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Ovarian Cancer: Early Signs and Symptoms

Ovarian cancer

Highlights

  1. Ovarian cancer occurs when a tumor forms in the ovary’s cells.
  2. Tell your doctor about any symptoms you’re having that may suggest ovarian cancer.
  3. Ovarian cancer treatment involves a combination of therapies, such as surgery, chemotherapy, hormone therapy, and radiation.

Ovarian cancer occurs in the ovary’s cells. The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones estrogen and progesterone. Cancer starts when abnormal cells in the ovary begin to multiply out of control and form a tumor. The tumor can then spread to other parts of the body. More than 22,000 women will receive an ovarian cancer diagnosis in 2016, and 14,000 women will die from it.

Ovarian cancer often has warning signs, but the earliest symptoms are vague and easy to dismiss. Twenty percent of ovarian cancers are detected at an early stage.

Types of ovarian cancer

 Type 1

The ovaries are made up of three types of cells. Each cell can develop into a different type of tumor:

  • Epithelial tumors form in the layer of tissue on the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors
  • Stromal tumors grow in the hormone-producing cells. Seven percent of ovarian cancers are stromal tumors.
  • Germ cell tumors develop in the egg-producing cells. Germ cell tumors are rare.

Ovarian cysts

Most ovarian cysts aren’t cancerous. These are called benign cysts. However, a very small number can be cancerous.

An ovarian cyst is a collection of fluid or air that develops in or around the ovary. Most ovarian cysts form as a normal part of ovulation, which is when the ovary releases an egg. They usually only cause mild symptoms, like bloating, and go away without treatment.

Cysts are more of a concern if you aren’t ovulating. Women stop ovulating after menopause. If an ovarian cyst forms after menopause, your doctor may want to do more tests to find out the cause of the cyst, especially if it’s large or doesn’t go away within a few months.

If the cyst doesn’t go away, your doctor may recommend surgery to remove it just in case. Your doctor can’t determine if it’s cancerous until they remove it surgically.

What are the early symptoms of ovarian cancer?

Symptoms

It’s easy to overlook the early symptoms of ovarian cancer because they’re similar to other common illnesses or they tend to come and go. The early symptoms include:

  • abdominal bloating, pressure, and pain
  • abnormal fullness after eating
  • difficulty eating
  • an increase in urination
  • an increased urge to urinate

Ovarian cancer can also cause other symptoms, such as:

  • fatigue
  • indigestion
  • heartburn
  • constipation
  • back pain
  • menstrual irregularities
  • painful intercourse

These symptoms may occur for any number of reasons. They aren’t necessarily due to ovarian cancer. Many women have some of these problems at one time or another. These types of symptoms are temporary and respond to simple treatments in most cases.

The symptoms will persist if they’re due to ovarian cancer. Contact your doctor if you have one or more of these symptoms for a significant period. Symptoms usually become more severe as the tumor grows. By this time, the cancer has usually spread outside of the ovaries. This makes it much harder to treat effectively.

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Risk factors for ovarian cancer

Risk Factors

The exact cause of ovarian cancer is unknown. These factors can increase your risk:

  • a family history of ovarian cancer
  • genetic mutations of genes associated with ovarian cancer, such as BRCA1 or BRCA2
  • a personal history of breast, uterine, or colon cancer
  • obesity
  • the use certain fertility drugs or hormone therapies
  • no history of pregnancy
  • endometriosis

Older age is another risk factor. Most cases of ovarian cancer develop after menopause.

It’s possible to have ovarian cancer without having any of these risk factors. Likewise, having any of these risk factors doesn’t necessarily mean you’ll get ovarian cancer.

How is ovarian cancer diagnosed?

Diagnosis

It’s much easier to treat ovarian cancer when your doctor diagnoses it in the early stages. However, it’s not easy to detect. Your ovaries are situated deep within the abdominal cavity, so you’re unlikely to feel a tumor. There’s no routine diagnostic screening available for ovarian cancer. That’s why it’s so important for you to report unusual or persistent symptoms to your doctor.

If your doctor is concerned that you have ovarian cancer, they’ll likely recommend a pelvic exam. Performing a pelvic exam can help your doctor discover irregularities, but small ovarian tumors are very difficult to feel. As the tumor grows, it presses against the bladder and rectum. Your doctor may be able to detect irregularities during a rectovaginal pelvic examination.

