Ovarian cancer is a disease that starts when abnormal cells in, on, or near the ovaries grow out of control and form a mass, called a tumor. Researchers do not know the exact cause of ovarian cancer, but some risk factors include having a family history of the condition or late-onset menopause, which can increase your chances of developing the condition. About 1 in 78 people with ovaries will develop ovarian cancer at some point in their lifetime.
The signs and symptoms of ovarian cancer are abdominal discomfort, bloating, feeling full very quickly, and frequent urination. There is no screening test to diagnose ovarian cancer. Doctors normally use a combination of imaging tests, blood tests, and tissue biopsies to make a diagnosis. Treatment for ovarian cancer can include surgery, chemotherapy, and targeted therapies.
Types of Ovarian Cancer
There are various forms of ovarian cancer that can be categorized based on the kind of cell from which they start. The three major kinds of ovarian cancer include:
American Cancer Society. What is ovarian cancer?
- Epithelial: Epithelial tumors arise from the cells lining the outside surface of the ovaries. These tumors account for between 85 to 90% of all ovarian cancers.
- Germ: Germ cell tumors develop from the cells that produce ova (eggs). These tumors are more common in teenagers and people in their 20s.
- Stromal: Stromal cell tumors develop from the cells that form the ovarian structural tissues and produce sex hormones estrogen and progesterone. These tumors are rare, accounting for about 1% of all ovarian cancers.
These are the main types of ovarian cancer, and each type has further subtypes. All are ovarian cancer, but they represent different diseases that can have different causes, risk factors, treatment options, and prognosis.
Ovarian cancers are also staged from stage 1, which is early disease, to stage 4, which is advanced disease. Doctors determine the stage of the cancer by using imaging scans, lab tests, and other procedures. The TNM system is used in ovarian cancer staging, and it takes into account three factors:4
- T: The size of the primary tumor
- N: Whether cancer has spread to nearby lymph nodes
- M: Whether the cancer has metastasized to other parts of the body or not
Ovarian Cancer Symptoms
Ovarian cancer symptoms are general and can easily be ascribed to other, more benign causes. In the early stages, symptoms may be subtle and brushed off. Pay attention to your body and be aware of early warning signs of ovarian cancer, including:
- Abdominal discomfort or pain
- Bloating
- Feeling full quickly when eating
- Frequent urination
- Pelvic pressure
As the cancer progresses and reaches an advanced stage, symptoms that existed can be more severe, and new symptoms can arise. Some symptoms of advanced ovarian cancer include:
Abnormal vaginal discharge
- Back pain
- Constipation
- Fatigue
- Fluid build-up in the abdomen (ascites)
Remember, all people who have these signs will not be diagnosed as having ovarian cancer. Symptoms related to ovarian cancer persist and usually occur more than 12 times during a month.
- Heavy periods or breakthrough bleeding (bleeding between menstrual cycles)
- Loss of appetite
- Pain during sex
- Post-menopausal bleeding
- Unintentional weight loss
Remember, all people who have these signs will not be diagnosed as having ovarian cancer. Symptoms related to ovarian cancer persist and usually occur more than 12 times during a month.
What Causes Ovarian Cancer?
Ovarian cancer starts when mutated cells in the ovary or surrounding tissues grow and multiply uncontrollably. Eventually, these abnormal cells become a mass called a tumor.
There are several reasons that may lead to the mutation of normal ovary cells. In some instances, inherited mutations passed down in families cause ovarian cancer. Studies have shown that around 25% of ovarian cancers are associated with inherited gene mutations. Mutations can also result from environmental, hormonal, or lifestyle factors.
Risk Factors
Some risk factors may increase your likelihood of developing ovarian cancer. Some of these risk factors are beyond your control, including:
- Personal or family history of breast, colon, or ovarian cancer
- Inheriting certain genes (BRCA1 and BRCA2)
- Being middle-aged or older
- Having endometriosis
- Having an Eastern European or Ashkenazi Jewish background
- Having an early first period (before 12) or late-onset menopause (after age 55)
- Other risk factors are lifestyle-related and can be modified to reduce your risk.
