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OVARIAN CANCER

What is an ovary?

 anatomy of ovaries

Illustration of ovaries

The ovaries are the female reproductive organs that produce eggs. The eggs produced by the ovaries travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus.

What is ovarian cancer?

Ovarian cancer is cancer that starts in the ovaries.

The most common form of ovarian cancer (about 80%) arises from the outer lining (epithelium) of the ovary. However, recent evidence shows cells that line the Fallopian tube (epithelium) also to be prone to develop into the same kind of cancer as seen in the ovaries. Since the ovaries and tubes are closely related to each other, it is believed that these cells can mimic ovarian cancer. Other forms arise from the egg cells (germ cell tumor).

 ovarian cancer

Illustration of ovarian cancer

Cancer of the ovaries is considered very dangerous because the ovaries are in close proximity to many other abdominal organs and the risk of metastasis is high.

Ovarian cancer usually occurs in women over age 50 but can affect younger women. It causes more deaths than any other cancer of the female reproductive system and is the leading cause of death from gynecologic cancer in the developed world. About two-thirds of the deaths from ovarian cancer occur in women age 55 and older. About 25% of ovarian cancer deaths occur in women ages 35 - 54.

Causes and risk factors of ovarian cancer

The cause of ovarian cancer is unknown.

Risk factors include:

  • Presence of certain genes (BRCA1 and BRCA2)
  • Personal history of breast cancer or a family history of breast or ovarian cancer
  • Older age (above 50)
  • Taking estrogen replacement only (not with progesterone) for 5 years or more

Points of interest:

  • Having more children and having them earlier in life lower the risk for ovarian cancer
  • Birth control pills decrease the risk of ovarian cancer
  • Fertility drugs do not increase the risk for ovarian cancer
  • Having regular pelvic examinations may decrease the overall risk
  • Preventive surgery to remove the ovaries in women who have a mutation in the BRCA1 and BRCA2 genes can dramatically reduce their risk of developing ovarian cancer

Signs and symptoms of ovarian cancer

Ovarian cancer symptoms are often vague. Women and their doctors often blame the symptoms on other, more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries i.e. metastasized.

With ovarian cancer, the following symptoms may occur on a daily basis for more than a few weeks:

  • Bloating
  • Difficulty eating or feeling full quickly
  • Pelvic or abdominal pain

Other symptoms that can also be due to other reasons are:

  • Abnormal menstrual cycles
  • Digestive symptoms:
  • Constipation
  • Increased gas
  • Indigestion
  • Lack of appetite
  • Nausea and vomiting
  • Sense of pelvic heaviness
  • Swollen abdomen or belly
  • Unexplained back pain that worsens over time
  • Vaginal bleeding
  • Vague lower abdominal discomfort
  • Weight gain or loss
  • Excessive hair growth
  • Increased urinary frequency or urgency

Diagnostic tests and exams for ovarian cancer

  • Physical examination may reveal a swollen abdomen and fluid in the abdominal cavity (ascites)
  • Pelvic examination may reveal an ovarian or abdominal mass
  • Alpha fetoprotein
  • Blood chemistry
  • CA125 (may be done if ovarian cancer is strongly suspected or has been diagnosed, and to follow the cancer during or after treatment)
  • CBC
  • Quantitative serum HCG (blood pregnancy test)
  • Urinalysis
  • Abdominal CT scan or MRI of abdomen
  • GI series
  • Ultrasound
  • Pelvic laparoscopy or exploratory laparotomy for symptom evaluation and to get a biopsy

No lab or imaging test has ever been shown to be able to diagnose ovarian cancer in its early stages (screening).

Treatment of ovarian cancer

  • Surgery: Surgery is part of the treatment for all stages of ovarian cancer. For earlier stages, it may be the only treatment. Surgical options include:
    • Removal of the uterus (total hysterectomy)
    • Removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy)
    • Partial or complete removal of the omentum, the fatty layer that covers and pads organs in the abdomen
    • Examination, biopsy, or removal of the lymph nodes and other tissues in the pelvis and abdomen
  • Chemotherapy: Chemotherapy is used after surgery to treat any remaining disease or if the cancer comes back.

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