Ovarian cancers at a glance

• Ovarian cancer is the rapid, unregulated growth of cells in the ovaries, which can spread to other parts of the body if untreated.
• While relatively rare, ovarian cancer is extremely deadly because it is often undiagnosed until the late stages of the disease.
• Ovarian cancer affects about 20,000 women in the U.S. each year.
• It mostly affects older women; about half of women diagnosed with ovarian cancer are older than age 62.
• Surgical removal of the cancerous tumor is the most common treatment option.

What is ovarian cancer?

Ovarian cancers begin with rapid cell growth, which is a hallmark of cancer, in one or more of the ovaries. Women have two oval-shaped ovaries, one on each side of the uterus (womb). The ovaries make the egg cells needed for reproduction, as well as producing female hormones involved in the reproduction cycle (estrogen and progesterone).

While cancer of the ovaries is relatively rare, it is extremely deadly because it is often undiagnosed until the late stages of the disease. Women over the age of 50 are most at risk of developing ovarian cancer.

Types of ovarian cancers

Ovarian cancer occurs when abnormal cells in the ovaries multiply, forming masses called malignant tumors. Non-cancerous (benign) tumors can also be found in the ovaries. Ovarian cancer is classified by where the abnormal cells originated. The most common types are:

• Epithelial cancers start from the cells covering the lining of the ovary (epithelial cells line organs). This is the most common type of ovarian cancer. Epithelial tumors most often occur in women over the age of 50.
• Germ cell cancers arise from the egg cells in the ovary. (Germ cells develop into eggs in women and sperm in men.) These malignant tumors account for about 10 percent of ovarian cancers and most often occur in women under the age of 35.
• Stromal cancers start from tissue that holds the ovary together. This is a very rare type of ovarian cancer that spreads quickly.

Stages of ovarian cancer

As with many forms of cancer, ovarian cancer is classified upon diagnosis as being in different stages of development.

Stage I – growth is limited to just the ovaries.

Stage II – growth has spread outside the ovaries but not outside the pelvis.

Stage III – growth has spread outside the ovaries and either beyond the pelvis or to the lymph nodes.

Stage IV – growth has spread to outside organs such as the lungs or liver. This is the most advanced stage of cancer.

Causes of ovarian cancer and risk factors

Cancer is caused by abnormal cells, in this case in the ovary, multiplying out of control. While the exact reason for a cell to become abnormal is unknown, there are typical risk factors for developing the epithelial form of ovarian cancer. Scientists have not identified risk factors for germ cell and stromal forms of ovarian cancer. Risk factors for epithelial ovarian cancer include:

• Age: most cases of ovarian cancer are in women over the age of 50.
• Family history: having a close family member, such as a mother or daughter, with the disease is the greatest risk factor for having ovarian cancer.
• Genetics: about 10 percent of cases are caused by faulty genes such as BRCA1 and BRCA2, which increase susceptibility to breast and ovarian cancer.
• Ovulation: the number of times a woman ovulates is linked to the risk of ovarian cancer. The higher the number, the higher the risk. Conversely, factors lowering ovulation, such as early menopause, breast-feeding, childbirth and taking oral contraceptives, appear to protect against the disease.
• Pregnancy: never being pregnant or first being pregnant after age 35.
  

Symptoms of ovarian cancer

Ovarian cancer symptoms are often minimal and unnoticeable until the later stages. Most cases are undiagnosed until the late stages of the disease, when treatment isn’t as effective.

Therefore, it is always important for a patient to pay attention to her body and discuss anything out of the ordinary with her doctor.

Early ovarian cancer typically presents itself in the following common symptoms:

• Persistent bloating
• Acid reflux and indigestion
• Constant pain in the abdomen
• Abnormal uterine bleeding
• Feeling full quickly or difficulty eating
• Pain in the abdomen during sexual intercourse.
  

Treatment of ovarian cancers

After an initial diagnosis, a patient should visit a gynecologic oncologist to determine a proper treatment plan. Treatment options depend upon the type and severity of the disease and often involve a combination of surgery, chemotherapy and radiation therapy. The gynecologic cancer specialist should discuss each option, success rates, possible side effects and other treatment details with each patient.

Treatment is most effective during early stages of the disease.

Primary treatment options

Surgery

Surgery is the most common treatment for ovarian cancer and can serve two purposes: to determine how advanced the cancer is (staging) and to remove as much of the tumor as possible (debulking).

Research on ovarian cancer treatment outcomes recommends that patients see a gynecologic oncologist for surgery.

Chemotherapy

Chemotherapy, sometimes called chemo, is a cancer treatment using anti-cancer drugs to stop the growth of cancer cells, either by destroying the cells or by stopping them from dividing. Chemotherapy is taken orally or injected into a vein.

Ovarian cancer patients are often initially treated with surgery aimed at removing or decreasing the size of a tumor. Afterwards, most patients are typically placed on a chemotherapy regimen in order to eradicate any cancerous cells left in the body.

Radiation therapy

This treatment uses high-energy x-rays or other radiation to kill cancer cells or keep them from growing. Since radiation therapy is not typically useful in eradicating cancer cells that have spread to other parts of the body, it is less common for ovarian cancer treatment. However, it can be useful in shrinking tumors prior to surgery and eliminating some of the symptoms of late-stage cancer.

At CU Anschutz Gynecologic Oncology, experts provide advanced diagnosis and care, from surgery to radiation and chemotherapy.