Why is it so deadly, and what can you do about it? 

About the ovaries

The ovaries are part of a woman’s reproductive system. There are 2 ovaries, with 1 located on each side of the uterus. In premenopausal women, they are almond-shaped and about 1.5 inches long. These glands contain germ cells, also called eggs. Ovaries are the primary source of estrogen and progesterone. These hormones influence breast growth, body shape, body hair, and regulate the menstrual cycle and pregnancy. During and after menopause, the ovaries stop releasing eggs and producing certain hormones.

Ovarian cancer happens when cells that are not normal grown in one or both of your ovaries, two small glands located on either side of your uterus.

Doctors are unsure of what exactly causes ovarian cancer, but they have identified several risk factors associated with a higher likelihood of developing the disease. These are:

Age:

Women of all ages have a risk of these cancers, but women over 50 are more likely to develop these cancers. About half of the women diagnosed with ovarian cancer are 63 years or older.

Obesity.

 If your Body Mass Index (BMI) is 30 or higher, your risk goes up.

Hormone replacement therapy. Some studies suggest using estrogen after menopause increases your risk.

Smoking:

Increased risk of serous ovarian tumors associated with smoking

Poly-cystic ovary syndrome, a problem with your endocrine system that leads to enlarged ovaries

Family history:

A strong family history of breast or ovarian/fallopian tube cancer puts women at higher risk for ovarian/fallopian tube cancer. Doctors believe this is because many of these families have genetic mutations (changes in the gene) that are passed from generation to generation

Weight:

Recent studies show that women who were obese in early adulthood may have an increased risk to develop ovarian/fallopian tube cancer.

Genetics:

About 10% to 15% of ovarian/fallopian tube cancers occur because a genetic mutation, or change, has been passed down within a family. This inherited risk is called a germline mutation.

There are several other genetic conditions that cause ovarian/fallopian tube cancer. Some of the most common include:

Lynch syndrome. 

Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, increases a woman’s risk of ovarian/fallopian tube cancer and uterine cancer. It is caused by mutations in several different genes. Lynch syndrome also increases the risk of colorectal cancer and several other cancers.

Peutz-Jeghers syndrome (PJS). 

PJS is caused by a specific genetic mutation. The syndrome is associated with multiple polyps in the digestive tract that become noncancerous tumors and with increased pigmentation (dark spots on the skin) on the face and hands. PJS raises the risk of ovarian/fallopian tube cancer, breast cancer, colorectal cancer, cervical cancer, and several other types of cancer.

Nevoid basal cell carcinoma syndrome (NBCCS). 

Women with NBCCS, also called Gorlin syndrome, have an increased risk of developing fibromas. Fibromas are benign fibrous tumors of the ovaries. There is a small risk that these fibromas could develop into a type of ovarian cancer called fibrosarcoma.

It’s possible for women with ovarian  cancer to not show any symptoms. It’s also important to note that symptoms are not specific and may be caused by a different medical condition that is not cancer.

Symptoms:

• Abdominal bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms, such as urgency or frequency
• Fatigue
• Upset stomach
• Indigestion
• Back pain
• Pain with intercourse
• Constipation
• Menstrual irregularities
• Swelling in the pelvis or abdomen
• Vaginal discharge, which may be clear, white, or tinged with blood

For many women, these symptoms occur often and are different from what is normal for their bodies. Women who have any of the symptoms listed above everyday for more than a few weeks should see their primary care doctor or a gynecologist.

Diagnoses:

 Abdominal-pelvic examination:

Usually, the first exam is the abdominal-pelvic examination. The doctor feels the uterus, vagina, ovaries, bladder, and rectum to check for any unusual changes, such as a mass. Some cancers are very small before they spread and cannot be reliably felt and detected by pelvic examination.

Imaging Tests:

A physical exam cannot only reveal so much. Your doctor may want to use imaging tests to get a clearer picture of your ovaries.

One such test in a transvaginal ultrasound. During the procedure, the doctor inserts a probe (also called a transducer) into your vagina. The probe bounces soundwaves off the structures of your body, and those waves make echoes, which in turn form a picture on a computer screen.

