Ovarian Cancer

Ovarian cancer is a type of cancer that begins in the ovaries, part of the female reproductive system that produces reproductive eggs and the female hormones of estrogen and progesterone. This year an estimated 22,000 women will be diagnosed with ovarian cancer in the United States.

Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions. Some of the more common signs and symptoms include: abdominal bloating or swelling; quickly feeling full when eating; unexplained weight loss; discomfort in the pelvis area; changes in bowel habits, such as constipation; a frequent need to urinate. Other less common symptoms include: fatigue; upset stomach; back pain; pain during sex; menstrual changes. However, these less common symptoms are more likely to be caused by other conditions since they occur quite often in women without ovarian cancer.

To plan the most effective course of treatment, first the specific type and stage of ovarian cancer must be diagnosed.

  • Epithelial Tumors begin in the thin layer of tissue that covers the outside of the ovaries. About 90% of ovarian cancers are epithelial tumors.
  • Stromal Tumors begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7% of ovarian tumors are stromal.
  • Germ Cell Tumors begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

To help determine the type of ovarian cancer, a physical exam or pelvic exam may be performed. Blood tests, a pelvic ultrasound/ transvaginal ultrasound and a biopsy (called a laparotomy) of fluid and tissue from the pelvis and abdomen may be needed. Although most women have a laparotomy for diagnosis, some women have a procedure known as laparoscopy. A thin, lighted tube (a laparoscope) is inserted through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer, but also may be used to learn if the cancer has spread.

To help determine the correct staging of ovarian cancer, a CT scan may be used to take pictures of organs and tissues in the pelvis or abdomen. A chest x-ray to show fluid or tumors and barium enema x-ray to show blockage may also be used. Often times a colonoscopy will be required to see if the cancer has spread outside of the ovaries into areas such as the colon or rectum.

Ovarian cancer is divided into four stages, represented numerically by stages 1 to 4 or I to IV:

Stage I means cancer cells are found in one or both ovaries, and may be found on the surface of the ovaries or in fluid collected from the abdomen.

Stage II means cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus or other tissues in the pelvis, and may be found in fluid collected from the abdomen.

Stage III means cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes, and may be found on the outside of the liver.

Stage IV means 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.

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. One surgery option is to remove one or both of the ovaries, plus their fallopian tubes, as long as the cancer has not spread. Removing only the ovaries allows the uterus to stay intact, still allowing for the possibility of having children through frozen eggs or a donor. If the cancer is more extensive, surgery removing both ovaries, their fallopian tubes, the uterus, nearby lymph nodes and more surrounding tissue may be recommended.