Ovarian Cancer

What’s the Problem?

Ovarian cancer is cancer that begins in the ovaries. The ovaries are a part of a woman’s reproductive system. There are two ovaries; one is located on each side of the uterus in the pelvis. The functions of the ovaries are: to produce eggs, regulate the menstrual cycle and pregnancy, and to produce the female hormones (estrogen and progesterone).

There are several types of ovarian cancer. Epithelial carcinoma begins on the surface of the ovaries and is the most common type. Germ cell tumors begin in the egg-producing cells of the ovary and stromal tumors are found in the supportive tissue surrounding the ovary. These types of ovarian cancer are rare and will not be addressed here.

More than 23,300 new cases of ovarian cancer will be diagnosed in 2002. More than 13,900 women will die of the disease.

Who’s at Risk?

Although most cases of ovarian cancer occur in women age 50 years and older, the disease can occur in younger women. The most common form-epithelial-is usually diagnosed in women age 40 years or older, the age at which risk begins to increase. A woman’s chance of having ovarian cancer increases if she has one or more close relatives (mother, daughter, or sister) with the disease. Rarely, women may inherit genes that increase the risk for ovarian cancer substantially. Women with a history of breast, endometrial, or colon cancer also have a greater chance of developing ovarian cancer than women who have not had these cancers. Several factors have also been identified that appear to decrease a woman’s risk, including childbearing, the use of oral contraceptives and having a tubal ligation or hysterectomy.

The sooner ovarian cancer is found and treated, the better chance for a woman’s recovery. Symptoms of ovarian cancer tend to be non-specific and can mimic non-gynecologic conditions, such as bloating and abdominal pain. Currently, no screening test has been shown to reduce the risk of dying from ovarian cancer. However, several potential screening methods are being tested, including transvaginal ultrasound and the measurement of tumor markers such as CA 125.

Can It Be Prevented?

Although the causes of ovarian cancer are unknown, the disease is associated with certain risk factors. Some, but not all, of these factors can be avoided. Although a familial predisposition to the disease cannot be avoided, sometimes women with this risk factor will make the decision to have both ovaries removed as a precaution against developing ovarian cancer. This procedure is known as a prophylactic oophorectomy. Having children, breast-feeding, taking oral contraceptives, and having a tubal ligation or hysterectomy are all factors that decrease a woman’s chances of developing ovarian cancer.

The sooner ovarian cancer is found and treated, the better chance for a woman’s recovery. Ovarian cancer is difficult to detect early. Symptoms may be mild or non-existent until the disease is advanced. Scientists are looking for tests to indicate the disease before symptoms are present. Increased blood levels of a tumor marker, CA 125, have been found in women with ovarian cancer. Scientists are exploring the usefulness of measuring levels of CA 125 as a test for the disease.

The Bottom Line

• A woman in the US has about a one in sixty chance of developing ovarian cancer during her lifetime.
• 65% of the women diagnosed with ovarian cancer each year will die of their disease.
• Family history is the strongest known risk factor for developing ovarian cancer, but most women diagnosed with ovarian cancer do not have family history of the disease.
• Ovarian cancer is difficult to detect at an early stage because symptoms may go unrecognized until the cancer is advanced.
• Symptoms tend to be nonspecific, such as gastrointestinal discomfort, pressure in the pelvic area, frequent urination, lack of energy, swelling or bloating of the abdomen.
• Tests used to diagnose ovarian cancer examine the ovaries, pelvic area, blood, and ovarian tissue.

Case Example

Corinne, 49, was going through a rough time in her life. Her husband had recently left her and was now filing for a divorce. Corinne was tired all the time and had no enthusiasm for life. Several of Corinne’s friends were taking antidepressants and suggested that medication might solve Corinne’s problem. She tried the antidepressant but her malaise continued. Corrine assumed that she must be going through menopause. When she went to her gynecologist for her annual pelvic exam and Pap test, she told the doctor how she was feeling. Because the doctor was familiar with Corinne’s family history, he became concerned about the possibility of ovarian cancer and scheduled the appropriate tests. Corinne was soon diagnosed with early stage ovarian cancer and has begun aggressive therapy for the treatment of her disease.