The ovaries are small, almond-shaped organs located on either side of the uterus. Eggs are produced in the ovaries. Cancer can start in different parts of the ovary.
Ovarian cancer usually begins in one of three types of cells:
Germ Cells: These cells develop into eggs.
Stromal Cells: These form the inner structure of the ovary.
Epithelial Cells: These form the outer layer of the ovary.
Cancer can start in any one of these three types of cells.
According to a report from the American Cancer Society, about 22,240 women in the United States were diagnosed with ovarian cancer in 2018, and 14,070 died from it.
Also, nearly half of the women diagnosed were over 63 years old.
Symptoms of Ovarian Cancer
Early-stage ovarian cancer usually shows no symptoms, making it very difficult to detect. However, some common symptoms may appear, such as:
Frequent bloating
Feeling full quickly when eating
Loss of appetite or difficulty eating
Frequent or urgent urination
Pain or discomfort in the lower abdomen or pelvis
These symptoms begin suddenly and feel different from common digestive issues or menstrual discomfort. The most important thing is that these symptoms do not go away on their own.
Other symptoms may include:
Pain in the lower back
Pain during intercourse
Constipation
Digestive problems or gas
Excessive fatigue
Changes in menstrual cycle
Weight gain or loss
Abnormal vaginal bleeding
Skin problems like acne
Slowly increasing back pain
If these symptoms persist for more than two weeks, consulting a doctor is essential.
Causes of Ovarian Cancer
Researchers have not yet fully understood how ovarian cancer develops. Some specific risk factors can increase a woman’s chance of developing ovarian cancer, but having risk factors does not mean one will definitely get cancer.
Cancer forms when body cells grow and divide abnormally. Ovarian cancer researchers are investigating which genetic mutations are responsible.
These mutations can occur in two ways:
Inherited: Such as BRCA1 and BRCA2 gene mutations
Acquired: Mutations that develop during a person’s lifetime
Types of Ovarian Cancer
Epithelial Carcinoma of the Ovary
Epithelial carcinoma is the most common type of ovarian cancer, accounting for 85 to 89 percent of cases. It is the fourth leading cause of cancer death among women.
This type often shows no symptoms in the early stages, and most people seek treatment only when the disease has progressed.
Genetic factors:
This cancer tends to run in families, especially where there is a history of:
Both ovarian and breast cancer
Ovarian cancer alone (without breast cancer)
Ovarian and colon cancer
Women with multiple first-degree relatives (parents, siblings, or children) affected have the highest risk, though risk increases even if only one first-degree relative is affected.
BRCA1 and BRCA2 genes, known as “breast cancer genes,” are also associated with increased risk of ovarian cancer.
Factors influencing better survival:
Early-stage diagnosis
Younger age at diagnosis
Well-differentiated tumors (cancer cells resemble normal cells)
Small tumors at removal
Cancer caused by BRCA1 or BRCA2 mutations
Germ Cell Cancer of the Ovary
This term covers various cancers that arise from the cells that produce eggs. Germ cell cancer typically occurs in young women and teenagers, especially in their 20s.
These tumors can be large and grow rapidly. Sometimes they secrete human chorionic gonadotropin (HCG), which can cause false-positive pregnancy tests.
Germ cell cancers are generally very treatable. Treatment usually begins with surgery followed by chemotherapy.
Stromal Cell Cancer of the Ovary
Stromal cell cancer arises from cells that make up the ovary’s structure and sometimes secrete hormones like estrogen, progesterone, or testosterone.
This type is very rare and grows slowly. Excess testosterone secretion can cause acne or excessive facial hair, while excess estrogen secretion may cause uterine bleeding. These signs are often easy to detect.
Stromal cell cancers are usually diagnosed early and have a good prognosis. Treatment generally involves surgery.
Treatment for Ovarian Cancer
The type of treatment depends on the cancer type, stage, and whether the patient wishes to have children in the future.
Surgery
Surgery is performed to confirm diagnosis, determine the cancer stage, and remove cancer if possible.
Surgeons try to remove all cancerous tissue.
Biopsies are taken to check if the cancer has spread.
The extent of surgery depends on the desire for future fertility.
If the patient wants children and the cancer is stage 1, surgery may include:
Removing the affected ovary and biopsy of the other ovary
Removing fatty tissue (omentum) attached to abdominal organs
Removing lymph nodes in the abdomen and pelvis
Biopsies of other tissues and fluid collection from the abdomen
For advanced ovarian cancer (stages 2, 3, or 4) or if fertility is not desired, surgery is more extensive:
Removal of the uterus
Removal of both ovaries and fallopian tubes
Removal of the omentum
Removal of as much cancerous tissue as possible
Biopsy of any suspicious tissue
Chemotherapy
Chemotherapy is usually given after surgery. Drugs may be administered intravenously or directly into the abdominal cavity (intraperitoneal).