Your doctor may also do the following tests:

  • A transvaginal ultrasound (TVUS) is a type of imaging test that uses sound waves to detect tumors in the reproductive organs, including the ovaries. However, TVUS can’t help your doctor determine if tumors are cancerous or not.
  • Your doctor may order an abdominal and pelvic CT scan. If you’re allergic to dye, they may order an MRI.
  • A blood test to measure cancer antigen 125 (CA-125) levels is useful in assessing treatment for ovarian cancer as well as other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
  • A biopsy involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way your doctor can confirm whether or not you have ovarian cancer.

What are the stages of ovarian cancer?

Type 2

Your doctor determines the stage based on how far the cancer has spread. There are four stages, and each stage has sub-stages:

Stage 1

Stage 1 ovarian cancer has 3 sub-stages:

  • The cancer is limited, or localized, to one ovary in stage 1A.
  • The cancer is in both ovaries in stage 1B.
  • In 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. In stage 2A, the cancer has spread to the uterus or fallopian tubes. In stage 2B, it has spread to the bladder or rectum.

Stage 3

Stage 3 ovarian cancer has three sub-stages:

  • In stage 3A, the cancer has spread beyond the pelvis to the lining of the abdomen and the lymph nodes in the abdomen.
  • In stage 3B, the cancer cells are outside of the spleen or liver.
  • In 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. In stage 4A, the cancerous cells are in the fluid around the lungs. Stage 4B is the most advanced stage. In stage 4B, 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

Treatment

The treatment depends on how far the cancer has spread. A team of doctors will determine a treatment plan depending on your situation. It will most likely include two or more of the following:

  • chemotherapy
  • radiation
  • surgery to stage the cancer and remove the tumor
  • targeted therapy
  • hormone therapy

Surgery

Surgery is the main treatment for ovarian cancer. The goal of surgery is to remove the tumor, but a hysterectomy, or complete removal of the uterus is often necessary. Your doctor may also recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue. Identifying all tumor locations is difficult. In one study, researchers investigated ways to enhance the surgical process so that it’s easier to remove all of the cancerous tissue.

Targeted therapy

Targeted therapies, such as chemotherapy and radiation treatments, attack the cancer cells while doing little damage to normal cells in the body. Newer targeted therapies to treat advanced epithelial ovarian cancer include bevacizumab (Avastin) and olaparib (Lynparza). Doctors only use olaparib in people with mutations in the BRCA genes.

Ovarian cancer research and studies

Research

New treatments for ovarian cancer are studied each year. Researchers are also exploring new ways to treat platinum-resistant ovarian cancer. When platinum resistance occurs, standard first-line chemotherapy drugs like carboplatin and cisplatin are ineffective.

Certain drugs are also studied for their potential benefits in ovarian cancer. A 2014 study examined targeted treatments for those with more advanced stages of this cancer.

Ovarian cancer treatment primarily focuses on surgery to remove the ovaries and uterus, and chemotherapy. As a result, some women will experience menopause symptoms. A recent study examined how hormone therapy (HT) affects quality of life after ovarian cancer treatment. This study found that HT is safe for menopause treatments in women with ovarian cancer. People in the study maintained a high quality of life while receiving HT after being treated for ovarian cancer.

A 2015 article looked at intraperitoneal (IP) chemotherapy. This study found that those who received IP therapy had a median survival rate of 61.8 months. This was an improvement as compared to 51.4 months for those who received standard chemotherapy.

What is the outlook?

Outlook

Your outlook depends on a variety of factors, including the stage of the cancer at diagnosis, your overall health, and how well you respond to treatment. Every cancer is unique, but the stage of the cancer is the most important indicator of outlook.

Survival rate

The survival rate is the percentage of women who survive a certain number of years at a given stage of diagnosis. For example, the five-year survival rate is the percentage of patients who received a diagnosis at a particular stage and live at least five years after their doctor diagnosed them. The relative survival rate also takes into account the expected rate of death for people without cancer.

Epithelial ovarian cancer is the most common type of ovarian cancer. The American Cancer Society estimates the relative survival rate for this type of ovarian cancer as:

  • Stage 1: 90 percent
    • 1A: 94 percent
    • 1B: 92 percent
    • 1C: 85 percent
  • Stage 2: 70 percent
    • 2A: 78 percent
    • 2B: 73 percent
  • Stage 3: 39 percent
    • 3A: 59 percent
    • 3B: 52 percent
    • 3C: 39 percent
  • Stage 4: 17 percent

The survival rate is higher than 90 percent when the cancer is found early and treated right away. Doctors diagnose 15 percent of ovarian cancers at the earliest stages. Scientists are currently researching more improved and reliable ways to detect ovarian cancer early.  

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Advanced Ovarian Cancer and Clinical Trials
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