Each year, an estimated 25,000 women are diagnosed with ovarian cancer, the fifth leading cause of cancer death—resulting in more than 15,000 deaths in 2008 alone. Although it generally strikes women 60 and older, 10 percent of cases occur in women under 40. Protect yourself now.
What it is
The ovaries, located in the pelvis, are part of a woman's reproductive system. Each ovary is about the size of an almond. The ovaries produce the female hormones estrogen and progesterone. They also release eggs. An egg travels from an ovary through a fallopian tube to the womb (uterus). When a woman goes through menopause, her ovaries stop releasing eggs and make far lower levels of hormones.
Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells).
Ovarian cancer can invade, shed, or spread to other organs:
- A malignant ovarian tumor can grow and invade organs next to the ovaries, such as the fallopian tubes and uterus.
- Cancer cells can shed (break off) from the main ovarian tumor. Shedding into the abdomen may lead to new tumors forming on the surface of nearby organs and tissues. The doctor may call these seeds or implants.
- Cancer cells can spread through the lymphatic system to lymph nodes in the pelvis, abdomen, and chest. Cancer cells may also spread through the bloodstream to organs such as the liver and lungs.
Who's at risk?
Doctors cannot always explain why one woman develops ovarian cancer and another does not. However, we do know that women with certain risk factors may be more likely than others to develop ovarian cancer:
- Family history of cancer Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer.
If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor about testing for you and the women in your family.
- Personal history of cancer Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer.
- Age Most women are over age 55 when diagnosed with ovarian cancer.
- Never pregnant Older women who have never been pregnant have an increased risk of ovarian cancer.
- Menopausal hormone therapy Some studies have suggested that women who take estrogen by itself (without progesterone) for 10 or more years may have an increased risk of ovarian cancer.
Other possible risk factors: taking certain fertility drugs, using talcum powder, or being obese. It is not yet clear whether these do in fact pose a risk, but if they do, they are not strong factors.
Early ovarian cancer may not cause obvious symptoms—only 19 percent of cases are detected in the earliest stages. But, as the cancer grows, symptoms may include:
- Pressure or pain in the abdomen, pelvis, back, or legs
- A swollen or bloated abdomen
- Nausea, indigestion, gas, constipation, or diarrhea
Less common symptoms include:
- Shortness of breath
- Feeling the need to urinate often
- Unusual vaginal bleeding (heavy periods, or bleeding after menopause)
If you have a symptom that suggests ovarian cancer, your doctor will likely suggest one or more of the following:
- Physical exam This checks general signs of health. Your doctor may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
- Pelvic exam Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. While a Pap test is part of a normal pelvic exam, it is not used to diagnose ovarian cancer, but rather as a way to detect cervical cancer.
- Blood tests Your doctor may order blood tests to check the level of several substances, including CA-125, a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. It is approved by the Food and Drug Administration for monitoring a woman's response to ovarian cancer treatment and for detecting its return after treatment.
- Ultrasound Sound waves from the ultrasound device bounce off the organs inside the pelvis to form a computer image that may show an ovarian tumor. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound).
- Biopsy A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen to diagnose ovarian cancer.
Although most women have a laparotomy for diagnosis, some have a procedure known as laparoscopy. The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.
If ovarian cancer cells are found, the pathologist describes the grade of the cells. Grades 1, 2, and 3 describe how abnormal the cancer cells look. Grade 1 cancer cells are not as likely as to grow and spread as Grade 3 cells.
Your doctor may order tests to find out whether the cancer has spread:
- CT scans create pictures of organs and tissues in the pelvis or abdomen: An x-ray>machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly.
Chest x-ray can show tumors or fluid
- Barium enema x-ray of the lower intestine. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
- Colonoscopy, during which your doctor inserts a long, lighted tube into the rectum and colon to determine if the cancer has spread.
These are the stages of ovarian cancer:
- Stage I: Cancer cells are found in one or both ovaries on the surface of the ovaries or in fluid collected from the abdomen.
- Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis such as the fallopian tubes or uterus, and may be found in fluid collected from the abdomen.
- Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.
- Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis and may be found inside the liver, in the lungs, or in other organs.
Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used.
Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body:
- Local therapy Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
- Intraperitoneal chemotherapy Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis.
- Systemic chemotherapy When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.
You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.
You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women with all stages of ovarian cancer.
The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:
- both ovaries and fallopian tubes (salpingo-oophorectomy)
- the uterus (hysterectomy)
- the omentum (the thin, fatty pad of tissue that covers the intestines)
- nearby lymph nodes
- samples of tissue from the pelvis and abdomen
If the cancer has spread, the surgeon removes as much cancer as possible. This is called "debulking" surgery.
If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.
You may be uncomfortable for the first few days after surgery. Medication can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan. The time it takes to heal after surgery is different for each woman. It may be several weeks before you return to normal activities.
If you haven't gone through menopause yet, surgery may cause hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your doctor or nurse about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time.
Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some have chemotherapy before surgery.
Usually, more than one drug is given. Drugs for ovarian cancer can be administered in different ways:
- By vein (IV): The drugs can be given through a thin tube inserted into a vein.
