Ovarian cancer is cancer of the ovaries. Women are born with two ovaries, one on each side of the uterus. A woman’s ovaries are small, about the size of an almond. Though small, they’re responsible for many reproductive functions.
Ovarian cancer can be very difficult to detect and diagnose. Many of the symptoms of ovarian cancer are similar to symptoms caused by much less serious problems, including indigestion and bloating. Because the ovaries are deep within the pelvis, there often are neither signs nor symptoms of early ovarian cancer. Some cases of ovarian cancer will not be diagnosed until the cancer has spread to a woman’s abdomen or elsewhere within the pelvis. Unfortunately, ovarian cancer that has progressed this far is very difficult to treat. While the cancer remains confined to the ovaries, doctors have an easier chance of treating it. Advanced stages of ovarian cancer are frequently fatal.
Ovarian cancer occurs most frequently in older women. However, it’s also possible for younger women and even adolescent girls to be diagnosed with a type of ovarian cancer.
Types of Ovarian Cancer
The type of ovarian cancer you have is determined by where the cancer cells develop. The types of ovarian cancer include:
Epithelial tumors. About 90 percent of ovarian cancers are epithelial tumors. Epithelial ovarian carcinomas (EOCs) begin in the thin layer of tissue that covers the outside of the ovaries. Epithelial tumors are difficult to diagnose. They are typically discovered after the tumor has been able to grow for a long period of time, and spread of these tumors is likely to have already occurred by the time of diagnosis.
Stromal tumors. This type of ovarian cancer develops in the tissue responsible for producing estrogen and progesterone. Stromal tumors make up about 7 percent of all ovarian tumors. This type of tumor is typically diagnosed at an earlier stage.
Germ cell tumors. Cancer that develops in the egg-producing cells of the ovaries is called germ cell tumors. These tumors are very rare and often occur in younger women and adolescent girls. Though these rare tumors are aggressive, they can be curable if found early and treated.
Ovarian cancer is the fifth most common cancer in women. Each year, almost 22,000 women will be diagnosed with ovarian cancer. More than 14,000 women will die from it.
A woman’s lifetime risk of developing ovarian cancer is about one in 73. A woman’s lifetime risk of dying from ovarian cancer is one in 100.
Thankfully we are learning more about how to detect ovarian cancer. According to the National Cancer Institute, fewer women are dying from it each year than in the previous 20 years.
According to the Centers for Disease Control and Prevention (CDC), the states with the fewest cases of ovarian cancer are: Rhode Island, Mississippi, Delaware, and Nevada, as well as the District of Colombia.
States with the most cases of ovarian cancer are: Vermont, New Jersey, Washington, Wyoming, and Connecticut.
White females are more likely to be diagnosed with and die from ovarian cancer than women in other ethnic groups. Black females are the second group most commonly diagnosed with ovarian cancer. Hispanic women follow from there, and American Indian/Alaska Native, and Asian/Pacific Islander come after.
Many factors can increase a woman’s risk for ovarian cancer. However, it’s important to note that just because a person may fit one or many of these categories, that doesn’t mean they will develop the disease. The factors included here are known risks for developing epithelial ovarian cancer, the most common type.
Age. Ovarian cancer can develop at any point in a woman’s life. However, it is rare for women younger than age 40 to develop it. According to the American Cancer Society, the majority of ovarian cancers occur in women ages 63 and older.
Inherited genes. An inherited gene mutation may be to blame for a small percentage of ovarian cancers. The genes called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) have been shown to increase a woman’s risk of ovarian cancer significantly.
Family history. Inherited genes aren’t the only way your family may impact your risk for ovarian cancer. If your mother, sister, or daughter had or have ovarian cancer, you have an increased risk.
History of breast cancer. If you have been diagnosed with breast cancer, you have an increased risk of developing ovarian cancer.
Hormone replacement therapy. Long-term and high-dose use of estrogen hormone replacement therapy increases your risk for ovarian cancer.
Reproduction. Women who became pregnant and carried the pregnancy to full term before the age of 26 are less likely to develop ovarian cancer than women who have never been pregnant. Likewise, women who became pregnant for the first time and carried the pregnancy to full term after the age of 35 are more likely to develop ovarian cancer. Each successive pregnancy reduces the risk of ovarian cancer, and breastfeeding may cut your risk even more.
Fertility treatment. Women who have undergone any type of fertility treatment have an increased risk of ovarian cancer.
Birth control use. Women who have used oral contraceptives have a lower risk of ovarian cancer. The longer you use the pills, the lower your risk drops. However, it is important to realize that oral contraceptive use is also associated with an increased risk of other types of cancer (breast, cervical, others).
Obesity. Obese women, or women with a body mass index of at least 30, have an increased risk of ovarian cancer.
While researchers have identified some risk factors that increase a woman’s risk for ovarian cancer, a cause is not known. Researchers speculate that how often a woman ovulates (her ovaries release eggs) may impact her ovarian cancer risk. More specifically, women who ovulate fewer times have a lower risk than women who ovulate more.
Still, these theories remain unproven. Researchers have identified two common themes when researching ovarian cancer causes, however. Both of these are related to a woman’s genes.
Inherited gene mutations. Women who have the BRCA1 and BRCA2 gene mutations have an increased risk of developing ovarian cancer. Other mutated genes may also impact a woman’s ovarian cancer risk.
