Ovarian Cancer

The ovaries are small almond-sized organs that produce eggs and the hormones estrogen and progesterone. When cells in the ovary multiply abnormally, forming a tumor, it’s called ovarian cancer. The American Cancer Society estimates that about 21,000 people are diagnosed with ovarian cancer each year in the US, with a woman’s lifetime risk being about 1 in 72. 

Types of Ovarian Cancer

• Epithelial ovarian cancer. Starts in the lining of the ovary or fallopian tube. It’s the most common type, with different subtypes including serous, mucinous, endometrioid, and clear cell. Women with hereditary ovarian cancer usually have high-grade serous subtype. Most women who get this cancer are in their 50s and 60s.
• Borderline tumors of the ovaries. Originate from the surface of the ovary. The tumors are not benign, but they also don’t fully meet the criteria for ovarian cancer. 
• Germ cell tumors. More common in teenagers and young women. There are several types of tumors, including dysgerminoma, immature teratoma, and yolk sac tumor. It’s possible to preserve fertility and cure this type of cancer.
• Sex-cord stromal tumors. Rare subtypes, including granulosa cell tumor and Sertoli-Leydig cell tumor. They affect women in their 20s, 30s, 50s, and 60s. They tend to grow slowly. They also have high cure rates and may be a candidate for fertility preservation surgery. This tumor is known to recur several years after initial diagnosis. 

Risk Factors

Risks for ovarian cancers are out of our hands. Most ovarian cancers are sporadic and not inherited or caused by lifestyle related factors. Approximately 20% of ovarian cancers are caused by genetic predisposition—gene mutations you inherit from your family. 

A gene mutation is a permanent change in the DNA sequence that makes up a gene. Some gene mutations cause cancer. Mutations in the BRCA1 and BRCA2 genes are the most common mutations associated with ovarian cancer, but scientists have found new mutations. Your lifetime risk of developing ovarian cancer can increase by up to 44% depending on the gene mutation. Having a gene mutation has a major impact on your treatment decisions. Our Hereditary Breast and Ovarian Cancer Center is specifically designed to evaluate women and their families with or at risk for hereditary ovarian cancer. 

Other risk factors for ovarian cancer are age (higher risk with increasing age), endometriosis, and history of infertility. 

Symptoms

Many people with ovarian cancer have no symptoms until the cancer has spread beyond the ovary. Symptoms of ovarian cancer are common in women for many other conditions. Just because you experience these symptoms does not mean you have ovarian cancer, but you should see your doctor for an evaluation particularly if these symptoms are severe or persistent.

• Abdominal swelling or bloating
• Pelvic pain or pressure
• Difficulty eating or feeling full
• Urinary frequency or urgency
• Changes in bowel habits, such as constipation or diarrhea
• Back pain
• Change in menstrual periods

Diagnosis

Doctors use two types of tests to evaluate women whose symptoms raise concern about ovarian cancer. Your doctor will usually use both tests if they suspect ovarian cancer. If you have BRCA mutations, you might have these tests: 

• Pelvic exams. Performed by your gynecologist in order to detect any abnormalities. A gynecologist will also feel the abdomen to assess the uterus and ovaries for shape, size, and position. 
• Transvaginal ultrasound. Uses sound waves to create a picture of the ovary, looking for fluid-filled cysts or solid masses. This test can also detect abnormal fluid, called ascites, in the abdomen. The test can’t tell if an ovarian mass is cancer or not.
• Blood tests. CA-125 is a blood test that looks for elevated levels of proteins that ovarian cancers secrete into the bloodstream, but the test is nonspecific. CA-125 is often elevated in people with noncancerous conditions. Your doctor may also screen for other proteins associated with ovarian cancer, including CEA, AFP, and LDH.

Your doctor might also order these tests:

• A CT (computed tomography) scan. Converts data from different angles of X-ray images of the body into pictures on a monitor. 
• An MRI (magnetic resonance imaging) test. Uses powerful magnetic fields to create a 3D picture of the lower abdomen and pelvis to detect tumors.
• A PET (positron emission tomography) scan. Uses a small amount of radionuclide glucose (sugar) injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used. Malignant tumor cells show up brighter than normal cells do.