What is Ovarian Cancer?
Ovarian cancer is a rare but deadly form of cancer. Chances for successful treatment are best when the ovarian cancer is caught in its early stages. However, it’s early detections is very difficult because it spreads quickly and often presents with no symptoms until it’s at an advanced stage.
Types of Ovarian Cancers
There are many types of ovarian tumors that can either be benign (non-cancerous) or malignant (cancerous). These cancer types must be treated as soon as possible to minimize the risk of the tumor spreading or becoming cancerous.
Epithelial Ovarian Cancer
About 90% of ovarian cancers start in the epithelium tissue, which is the lining on the outside of the ovary. This type of ovarian cancer is divided into the serous, mucinous, endometrioid, clear cell, transitional, and undifferentiated types. The risk of epithelial ovarian cancer increases with age, especially after the age of 50.
Germ Cell Ovarian Cancer
Germ cell tumors account for about 5% of ovarian cancers. They begin in the egg-producing cells. This type of ovarian cancer can occur in women of any age, but about 80% are found in women under the age of 30. The main subtypes are teratoma, dysgerminoma, endodermal sinus tumor, and choriocarcinoma.
Stromal Ovarian Cancer
These tumors, about 5% of ovarian cancers, grow in the connective tissue that holds the ovary together and makes estrogen and progesterone. Most are found in older women, but sometimes they occur in girls.
Stromal tumors usually do not spread as fast as other ovarian tumors. Sub-types include granulosa, granulosa-theca and Sertoli-Leydig cell tumors.
Primary Peritoneal Cancer
This is rare cancer. It has cells like those on the outside of the ovaries, but it starts in the lining of the pelvis and abdomen. Women can get this type of cancer even after their ovaries have been removed. Symptoms and treatment are similar to epithelial ovarian cancer. Fallopian tube cancer is also rare cancer. It starts in the fallopian tube and acts like epithelial ovarian cancer. Symptoms and treatment are similar to ovarian cancer.
Symptoms of Ovarian Cancer
Ovarian tumors frequently have no symptoms until they are at advanced stages. You may not know you have gynecologic cancer until you have a pelvic exam. However, if you do have symptoms, you should make an appointment with your gynecologist as soon as possible. If a tumor has developed to the point where it is causing symptoms, it could be a sign of malignancy. Ovarian cancer tends to spread quickly, so catching tumors early gives you the best chance for a successful treatment.
Some symptoms of ovarian tumors or cancer include:
- Lower back pain
- Severe cramps and persistent pain in the abdomen
- Abnormal vaginal bleeding
- Pain during sexual intercourse
- Frequent or difficult urination
- Nausea or vomiting
- Loss of appetite, feeling full quickly
- Weight gain
- Weight loss
If these symptoms are new and are occurring daily for at least two weeks, please make an appointment with your gynecologist as soon as possible.
Ovarian Cancer Risk Factors
Not all tumors are cancerous, but when they are, they can be life-threatening. Cancer is a complicated disease with many compounding risk factors, which may include:
- Age – Post-menopausal women seem to have an increased risk of ovarian cancer.
- Family history of ovarian, colorectal, or breast cancer
- Smoking cigarettes
- Taking fertility drugs
- Never having a child or never breastfeeding
- Hormone replacement therapy
On the other hand, using hormonal birth control (such as birth control pills) can decrease the lifetime risk of developing ovarian cancer.
A family history of ovarian cancer or breast cancer may put you at higher risk of ovarian cancer. Your health care doctor may refer you to a genetic counselor to discuss genetic testing for certain gene mutations that increase your risk of breast and ovarian cancers.
Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer.
Diagnosing Ovarian Cancer
Typically, your gynecologist will find a pelvic mass during a pelvic exam. Although most masses are not cancerous, your doctor will want to test you for signs of cancer.
Many people mistakenly believe that a pap smear test can detect ovarian cancer. In fact, there is no reliable routine screening test for ovarian cancer, so women with a family history of the disease or other risk factors should talk to their doctor. This may involve:
Your gynecologist will order a blood test to detect a protein known as CA-125. High levels of CA-125 can be an indication of ovarian cancer, but it could also indicate other problems like endometriosis or uterine fibroids. If a postmenopausal woman has a mass and an elevated CA-125, she has an extremely high risk of having cancer. However, in younger women, CA-125 is extraordinarily inaccurate.
Taking a biopsy or removing the mass completely is the only way to know for sure if a growth is cancerous. A biopsy can be taken during a laparoscopy, where the doctor removes the mass or a sample of the mass by inserting a narrow, flexible tube through a small incision in your abdomen. The sample is then sent to a lab for testing.
Ovarian Cancer Treatment
If your gynecologist believes you have ovarian cancer, you will be referred to a gynecological oncologist for further cancer treatment. Cancer is a complicated disease that requires aggressive treatment. Treatment for ovarian cancer usually involves chemotherapy and surgery, and because ovarian cancer tends to spread, this may mean the removal of other tissues and organs in addition to the ovaries. Your specialist will provide you with recommendations based on the stage of your cancer, the extent to which it has spread, and your wishes for the future.
Epithelial ovarian cancer treatment
This most often consists of surgery and chemotherapy. The order is best determined by a gynecologic oncologist.
A patient healthy enough to tolerate chemotherapy will often benefit greatly from its use. The drugs used in ovarian cancer tend to have fewer side effects, hence are easier to tolerate than many other chemotherapy drugs. Currently, there are two ways to give chemotherapy in ovarian cancer. Traditionally, it is given into the vein intravenously (IV). When initially diagnosed, the usual first-line approach is to give a combination of a platinum drug (typically carboplatin) and a taxane drug, such as paclitaxel (Taxol) or docetaxel (Taxotere).
Targeted therapy is a type of treatment that uses drugs or other treatments to identify and attack specific cancer cells without harming normal cells.
The drug bevacizumab is an example of targeted therapy that has been used in the treatment of advanced ovarian cancer.
Stromal and germ cell ovarian tumors
Stromal and germ cell ovarian tumors are most often treated with a combination of chemotherapy drugs. There is much less research on these as they are more curable and much less common than epithelial tumors. Because of their rarity, it will be very difficult to find effective new treatments.
Some may offer clinical trials in gynecologic cancers. Patients can ask their physician if they are eligible for a clinical trial that may help them, as this is how new drugs are discovered through cancer research. If a doctor or hospital does not participate in clinical trials, the doctor can contact a facility which may offer clinical trials.
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. It is now used in the management of a number of different types of cancer. With immunotherapy, substances made by the body or made synthetically are used to strengthen the body’s natural defenses against cancer.