What is ovarian cancer?

Ovarian cancer is a disease in which malignant (cancer) cells form in the tissues of the ovaries. The ovaries are two glands, one located on each side of the uterus, that make hormones and release eggs. Ovarian cancer makes up about 22 percent of all gynecologic cancers and 7 percent of all cancers in women.

Ovarian cancer is the fifth-leading cause of death from cancer in women, exceeded only by lung, breast, colorectal, and pancreatic cancers.

The risk of developing ovarian cancer increases with age and is greater than 1 percent among women 45 to 49 years old. It is rare before age 40.

Signs of ovarian cancer

The symptoms of ovarian cancer can include bloating, pain and swelling in the abdomen, back pain, and frequent urination. When you have these symptoms it’s important to see your doctor right away.

The following are signs that might indicate you have ovarian cancer:

• A change in bowel habits (constipation or diarrhea)
• A feeling of fullness after eating less than normal
• Unexplained weight gain or weight loss
• Pain in the pelvis or legs that does not go away with rest or changes in activity level
• Pain during sexual intercourse and/or after menopause (for women who are older than 55)
• Feeling bloated for no apparent reason

Types of ovarian cancer

Ovarian cancer typically doesn’t have symptoms until it’s advanced and hard to treat, so it’s important to get tested if you have risk factors or symptoms of ovarian cancer.

There are different types of ovarian cancer:

Epithelial carcinoma (most common): This type of tumor starts in cells lining the outside surface of the ovary

Stromal tumors: These tumors start in connective tissue within an ovary

Mixed epithelial/stromal tumors: These tumors have both epithelial (the type found in epithelial carcinomas) and stromal (the type found in stromal tumors) components

Ovarian cysts

Ovarian cysts are a common occurrence for women of reproductive age, though they can also occur in men, children and even teenagers.

Ovarian cysts are most common in women between their late 20s and early 50s. Ovarian cysts can be caused by having irregular periods, hormonal imbalances or pregnancy. They are sometimes found during a pelvic exam when your doctor feels them on the outside of your abdomen.

Ovarian cysts are fluid-filled sacs that grow on or around an ovary. They develop when the egg follicle (the sac that contains an egg) doesn’t break open after releasing an egg. Instead, the fluid builds up inside the follicle until it’s ready to burst — usually about two weeks after ovulation occurs.

Risk factors for ovarian cancer

The risk of ovarian cancer increases as you age. In the United States, about 1 in 70 women will be diagnosed with ovarian cancer during their lifetime.

Risk factors for ovarian cancer include:

Age. Ovarian cancer is most common among women who are older than 50.

Family history. Having a family member with ovarian cancer raises your risk of developing the disease. However, only 5 percent of cases are linked to inherited genetic mutations that make you more susceptible to the disease.

Menstrual history. Women who started menstruation early (before age 12) or reached menopause late (after age 55) have an increased risk of ovarian cancer compared to those who started menstruating at a later age or reached menopause earlier than average, according to the National Cancer Institute (NCI).

Increased body weight and obesity may also increase your risk of developing this form of cancer, according to NCI research published in 2012.

How is ovarian cancer diagnosed?

Ovarian cancer can be difficult to diagnose because the symptoms are often vague and similar to those of other conditions.

The following tests may help determine if you have ovarian cancer:

Ultrasound. A technician uses a wandlike instrument, called a transducer, to bounce sound waves off the organs and tissues of your pelvic area. The echoes produce a picture that is displayed on a video screen. An ultrasound may be done to view your ovaries and look for abnormal tissue growths or cysts.

CT scan (computed tomography scan). In this test, you lie on a table while an X-ray tube behind your back takes pictures of your internal organs, including your ovaries and uterus. A computer combines all these images into cross-sectional views of your body that can be viewed on a monitor at the same time as they’re being taken, which helps doctors get a better understanding of what’s going on inside you. CT scans are more extensive than ultrasounds but often take less time because they aren’t performed manually by a technician.

MRI (magnetic resonance imaging). This procedure uses magnetic waves instead of X-rays to create detailed pictures of soft tissues inside your body — particularly important in diagnosing ovarian cancer because it often produces accurate results.

What are the stages of ovarian cancer?

Stage 1

Stage 1 ovarian cancer has three substages:

• Stage 1A.The cancer is limited, or localized, to one ovary.
• Stage 1B. The cancer is in both ovaries.
• Stage 1C. There are also cancer cells on the outside of the ovary.

Stage 2

In stage 2, the tumor has spread to other pelvic structures. It has two substages:

• Stage 2A. The cancer has spread to the uterus or fallopian tubes.
• Stage 2B. The cancer has spread to the bladder or rectum.

Stage 3

Stage 3 ovarian cancer has three substages:

• Stage 3A. The cancer has spread microscopically beyond the pelvis to the lining of the abdomen and the lymph nodes in the abdomen.
• Stage 3B. The cancer cells have spread beyond the pelvis to the lining of the abdomen and are visible to naked eye but measure less than 2 centimeters.
• Stage 3C. Deposits of cancer at least 3/4 of an inch are seen on the abdomen or outside the spleen or liver. However, the cancer isn’t inside the spleen or liver.

Stage 4

In stage 4, the tumor has metastasized, or spread, beyond the pelvis, abdomen, and lymph nodes to the liver or lungs. There are two substages in stage 4:

• In stage 4A, the cancerous cells are in the fluid around the lungs.
• In stage 4B, the most advanced stage, the cells have reached the inside of the spleen or liver or even other distant organs like the skin or brain.

How ovarian cancer is treated?

Ovarian cancer is treated with surgery, chemotherapy and radiation therapy. The type and combination of treatments you receive depends on the stage of your cancer.

Surgery. Surgery to remove the tumor is the most common treatment for ovarian cancer. Doctors often perform surgery first because it’s usually an effective treatment. Surgery may be able to cure some types of ovarian cancer if they’re caught early enough.

Chemotherapy. Chemotherapy is a drug that kills or slows the growth of cancer cells in your body by preventing them from dividing (making copies of themselves). It’s given by injection into a vein (IV), through a catheter placed in a vein in your chest or arm, or taken by mouth. The drugs enter your bloodstream and travel throughout your body killing the cancer cells that have spread from the original tumor site to other areas but may not have spread to lymph nodes or distant organs yet.

Radiation therapy (radiotherapy). Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors so they can be removed surgically or treated with hormone therapy or targeted therapies like Herceptin® or Tyverb®.