Acquired genetic mutations. Another theory is that a woman’s DNA can be altered during her lifetime, and these mutations increase her risk for ovarian cancer. These mutations may be the result of environmental impacts, radiation, or exposure to cancer-causing chemicals or substances. However, researchers have not been able to identify a common link between these acquired genetic mutations and a woman’s risk for ovarian cancer.
Early stage ovarian cancer causes few noticeable symptoms. The cancer often progresses to advanced stage before it’s finally detected and diagnosed. Even then, many of the symptoms of advanced-stage ovarian cancer can be mistaken for benign conditions, including irritable bowel syndrome and constipation.
Being aware of the signs and symptoms of early and later-stage ovarian cancer can help you detect it sooner. In almost all cases, ovarian cancers that are detected early can be treated successfully.
Symptoms of ovarian cancer include:
- changes in bowel habits, including frequent constipation
- abdominal bloating and swelling
- frequently urinating or feeling you need to urinate urgently
- feeling full quickly when eating
- unexplained weight loss
- general discomfort in your pelvis area
- pain during sexual intercourse
- upset stomach
- general fatigue
- changes in your menstrual cycle
Tests and Diagnosis
In order to diagnose ovarian cancer or to exclude it as a cause for your symptoms, your doctor will need to conduct a thorough workup. In addition to the physical exam, your doctor will ask you about the symptoms you’ve been experiencing and any family history of diseases that may impact your personal health. Doctors also have a number of tests they can use to diagnose the disease.
Imaging tests. Your doctor may request one or more imaging tests. These tests include ultrasound, CT scans, MRIs, and PET scans. If your doctor suspects you have a tumor, these tests can help determine where the tumor is, how large it has grown, and in what stage your cancer is.
Blood tests. Certain ovarian cancers release a protein called CA-125. Blood tests can detect the presence of this protein.
Biopsy. In order to further test any suspicious spots or tumors, your doctor may remove a sample of tissue from your abdomen/pelvis. This is called a biopsy. It allows your doctor to check for the presence of ovarian cancer. If these tests confirm their suspicions and you do have cancer, your doctor may choose to perform surgery to remove the cancerous area.
Ovarian cancer can be divided into four stages. These stages are primarily concerned with where the cancer cells are located, although some of the later sub-stages are determined by tumor size as well. In order to determine a cancer’s stage, your doctor will take several tissue samples from your ovaries, pelvis, and abdomen. If cancer is detected in any or all of the samples, your doctor can determine how widespread, or how advanced, the cancer is.
Stage 1: Ovarian cancer in stage 1 is contained to one or both ovaries.
Stage 2: Ovarian cancer in stage 2 has spread to other organs in the pelvis. These organs might include the uterus, bladder, rectum, or Fallopian tubes.
Stage 3: Ovarian cancer in stage 3 has spread beyond the ovaries and pelvis and into the abdomen, abdominal lining, or nearby lymph nodes.
Stage 4: Stage 4 ovarian cancer is the terminal stage of ovarian cancer. Cancer in this stage has spread beyond the abdomen. It may have reached the spleen, lungs, or liver.
Your treatment options depend largely on the cancer’s stage as well as your overall health. Treatment for ovarian cancer typically involves one or both of these two main treatments:
Surgery. Surgery is the primary treatment for ovarian cancer. Removing the ovaries and Fallopian tubes can treat most early-stage cases of ovarian cancer. If the cancer has spread into the pelvis, the uterus may need to be removed. Neighboring lymph nodes and abdominal tissue may also need to be removed with surgery.
Later-stage ovarian cancer that has spread into the abdomen may require additional surgery to remove cancerous organs or tissues.
If you have been diagnosed with ovarian cancer but are still of childbearing age and want to have children, surgery may still be an option. Depending on your cancer and how far it has spread, your doctor may only need to take one ovary.
Chemotherapy. Chemotherapy is drug therapy that tries to destroy any rapidly dividing cells in the body, including cancer cells. For some women, chemotherapy may be the initial treatment option. Others use chemotherapy in conjunction with other treatments, including surgery.
Additional Ovarian Cancer Treatments
Your doctor may recommend additional treatments. These treatments include:
Hormone therapy. Some ovarian cancers are sensitive to the hormone estrogen. Medications can block the production of estrogen or prevent the body from responding to it. This treatment may slow and possibly stop the growth of the cancer.
Radiation therapy. Radiation therapy uses X-ray or particle beams to target and kill cancer cells. Radiation may be used to treat areas where the cancer has spread. It’s often used in conjunction with surgery.
One way to understand your prognosis is to know how patients diagnosed with a similar stage cancer fared through their treatment and in the five years after their treatment.
For all types of ovarian cancer, the five-year survival rate is 44 percent. Younger women have a higher survival rate than older women. Women diagnosed with early-stage ovarian cancer — specifically, stage 1 ovarian cancer — have a higher survival rate than women diagnosed with late-stage ovarian cancer. If ovarian cancer is found in stage 1, 92 percent of patients have a five-year survival rate. Unfortunately, only 15 percent of ovarian cancers are diagnosed at this stage. Fortunately, according to statistics from the CDC, rates of ovarian cancer have generally decreased the last 10 years.
Survival rates by stage:
- stage 1 ovarian cancer: 92 percent
- stage 2 ovarian cancer: 70 percent
- stage 3 ovarian cancer: 39 percent
- stage 4 ovarian cancer: 17 percent