- By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen.
- By mouth: Some drugs for ovarian cancer can be given by mouth.
Chemotherapy is administered in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the drugs used. You may have your treatment in a clinic, at the doctor's office, or at home. Some women may need to stay in the hospital during treatment.
The side effects of chemotherapy depend mainly on which drugs are given and how much. The drugs can harm normal cells that divide rapidly:
- Blood cells: These cells fight infection, help blood to clot, and carry oxygen to all parts of your body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team checks you for low levels of blood cells. If blood tests show low levels, your team can suggest medicines that can help your body make new blood cells.
- Cells in hair roots: Some drugs can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
- Cells that line the digestive tract: Some drugs can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Ask your health care team about medicines that help relieve these problems.
Some drugs used to treat ovarian cancer can cause hearing loss, kidney damage, joint pain, and tingling or numbness in the hands or feet. Most of these side effects usually go away after treatment ends.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. A large machine directs radiation at the body.
Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment is given at a hospital or clinic. Each treatment takes only a few minutes.
Side effects depend mainly on the amount of radiation given and the part of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea, or bloody stools. Also, your skin in the treated area may become red, dry, and tender. Although the side effects can be distressing, your doctor can usually treat or control them, and they gradually go away after treatment ends.
Ovarian cancer and its treatment can lead to other health problems. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life.
Your health care team can help you with the following problems:
- Pain Your doctor or a specialist in pain control can suggest ways to relieve or reduce pain.
- Swollen abdomen (from abnormal fluid buildup called ascites) The swelling can be uncomfortable. Your health care team can remove the fluid whenever it builds up.
- Blocked intestine Cancer can block the intestine. Your doctor may be able to open the blockage with surgery.
- Swollen legs (from lymphedema) Swollen legs can be uncomfortable and hard to bend. You may find exercises, massages, or compression bandages helpful. Physical therapists trained to manage lymphedema can also help.
- Shortness of breath Advanced cancer can cause fluid to collect around the lungs, making it hard to breathe. Your health care team can remove the fluid whenever it builds up.
Nutrition and physical activity
It's important for women with ovarian cancer to take care of themselves. Taking care of yourself includes eating well and staying as active as you can. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems.
Many women find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know.
You will need regular checkups after treatment for ovarian cancer. Even when there are no longer any signs of cancer, the disease sometimes returns because undetected cancer cells remained somewhere in your body after treatment.
Checkups help ensure that any changes in your health are noted and treated if needed. Checkups may include a pelvic exam, a CA-125 test, other blood tests, and imaging exams.
If you have any health problems between checkups, contact your doctor.
Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). They are studying new and better ways to prevent, detect, and treat ovarian cancer.
Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to advances, and researchers continue to search for more effective methods. Although clinical trials may pose some risks, researchers do all they can to protect their patients.
Among the research being conducted:
- Prevention studies: For women who have a family history of ovarian cancer, the risk of developing the disease may be reduced by removing the ovaries before cancer is detected. This surgery is called prophylactic oophorectomy. Women who are at high risk of ovarian cancer are taking part in trials to study the benefits and harms of this surgery. Other doctors are studying whether certain drugs can help prevent ovarian cancer in women at high risk.
- Screening studies: Researchers are studying ways to find ovarian cancer in women who do not have symptoms.
- Treatment studies: Doctors are testing novel drugs and new combinations. They are studying biological therapies, such as monoclonal antibodies which can bind to cancer cells, interfering with cancer cell growth and the spread of cancer.
If you are interested in being part of a clinical trial, talk with your doctor or visit at http://www.cancer.gov/clinicaltrials. NCI's Information Specialists at 1-800-4-CANCER or at LiveHelp at http://www.cancer.gov/help can answer questions and provide information about clinical trials as well.
Here are three easy ways to protect yourself against ovarian cancer:
1. Eat plenty of fruits and vegetables. Carrots and tomatoes are loaded with the cancer-fighting antioxidants carotene and lycopene, and eating them regularly may help reduce your risk of ovarian cancer by up to 50 percent. That was the conclusion of a Brigham and Women's Hospital, Boston, study comparing 563 women who had ovarian cancer with 523 who didn't.
Researchers suggest aiming for two half-cup servings of tomato sauce (the most concentrated lycopene source) or other tomato products and five raw carrots weekly. Other antioxidant-rich foods linked in the research to a lower ovarian-cancer risk are spinach, yams, cantaloupe, corn, broccoli and oranges. Additionally, recent research from the Harvard School of Public Health suggests that kaempferol, an antioxidant in broccoli, kale, strawberries and grapefruit, may reduce ovarian cancer risk by as much as 40 percent.
2. Peel yourself off the couch. Women who spend six hours a day or more sitting during leisure time may be up to 50 percent more likely to develop the disease than those who are more active, reports a National Cancer Institute study.
3. Consider popping the pill. Some research suggests that the hormone progestin, found in many oral contraceptives, may slash risk by up to 50 percent when taken for five years or longer.
Adapted from the National Cancer Institute (www.cancer.org)