Ovarian cancer is any cancerous growth that begins in the ovary. It is the portion of the female body producing eggs.
Ovarian cancer now in the United States is the fifth most common cause of cancer-related death in females. According to the American Cancer Society ( ACS), deaths from ovarian cancer have fallen over the U.S. in the past 2 decades.
The ACS predicts that about 22,530 women may be diagnosed with ovarian cancer in 2019. It’s estimated that about 13,980 people will die of this condition.
Read on for more detail about how to know the signs and what to do if they happen.
Symptoms
The majority of ovarian cancers begin in the ovary epithelium, or outer lining. There may be few signs or no in the early stages.
If symptoms do occur, they may mimic other conditions such as premenstrual syndrome, irritable bowel syndrome, or a temporary bladder problem. The signs can continue and worsen in ovarian cancer however.
Early symptoms may include:
- pain or pressure in the pelvis
- unexpected vaginal bleeding
- pain in the back or abdomen
- bloating
- feeling full rapidly when eating
- changes in urination patterns, such as more frequent urination
- changes in bowel habits, such as constipation
If any of these symptoms last for 2 weeks or more, a person should see a doctor.
There may also be:
- nausea and indigestion
- appetite loss
- weight loss
- breathlessness
- fatigue
The symptoms can change if the cancer spreads to other parts of the body.
Causes and risk factors
Ovarian cancer arises when cells divide and grow uncontrolledly within this area of the body.
It is not clear why ovarian cancer occurs but several risk factors have been identified by experts. They cover:
Family history
Having a close relative with a history of ovarian or breast cancer increases the risk a person has to develop ovarian cancer themselves.
Undergoing genetic tests for BRCA gene mutations will help decide if someone has a higher risk of both ovarian and breast cancer.
Age
Around 50 percent of cases of ovarian cancer occur after 63 years of age.
Reproductive history
Having experienced one or more full-term pregnancies is associated with lower ovarian cancer risk. The more pregnancies a woman has, the lower apparently the risk. Breastfeeding can reduce the risk, too.
Nonetheless, having children later in life (after age 35) or never having children is associated with an increased risk.
People who use other kinds of fertility medication may have a greater risk of developing borderline cells, although this is not proven by all research.
This also suggests that females who use birth control pills or an injectable pregnancy hormone are at a lower risk.
Breast cancer
Women with a history of breast cancer tend to have a greater risk of developing ovarian cancer. This may be attributed to variations in the BRCA gene.
Of this reason, as a preventive treatment, some women with breast cancer who test positive for this gene mutation can opt for an oophorectomy, or surgery to remove the ovaries.
Hormone therapy
Undergoing hormone replacement therapy ( HRT) tends to raise the risk of ovarian cancer after the menopause.
The longer an person uses HRT the greater the risk. The danger tends to decrease after the stoppage of medication, however.
Obesity and obesity
Ovarian cancer is more common in individuals with a body mass index ( BMI) greater than 30.
Gynecologic surgery
Having surgery to remove the uterus, called a hysterectomy, will reduce by one-third the risk of ovarian cancer.
HPV
Researchers have identified connections between the human papillomavirus ( HPV) and numerous cancers, including tonsil and cervical cancer.
The authors of a meta-analysis reported having a high HPV prevalence among those with ovarian cancer in 2013. They couldn’t prove it was triggered by HPV, however, so they called for further studies.
Read more about HPV here, including its impacts and how to avoid it.
Other possible risk factors
Other factors which could increase the risk of certain forms of ovarian cancer include:
- having high levels of androgens, or male hormones
- dietary factors
- the use of talcum powder
Researchers have yet to prove a link between these factors and ovarian cancer.
Risk for transgender people
Some studies indicate that having high androgen levels may increase the risk of ovarian cancer. This may be a problem for transgender people who are in transition using hormone therapy.
A 2017 study states that removing the ovaries may lower the risk, but the authors warn people to be aware that ovarian cancer is still a possibility.
The National LGBT Cancer Network points out that transgender people may find it difficult to receive routine medical assistance because of fears about disclosing their gender identity.
They urge people to ask relatives, their local hospital and their insurance provider to find an reliable doctor who will help them take care of their health and body.
Stages
When the ovarian cancer is diagnosed by a health care provider, they may need to assess the stage and grade to decide on a treatment plan.
