Ovarian Cancer

Ovarian cancer is cancer in the ovaries. The ovaries produce eggs in females. Most ovarian cancer is seen in women between the ages of 50 to 75. It happens more often in white women. Most patients do not have problems early in the disease. If this type of cancer is found in its later stages, survival is not as good.

CAUSES

There are no known causes of ovarian cancer. However, below are risk factors for ovarian cancer:

  • Aging.

  • North American or Northern European descent.

  • Personal or family history of endometrial, colon, or breast cancer and a family history of ovarian cancer.

  • Women with the BRCA 1 and BRCA 2 genes are at a very high risk of getting ovarian cancer.

  • The use of fertility medications may increase the risk of getting ovarian cancer.

  • Late menopause (after age 50).

  • Women who became pregnant for the first time at age 30 or older.

Having these risk factors does not mean you will get ovarian cancer. But you should know about them and report any that you have to your caregiver. Also, a woman with none of the risk factors can still get ovarian cancer.

SYMPTOMS

There may be no symptoms in some cases. Early ovarian cancer symptoms usually are minor and resemble other health problems. The following are symptoms that may be important to diagnosing cancer of the ovary:

  • Unexplained weight loss.

  • Increase abdominal size.

  • Pain in the abdomen.

  • Pain and pressure in the back and pelvis.

  • Indigestion, increased gas and bloating.

  • Abnormal vaginal bleeding.

  • Loss of appetite.

  • Frequent urination.

  • Painful sexual intercourse.

  • Tiredness.

DIAGNOSIS

  • During an exam, an abnormal pelvis mass is found.

  • An ultrasound may be done.

  • X-ray, CT scan or MRI may be done.

  • Blood tests are taken.

TREATMENT

All women with ovarian cancer should have careful and precise staging performed before treatment for the best outcome. In Stage I ovarian cancer, the option of keeping the uterus and the normal ovary should be given. All treatment options should be discussed with the patient before any treatment is started. Types of treatment include:

  • Surgery to remove one or both ovaries. The surgery should be done by a doctor who is an expert in ovarian cancer. He/she should be well trained and have experience with gynecology oncology (cancer surgery).

  • Removal of both ovaries, both fallopian tubes and uterus. This can be done with or without removing the surrounding lymph nodes.

  • Chemotherapy. This therapy should be discussed with specialists in those fields.

  • Radiation therapy. This therapy should be discussed with specialists in those fields.

  • A combination of surgery, chemotherapy and radiation therapy may be recommended.

  • After treatment, your caregivers may want to do a "second look" operation. This is to see if the cancer is coming back and if extra treatment is needed.

PREVENTION & SCREENING RECOMMENDATIONS

  • There is no way of preventing ovarian cancer. Regular exams do not improve early diagnosis and treatment success.

  • Ovary removal and tubal sterilization reduce the risk of ovarian cancer. But even removal of both ovaries may not be completely effective in preventing it.

  • Other protective factors include:

  • Having more than one full-term pregnancy.

  • Taking birth control pills.

  • Breastfeeding.

  • Having a tubal ligation.

All of these factors reduce continual ovulation.

  • BRCA 1 and BRCA 2 blood test screening may be helpful for women with a strong family history for breast, ovary and colon cancer.

  • Caregivers should take a thorough family history regarding breast, colon, ovarian and other cancers. Women at high risk should be counseled about the benefits and risks of ovarian cancer screening. Rectovaginal pelvic examinations should be done every year.

  • No data has shown that screening high-risk women reduces their mortality from ovarian cancer. Still, the following are recommended in these women until childbearing is completed, or at least by age 35:

  • Yearly rectovaginal pelvic examinations.

  • CA-125 determinations (not reliable if normal and can be elevated with other noncancerous conditions such as fibroid tumors, endometriosis, pelvic infections, pregnancy and even during a menstrual period).

  • Transvaginal ultrasonography.

Then preventative removal of both ovaries (prophylactic bilateral oophorectomy) is recommended. A small risk of developing peritoneal carcinomatosis remains following prophylactic oophorectomy.

  • A Pap test does not help diagnose ovarian cancer. But it is helpful in detecting cervical cancer.

  • New screening tests are being studied to try to help detect ovarian cancer in its early stages.

HOME CARE INSTRUCTIONS

  • Inform your caregiver if you have had or a family member has had cancer.

  • Follow the advice of the specialists treating you.

  • Get a yearly physical and gynecology exams. This includes a rectovaginal pelvic exam, especially for women 40 years old and older even after you had treatment.

SEEK MEDICAL CARE IF:

  • You have any of the symptoms listed above that have not gone away after treating them for a week.

  • You have back or pelvic pressure or pain.

  • You have pain during sexual intercourse.

  • You are losing weight for no known reason.

  • Your belly (abdomen) is getting bigger.

  • You have abnormal vaginal bleeding.