- Smoking
- Consuming a diet rich in animal fats (such as red meats, dairy)
- Being overweight or obese
- Not having children
- Not breastfeeding
- Using hormone therapy after menopause
How Is Ovarian Cancer Diagnosed?
There are no reliable screening tests to check for ovarian cancer. If you have symptoms of ovarian cancer, your doctor may use different tests and procedures to diagnose ovarian cancer. Common diagnostic tests for ovarian cancer include:
- Medical history: Your doctor will want to know more about your personal risk factors for the disease, as well as your family history of breast, ovarian, and colorectal cancers.
- Pelvic exam: Your doctor will perform a pelvic exam to look for signs of ovarian cancer, including a lump or fluid in your abdomen.
- Imaging tests: Imaging scans, like transvaginal ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI), can be used to look inside your abdomen and pelvis for signs of cancer.
- CA-125 test: This blood test measures the amount of cancer antigen 125 (CA-125)—a protein that is found in high levels in many people with ovarian cancer.
- Tumor marker blood tests: These may be used to look for tumor markers—proteins and other substances released by cancer cells—in the blood.
- Biopsy: A small tissue sample will be taken from the tumor (most likely during surgery to remove the mass) and sent to the lab, where it will be checked for cancer cells.
Once a diagnosis is confirmed, an oncologist, a medical doctor who specializes in cancer, may order additional tests and procedures to determine the type of ovarian cancer as well as the stage and grade of the tumor. This will help your cancer care team find the best treatment plan for your particular cancer. These tests include
- Additional imaging scans: These may be ordered to get a better view of the tumor or to check other areas of the body for signs of cancer.
- Blood tests: Your doctor will order blood tests to check on your overall health and get an idea of how your liver and kidneys are functioning.
- Genetic testing: Multigene testing can be undertaken to identify a particular mutated gene that caused the mutation that led to ovarian cancer.
Treatments
Ovarian cancer treatment varies depending on the type of cancer, stage of the disease, a person’s overall health, and other factors. The goals of ovarian cancer treatments are to eliminate all cancer in the body to achieve remission (the tumor is either gone or has stopped growing). Some treatments are administered after the cancer is removed to prevent a recurrence.
If remission is not possible, advanced ovarian cancers can be treated to slow the growth of cancer, control symptoms, and prolong life.
Surgery
Surgery is the most common treatment for the vast majority of ovarian cancer sufferers. Surgery is utilized for the removal of the tumor, or as much of it that is feasible. Oncologists will check for signs of cancer elsewhere in the abdominal and pelvic cavities. Lymph nodes and other soft tissues around the tumor are aspirated for tissue samples and examined for cancer cells so that whether or not the disease has spread can be detected.
Depending on the stage of the disease, surgery may include removal of one or both ovaries and fallopian tubes and the uterus. Doctors may remove small pieces of other abdominal organs, such as the colon or bladder, in order to access and remove the tumor.
Chemotherapy
Chemotherapy uses anti-cancer drugs in order to destroy cancerous cells; chemo is nearly always used to treat ovarian cancer unless the disease is detected in its early stages or a person does not seem healthy enough to tolerate such drugs.
Chemotherapy can be administered prior to surgery to reduce the size of a tumor before it is removed, or after surgery to kill off any remaining cancer cells in the body. Individuals who have achieved remission after initial treatments (surgery and chemotherapy) are often given maintenance chemotherapy to lower the chances of the cancer cells returning (recurrence).
If you have ovarian cancer, you may be treated with a single chemotherapy drug or multiple drugs
- Platinum agents: Platinol (cisplatin) or Paraplatin (carboplatin)
- Taxanes: Abraxane (paclitaxel) or Taxotere (docetaxel)
- You’ll receive 3 to 6 cycles of chemotherapy that will be given in one of two ways:
- Intravenously (IV): The drug is injected directly into a vein using a needle or tube.