The stage makes reference to how far the cancer has spread. For instance:
- Localized: Cancer cells affect only the ovaries or fallopian tubes and have not spread elsewhere.
- Regional: Cancer has spread to nearby organs, such as the uterus.
- Distant: Cancer is present elsewhere in the body. It now affects other organs, such as the lungs or liver.
Meanwhile the classification applies to how the cancer cells look abnormal.
Having an early diagnosis typically means more successful treatment. This could however be influenced by other factors.
Such considerations include the age and overall health of the individual, and the cancer cell type or grade, as certain types are more aggressive than others.
Types
There are over 30 types of ovarian cancer, depending on the type of cell in which they start.
There are three common cell types:
- epithelial cells, which occur in the lining of the surface of the ovary
- germ cells, which will become eggs for reproduction
- stromal cells, which release hormones and link up the structures of the ovaries
The most dangerous and most invasive epithelial tumours. They occur in around 85–90 per cent of ovarian cancer patients.
Germ cell tumors are often benign. Treatment is successful in 90 per cent of cases that are cancerous.
Diagnosis
If routine screening or symptoms indicate a person may have ovarian cancer, usually a doctor will do:
- ask the person about their personal and family medical history
- carry out a pelvic examination
They may also recommend:
Blood tests: These tests will check for high levels of a marker called CA-125.
Imaging tests: Examples include a transvaginal ultrasound, an MRI scan, or a CT scan.
Laparoscopy: A health care provider can insert a thin tube with a camera connected to the abdomen through a small hole to see the ovaries and maybe take a sample of tissue for a biopsy.
Biopsy: It involves microscopic analysis of a variety of tissues.
Only a biopsy will show cancer is present in a person. As part of the initial assessment or subsequent operation to remove a tumor, this can be performed by a health care provider.
Treatment
Treatment will depend on many factors, including:
- the type, stage, and grade of the cancer
- the individual’s age and overall health
- their personal preferences
- accessibility and affordability of treatment
Options tend to include:
Surgery: The option depends on the type of cancer that has spread, and how far. Surgical options include hysterectomy, removal of one or both ovaries and removal of lymph nodes affected. A doctor should speak with the patient about the correct options.
Chemotherapy: These drugs are targeted at destroying cancer cells. If a person is taking chemotherapy drugs by mouth or as an injection or infusion, the entire body will be affected. Intraperitoneal chemotherapy is a further alternative. In this case, a tube transfers the drug directly to the cancer-affected body region. Chemotherapy can have widespread adverse reactions , especially if it affects the entire body.
Read more about chemotherapy here, including its negative effects
Targeted therapy: Some therapies target particular cells that lead to cancer development. Examples include inhibitors of monoclonal antibody therapy, and angiongenesis. Targeted treatment works by manipulating particular mechanisms to reduce adverse effects.
Radiation therapy: This procedure is used to destroy cancer cells using X-rays. One way to do this is to inject a radioactive substance into the peritoneum. This will support advanced ovarian cancer patients.
Immunotherapy (biotherapy): This is aimed at improving the ability of the immune system to protect the body from cancer. Vaccine treatment requires administering drugs that can recognize a tumor and suppress it. It can benefit women suffering from advanced ovarian cancer.
Some of these are relatively new types of treatment. Some people may opt to join a clinical trial, which can give access to some of the newest approaches.
Survival rates
The estimated 5-year survival rates for ovarian cancer represent the proportion of individuals who lived 5 years or more after diagnosis in 2008–2014.
The outlook is based upon the cancer stage and type. Human variables such as age, overall health and healthcare access also influence survival rates.
The ACS give figures for three types of ovarian cancer:
| Stage | Invasive epithelial ovarian cancer | Ovarian stromal tumors | Germ cell tumors of the ovary |
| Localized | 92% | 99% | 98% |
| Regional | 75% | 89% | 95% |
| Distant | 30% | 61% | 75% |
Outlook
All forms of ovarian cancer may be treated when an early-stage diagnosis is made to an individual. Some forms are also later highly treatable.
By evaluating ovarian cancer survival rates, it is also worth noting that scientific advancements have changed the outlook in the past 20 years.
Nonetheless, attending routine screening and finding support if any signs arise will also lead to early intervention and this can increase the probability of successful treatment.
