What is ovarian cancer?

Ovarian cancer is cancer that begins in the ovaries. Ovaries are reproductive glands found only in females (women). The ovaries produce eggs (ova) for reproduction. The ovaries are also the main source of the female hormones, estrogen and progesterone. One ovary is located on each side of the uterus in the pelvis.

The ovaries contain 3 main kinds of cells. Each of these types of cells can develop into a different type of tumour:

  • Epithelial tumours start from the cells that cover the outer surface of the ovary. Most ovarian tumours are epithelial cell tumours.
  • Germ cell tumours start from the cells that produce the eggs (ova).
  • Stromal tumours start from structural tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone.

Most of these tumours are benign (non-cancerous) and never spread beyond the ovary. Benign tumours can be treated by removing either the ovary or the part of the ovary that contains the tumour.  Ovarian tumours that are malignant (cancerous) or low malignant potential tumours can spread (metastasize) to other parts of the body.

What are the risk factors for ovarian cancer?

A risk factor is anything that changes your chance of getting a disease like cancer.  But risk factors don’t tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. Many people who get cancer may not have had any known risk factors.  The following are some risk factors that may change a woman’s likelihood of developing epithelial ovarian cancer (not germ cell or stromal).

  • Age: The risk of developing ovarian cancer gets higher with age.
  • Obesity: Obese women (those with a body mass index of at least 30) have a higher risk of developing ovarian cancer.
  • Reproductive history: A woman who has had children has a lower risk of ovarian cancer than women who have no children.
  • Family history of ovarian cancer, breast cancer, or colorectal cancer: Ovarian cancer can run in families. Your ovarian cancer risk is increased if your mother, sister, or daughter has (or has had) ovarian cancer. The risk also gets higher the more relatives you have with ovarian cancer
  • Personal history of breast cancer: If you have had breast cancer, you may also have an increased risk of developing ovarian cancer.
  • Diet: Eating a variety of healthful foods, such as fresh vegetables and fruits may decrease chances of cancer.

What are the signs and symptoms of ovarian cancer?

Ovarian cancer may cause several signs and symptoms. Women are more likely to have symptoms if the disease has spread beyond the ovaries, but even early stage ovarian cancer can cause them. The most common symptoms include:

  • Bloating
  • Pelvic or abdominal pain
  • Trouble eating or feeling full quickly
  • Urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often)

Others symptoms of ovarian cancer can include fatigue, upset stomach, back pain, pain during sex, constipation, menstrual changes and/or abdominal swelling with weight loss.

How is ovarian cancer diagnosed?

Tests and procedures used to diagnose ovarian cancer include:

  • Physical exam: Your doctor will first take your history and do a physical exam to look for signs of ovarian cancer. These include finding an enlarged ovary (on a pelvic exam) and signs of fluid in the abdomen (which is called ascites). If there is reason to suspect you may have ovarian cancer based on your history and physical exam, your doctor will order some tests to check further.
  • Biopsy: The only way to determine for certain if a growth is cancer is to remove a sample of the growth from the suspicious area and examine it under a microscope. This procedure is called a biopsy. For ovarian cancer, the biopsy is most commonly done by removing the tumour at surgery.
  • Imaging studies: Imaging methods like computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and ultrasound studies can confirm whether a pelvic mass is present. These studies cannot confirm that the mass is a cancer, but they may be useful if your doctor is looking for spread of ovarian cancer to other tissues and organs.

After the cancer is diagnosed, staging is very important because ovarian cancers have a different prognosis at different stages and are treated differently. The accuracy of the staging may determine whether or not a patient will be cured.

What are my treatment options?

After the diagnostic tests are done, your cancer care team will recommend one or more treatment options. The choice of treatment depends largely on the type of cancer and the stage of the disease. Other factors that could play a part in choosing the best treatment plan might include

your general state of health, whether you plan to have children, and other personal considerations.

The main treatments for ovarian cancer are surgery, chemotherapy, and radiation therapy:

  • Surgery: Surgery for ovarian cancer has 2 main goals: 1) to stage the cancer, to see how far the cancer has spread from the ovary and 2) to remove as much of the tumour as possible, called debulking.
  • Chemotherapy: Chemotherapy (chemo) is the use of drugs to treat cancer. Most often, chemo is a systemic treatment — the drugs are given in a way that allows them to enter the bloodstream and reach all areas of the body. Systemic chemo can be useful for cancers that have metastasized (spread).
  • Radiation Therapy: Radiation therapy uses high energy x-rays or particles to kill cancer cells. These x-rays may be given in a procedure that is much like having a diagnostic x-ray.

” Courtesy of the Aga Khan Hospital”