- Intraperitoneal (IP): The drug is infused directly into the abdominal cavity through a catheter.
Targeted Therapies
Targeted cancer drugs are used to slow or stop the growth of cancer cells. These therapies can’t cure ovarian cancer, but they may be used in combination with chemotherapy to prevent tumors from growing and spreading.
PARP (poly ADP ribose polymerase) inhibitors: These are drugs that prevent cancer cells from repairing DNA damage, the hope being that the cells will die. PARP inhibitors may be used in an attempt to reduce recurrence.
Monoclonal antibodies: Bevacizumab, marketed as Avastin, is a monoclonal antibody that cuts the blood supply to a tumour, essentially ‘starryving’ the growth of a tumor. Given with chemotherapy and/or subsequently following the completion of all chemo in an attempt at preventing a recurrence.
Folate-receptor alpha targeted drugs: Elahere (mirvetuximab soravtansine) is a drug that attaches itself to the folate receptor alpha. It is a protein, which is found in a majority of ovarian tumors. The drug attaches itself on the surface of the cancer cells in order to deliver chemo drugs directly into the cell. It is used at times in people whose tumors are not responding to other chemotherapies.
Other treatments
Oncologists sometimes advise the following extra therapies for ovarian cancer: These treatments are used rarely, but may help in the following people:
Radiation therapy: Intensive beams of energy (radiation) could be used to kill the cancerous cells by targeting specific areas where the tumors reside in the body. The use of radiation therapy for the treatment of ovarian cancer is not that common and often is administered when the disease has advanced to other areas of the body.
Hormone therapy: Hormone-blocking drugs are sometimes prescribed to reduce estrogen levels or to block enzymes that produce estrogen to inhibit cancer growth. These medications are sometimes used to treat stromal cell tumors, which are tumors that develop on the tissue holding the ovary together.
Clinical trials: Some patients with ovarian cancer may opt to undergo clinical trials in order to have access to new treatments or combination therapies before they become widely available
How to Reduce the Risk of Ovarian Cancer
There’s no surefire way of preventing ovarian cancer, but you can do several things that help reduce your chances of developing the disease:
- Use hormonal oral contraceptives (birth control pills)
- Breastfeed for more than a year
- Be of a healthy weight
- Do not use hormone replacement therapy after menopause
- Having a tubal ligation (surgical removal of the fallopian tubes, often called “getting your tubes tied”)
- Having a hysterectomy (removal of the uterus and sometimes the cervix), oophorectomy (removal of the ovaries), or bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes)
Comorbid conditions
Having ovarian cancer can increase the chances of acquiring other conditions, which are as follows:
- Other cancers: The individual diagnosed with ovarian cancer has an increased risk of developing other forms of cancer, which are: breast cancer and colorectal cancer. The same holds true for the patients suffering from BRCA gene mutation. Chemotherapy drugs prescribed to treat ovarian cancer may have some relation with increased leukemia risk or blood cancer.
- Cardiovascular disease: Studies indicate that survivors of ovarian cancer have a higher risk of developing cardiovascular disease, which include stroke, heart failure, pericarditis, coronary artery disease, and arrhythmia or irregular heartbeat.
Living with ovarian cancer
can certainly take a toll on your physical health and your emotional well-being. Alongside your physical symptoms and other side effects of treatment, you may experience a broad scope of emotions and be trying to determine what is waiting for you on your new journey with cancer.
The 5-year survival rate for ovarian cancer is 49%. Though this number is disheartening, it is vital to note that survival statistics cannot predict what will happen to you. There are many factors that can influence how you will respond to treatment, and researchers continue to find new, better ways to diagnose and treat ovarian cancer.
No matter how you are feeling, you don’t have to go through it alone. Discuss your expectations with your healthcare provider, and ask for help managing your symptoms and side effects. Reach out to family and friends for support as you need it. If you wish to connect with others who understand what you’re going through, consider joining an ovarian cancer support group online or in person.