Side effects of chemotherapy:
Nausea and vomiting
Hair loss
Fatigue
Sleep problems
Symptom Management
Pain or discomfort may occur due to the cancer or its treatment. Large tumors can press on nearby organs, muscles, nerves, or bones causing pain.
Discuss pain management options with your doctor.
Diagnosis of Ovarian Cancer
Physical exam, especially pelvic and rectal exams
Blood tests: Complete blood count (CBC), cancer antigen 125 (CA-125), HCG, alpha-fetoprotein, lactate dehydrogenase, inhibin, estrogen, testosterone, etc.
Liver and kidney function tests
Biopsy: Examining tissue samples for cancer cells
Imaging: CT scan, MRI, PET scan
Tests for metastasis: Urinalysis, chest X-ray, barium enema
Risk Factors for Ovarian Cancer
Genetics: Family history of ovarian, breast, fallopian tube, or colorectal cancer increases risk.
Personal medical history: Breast cancer, ovarian disorders like polycystic ovary syndrome (PCOS) or endometriosis.
Reproductive history: Use of birth control pills reduces risk, but fertility drugs may increase it. Pregnancy and breastfeeding reduce risk.
Age: Risk increases after age 40, especially after menopause.
Ethnicity: Non-Hispanic white women have higher risk.
Body weight: BMI over 30 increases risk.
Stages of Ovarian Cancer
Stages are determined by tumor size, spread, and involvement of other organs:
Stage 1: Limited to one or both ovaries
Stage 2: Limited to the pelvis
Stage 3: Spread within the abdomen
Stage 4: Spread outside the abdomen or to other organs
Each stage has substages, e.g.,
Stage 1A – cancer in one ovary
Stage 1B – cancer in both ovaries
Ovarian Cancer Survival Rates
What is survival rate?
Survival rate is a statistic indicating how many patients with a certain type of cancer remain alive after a specific period (usually 5 years). It does not predict individual lifespan but gives an idea about treatment success.
Five-year survival rates for ovarian cancer:
The average 5-year survival rate for all types of ovarian cancer is about 47%.
If cancer is confined to the ovaries and treated early, the 5-year survival rate is about 92%.
However, only about 15% of patients are diagnosed at this early stage.
Survival rates vary by cancer type and stage.
Can Ovarian Cancer Be Prevented?
Ovarian cancer usually shows no symptoms early and is often detected at advanced stages. There is currently no guaranteed way to prevent ovarian cancer, but some factors may reduce risk:
Taking birth control pills
Pregnancy
Breastfeeding
Tubal ligation (“getting your tubes tied”)
Hysterectomy (removal of the uterus)
Tubal ligation and hysterectomy should only be performed for appropriate medical reasons. Discuss preventive options with your doctor.
What to Do if There is a Family History of Cancer?
If ovarian cancer runs in your family, consult your doctor about early screening and genetic testing. Some genetic mutations increase ovarian cancer risk. Knowing these can help with timely precautions and treatment.
Prognosis of Ovarian Cancer
What is prognosis?
Prognosis depends on how advanced the cancer is at diagnosis and how effective the treatment is. Early-stage (stage 1) ovarian cancer has a better prognosis with good treatment outcomes.
How many cancers are diagnosed early?
Only 15% of ovarian cancers are found at an early stage.
More than 80% of patients are diagnosed at advanced stages.
National Awareness
September is “National Ovarian Cancer Awareness Month.”
Many wear teal ribbons as a symbol of ovarian cancer awareness.
Statistics on Ovarian Cancer
There are more than 30 types of ovarian cancer classified by the cell type and stage.
The most common type is epithelial tumors, originating from the outer layer of ovarian cells.
Among American women, ovarian cancer ranks fifth in cancer-related deaths.
One in 78 women will be diagnosed with ovarian cancer in her lifetime.
The average age of patients is 63 years.
The 5-year survival rate for early-stage patients is about 92%, but the overall average for all types and stages is around 47%.
In 2018, 22,240 cases were diagnosed in the US, and 14,070 women died.
The good news is the incidence of ovarian cancer has been decreasing over the past two decades.
Summary
The prognosis of ovarian cancer depends on the stage at diagnosis and treatment. Early detection dramatically improves success rates. Regular checkups are important, especially for women at risk.