Another imaging test is a CT scan, which stands for “computed tomography.” In a CT scan, an X-ray beam rotates around your body and takes images from various angles. A computer puts together all that information to produce a detailed look at that section of your body.

Blood Tests

There is no single blood test that shows whether you have ovarian cancer.

The main one that you may get is called the CA-125 test. It looks for a protein linked to ovarian cancer cells. But it’s not enough to make a diagnosis.

Some rarer types of ovarian cancer raise levels of other substances in the blood. Your doctor may order tests to look for higher levels of one or all of these:

Human chorionic gonadotropin (HCG)

Alpha-fetoprotein (AFP)

Lactate dehydrogenase (LDH)

Another type of ovarian tumor can raise the amount of estrogen and testosterone in your blood, and also a substance called inhibin. You may have a blood test to check these levels.

Biopsy

The only way to know for sure whether you have ovarian cancer is with a biopsy. It’s usually done by a doctor called a gynecologic oncologist. It usually involves surgery to take out the area where cancer is suspected, after which it is sent to a lab for testing. A specialist called a pathologist will look at the tissue under a microscope and test it to find out if it’s cancer.

After diagnostic tests are done, your doctor will review all of the results with you. As noted above, surgery and an examination of the lymph nodes may be needed before results are complete. If the diagnosis is cancer, these test results help the doctor describe the type & stage of cancer.

Types of Ovarian Cancer

There are three main types of ovarian cancer – each is distinguishable by the type of cell where cancer begins. These types include:

• Epithelial tumors. About 90% of ovarian cancers fall into this category. This type of cancer begins in the thin layer of tissue that covers the outside of the ovaries.
• Stromal tumors. About 7% of ovarian cancers fall into this category. This type of cancer begins in the ovarian tissue that contains cells that produce hormones.
• Germ cell tumors. This is the rarest form of ovarian cancer, and it tends to occur in younger women. This form of ovarian cancer begins in the egg-producing cells.

Stages for Ovarian Cancer

The stage provides a common way of describing the cancer, enabling doctors to work together to plan the best treatments. Doctors assign the stage of cancer using the FIGO system.

Stage I: The cancer is only in the ovaries or fallopian tubes.

Stage II: The cancer involves 1 or both of the ovaries or fallopian tubes and has spread below the pelvis, or it is peritoneal cancer.

Stage III: The cancer involves 1 or both of the ovaries or fallopian tubes, or it is peritoneal cancer. It has spread to the peritoneum outside the pelvis and/or to lymph nodes in the retroperitoneum (lymph nodes along the major blood vessels, such as the aorta) behind the abdomen.

Stage IV: The cancer has spread to organs outside of the abdominal area.

Ovarian Cancer Treatment Options

Treatment for ovarian cancer typically involves some combination of medications and surgery.

Ovarian Cancer Surgery

Surgical options for ovarian cancer will depend on the stage of your cancer. The options include:

Removing one ovary

Removing both ovaries

Removing both ovaries and the uterus

Surgery with chemotherapy for advanced cancers

In cases where just one or both of the ovaries are removed, women may still be able to have children.

Prevention

Although there is no proven way to prevent these diseases completely, you may be able to lower your risk. 

Certain factors may reduce a woman’s risk of developing ovarian/fallopian tube cancer:

Taking birth control pills:

Women who took oral contraceptives for 3 or more years are 30% to 50% less likely to develop ovarian/fallopian tube cancer. The decrease in risk may last for 30 years after a woman stops taking the pills.

Breastfeeding:

The longer a woman breastfeeds, the lower her risk of developing ovarian/fallopian tube cancer.

Pregnancy:

 The more full-term pregnancies a woman has had, the lower her risk of ovarian/fallopian tube cancer.

Surgical procedures.:

Women who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian/fallopian tube cancer.

Surviving Cancer

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

• Understanding the challenge you are facing
• Thinking through solutions
• Asking for and allowing the support of others
• Feeling comfortable with the course of action you choose.

For many people, survivorship serves as a strong motivator to make lifestyle changes.

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