Overview
Ovarian cancer is a common malignancy in women in the United States, with about 21,550 new cases diagnosed each year according to the National Cancer Institute (http://www.cancer.gov). The ovaries are small female reproductive organs that reside in the pelvis. There are two ovaries, one on each side of the uterus, or womb, and normal ovaries are about the size and shape of an almond. Ovaries makes female hormones and store egg cells, which are released once a month during ovulation. Egg cells are delivered from the ovaries to the uterus by hollow organs called fallopian tubes.
Ovarian cysts are common in women throughout the stages of life. Many of these ovarian tumors are benign (not cancerous). There are three types of ovarian cancer tumors. Malignant ovarian tumors can originate from the surface of the ovary, in the epithelium (these are the cells covering or lining the ovaries), or in the germ cells (cells within the ovaries that are destined to become eggs), or sex cord-stromal cells (cells that secrete hormones and connect the different structures of the ovaries). The majority of ovarian cancers develop from cells in the lining of the ovary. These are referred to collectively as epithelial ovarian cancers. In this treatment overview, the term ovarian cancer refers to epithelial ovarian cancer.
Common Epithelial Tumors:
Common epithelial cancers that start in the surface epithelium account for the majority of ovarian cancers and include the following types:
- Serous: This is the most common type of ovarian cancer and accounts for about 40% of common epithelial cancers. It occurs most often in women between the ages of 40 and 60.
- Endometrioid: This type of ovarian cancer accounts for about 20% of common epithelial cancers and is associated with endometriosis in 5% and endometrial carcinoma (uterine cancer) in 20% of cases. It occurs most often in women between the ages of 50 and 70.
- Mucinous: Mucinous cancers account for 6-10% of common epithelial ovarian cancer and most often affect women between 30 to 50 years of age.
- Clear Cell Carcinoma: Clear cell carcinomas account for about 5% of common epithelial tumors and most often affect women between age 40 and 80.
- Undifferentiated Cancers: The remaining 15% of common epithelial cancers are referred to as undifferentiated tumors because their exact cell of origin cannot be determined under a microscope.
- Borderline Ovarian Tumors: These ovarian tumors of low malignant potential are a subgroup of common epithelial tumors that occur in 10-15% of cases. These tumors are between cancerous and non-cancerous in nature. They originate on the surface of the ovary, but do not invade deeper tissues of the ovary. They have a better prognosis (prediction about the possible outcome of a disease) and cure rate than invasive ovarian tumors.
How is Ovarian Cancer Diagnosed?
Because epithelial ovarian cancers begin deep in the pelvis, they often do not cause any symptoms until they are at an advanced stage. Furthermore, many of the symptoms of ovarian cancer are hard to differentiate from symptoms experienced by women who do not have ovarian cancer, such as back pain, fatigue, abdominal bloating, constipation, vague abdominal pain, and urinary symptoms. Because the symptoms are vague, many women don't know they have cancer until the disease is quite advanced. Ovarian cancer is often originally suspected in women when their physician finds an abnormal pelvic growth during an internal pelvic examination.
Unlike some other types of cancer, there is no routine screening protocol for ovarian cancer. This is because no tool has been shown to be decrease the chances of dying from the disease. However, several tests that may detect ovarian cancer are being evaluated, including pelvic exam, transvaginal ultrasound, and the CA-125 assay.
What are the risk factors for developing ovarian cancer?
Women who have a family history of ovarian cancer are at an increased risk of developing ovarian cancer, themselves. Women who have one first-degree relative (mother, daughter, or sister) with ovarian cancer are at an increased risk of developing ovarian cancer. This risk is higher in women who have one first-degree relative and one second-degree relative (grandmother or aunt) with ovarian cancer. This risk is even higher in women who have two or more first-degree relatives with ovarian cancer.
While ovarian cancer in the family does increase a woman's risk of developing ovarian cancer, it is important to note that most women who are diagnosed with ovarian cancer do not have a relative who had the disease, as well. Hereditary ovarian cancer makes up approximately 5% to 10% of all cases of ovarian cancer. There is also a hereditary link between ovarian cancer and certain other cancers. There are currently three hereditary patterns that have been identified: ovarian cancer alone, ovarian and breast cancers, and ovarian and colon cancers. There are tests that can detect the gene mutation involved with these known cancer links. These genetic tests are sometimes done for members of families with a high risk of cancer.
Women with an increased risk of ovarian cancer may consider surgery to prevent it.
Some women who have an increased risk of ovarian cancer may choose to have a prophylactic oophorectomy (the removal of healthy ovaries so that cancer cannot grow in them). In high-risk women, this procedure has been shown to greatly decrease the risk of developing ovarian cancer. The Women's Surgery Center is highly experienced performing laparoscopic oophorectomy. For more information about our laparoscopic treatment options, please see the Treatment Options portion of our website.
What is the CA-125 Assay and what do my results mean?
CA-125 is a protein that can be found in the blood, commonly in high levels in patients with certain types of cancer. Elevated levels of this protein have been associated with ovarian cancer. However, the presence of elevated levels of CA-125 in the blood does not always indicate the presence of ovarian cancer because CA-125 levels can be elevated in a number of other conditions. The normal level of CA-125 is less than 35 units per milliliter in the blood. In general, the higher the level of CA-125 found, the greater the chance of having ovarian cancer, especially for women past menopause. However, not all patients with a high CA-125 level have ovarian cancer. Further diagnostic evaluation is required for women who receive an elevated CA-125 result. Once a diagnosis of ovarian cancer has been established, the level of CA-125 in the blood is a useful indicator of cancer growth during or after treatment.
How does the Women's Surgery Center treat ovarian cancer?
For information about treatment options for ovarian cancer, please see the Treatment Options for Ovarian Cancer portion of our website.