvic exam does not mean that the woman has cancer. Tests such as special X-rays or ultrasounds may be done to better define the type of mass that is present. A small sample of blood will be drawn to test for a tumor marker that some ovarian cancers produce. Not every ovarian cancer makes it, and some normal cells make it. After those tests are done, a piece of the tumor is removed to test for cancer.
If the woman has ovarian cancer, other surgery and testing will be done to determine the stage or extent of the cancer.

What are the long-term effects of the disease?

Untreated ovarian cancer leads to death. Treatment can be effective, especially in the early stages.

What are the treatments for the disease?

Surgery to remove the cancer and the surrounding tissues is an important part of treatment. This will get rid of most of the cancer. Any remaining cancer may be treated in another way.
Chemotherapy involves a combination of special medicines given in the veins. It can be very effective in killing any remaining tumor. The medicines travel in the bloodstream to places where the cancer may have spread. Some of the more common ones are taxanes, such as taxol and taxatere. Platinum-based medicines, such as cisplatin and paraplatin, are also used. Sometimes the chemotherapy is given directly into the abdomen through a special tube.
Radiation therapy has only limited use with this type of cancer. It may be used if the cancer has spread to the abdomen. Sometimes it is used along with chemotherapy.
Psychological support is important for the patient and her family. Social workers and other members of the healthcare team are available for consultation as needed.

What are the side effects of the treatments?

Surgery involves removal of one or both ovaries. When both ovaries are removed, the woman may be given hormone replacement therapy to prevent the symptoms of menopause. The uterus may also be removed. This will make the woman unable to bear children.
The side effects of chemotherapy depend on the specific medicines used and may include:

fatigue

increased risk of infection

nausea

temporary hair loss

What happens after treatment for the disease?

The woman will be followed closely to make sure the cancer is under control.

How is the disease monitored?

Sometimes ovarian cancer produces a tumor marker called Ca-125. If this was present at diagnosis, a small blood sample will be checked regularly to see if the level is changing. A rising Ca-125 level may indicate that additional treatment is needed. CT scans of the abdomen and pelvis may also be done regularly. The results of these studies will indicate how well the cancer responded to treatment. Any new or worsening symptoms should be reported to the healthcare provider