What Is Ovarian Cancer?
Current research suggests this
cancer begins in the fallopian tubes and moves to the ovaries, the twin organs
that produce a woman's eggs and the main source of the female hormones
estrogen and progesterone. Treatments for ovarian cancer have become more
effective in recent years, with the best results seen when the disease is found
early.
Ovarian Cancer Symptoms
Symptoms include:
- Bloating or pressure in the belly
- Pain in the abdomen or pelvis
- Feeling full too quickly during meals
- Urinating
more frequently
These symptoms can be caused by
many conditions that are not cancer. If they occur persistently for more than a
few weeks, report them to your health care professional.
Risk Factor: Family History
A woman's odds of developing
ovarian cancer are higher if a close relative has had cancer of the ovaries,
breast, or colon. Researchers believe that inherited genetic changes account
for 10% of ovarian cancers. This includes the BRCA1 and BRCA2 gene mutations,
which are linked to breast cancer. Women with a strong family history
should talk with a doctor to see whether closer medical follow-up could be
helpful.
Risk Factor: Age
The strongest risk factor
for ovarian cancer is age. It's most likely to develop after a woman goes
through menopause. Using postmenopausal hormone therapy may increase the risk.
The link seems strongest in women who take estrogen without progesterone for at
least 5 to 10 years. Doctors are not certain whether taking a combination of
estrogen and progesterone boosts the risk as well.
Risk Factor: Obesity
Obese women have a higher risk of
getting ovarian cancer than other women. And the death rates for ovarian
cancer are higher for obese women too, compared with non-obese women. The
heaviest women appear to have the greatest risk.
Ovarian Cancer Screening Tests
There is no easy or reliable way
to test for ovarian cancer if a woman has no symptoms. However, there are two
ways to screen for ovarian cancer during a routine gynecologic exam. One is a
blood test for elevated levels of a protein called CA-125. The other is an
ultrasound of the ovaries. Unfortunately, neither technique has been shown to
save lives when used in women of average risk. For this reason, screening is
only recommended for women with strong risk factors.
Diagnosing Ovarian Cancer
Imaging tests, such as ultrasound or
CT scans (seen here), can help reveal an ovarian mass. But these scans can't
determine whether the abnormality is cancer. If cancer is suspected, the next
step is usually surgery to remove suspicious tissues. A sample is then sent to
the lab for further examination. This is called a biopsy.
Stages of Ovarian Cancer
The initial surgery for ovarian
cancer also helps determine how far the cancer has spread, described by the
following stages:
Stage I: Confined to one or
both ovaries
Stage II: Spread to the uterus or other nearby organs
Stage III: Spread to the lymph nodes or abdominal lining
Stage IV: Spread to distant organs, such as the lungs or liver
Stage II: Spread to the uterus or other nearby organs
Stage III: Spread to the lymph nodes or abdominal lining
Stage IV: Spread to distant organs, such as the lungs or liver
Types of Ovarian Cancer
The vast majority of ovarian
cancers are epithelial ovarian carcinomas. These are malignant tumors that form
from cells on the surface of the ovary. Some epithelial tumors are not clearly
cancerous. These are known as tumors of low malignant potential (LMP). LMP
tumors grow more slowly and are less dangerous than other forms of ovarian cancer.
Ovarian Cancer Survival Rates
Ovarian cancer can be a
frightening diagnosis, with five-year relative survival rates that range from
90% to 17% for epithelial ovarian cancer, depending on the stage when the
cancer was found. For LMP tumors, the five-year relative survival rates range
from 97% to 89%.
Ovarian Cancer Surgery
Surgery is used to diagnose
ovarian cancer and determine its stage, but it is also the first phase of
treatment. The goal is to remove as much of the cancer as possible. This may include
a single ovary and nearby tissue in stage I. In more advanced stages, it may be
necessary to remove both ovaries, along with the uterus and surrounding
tissues.
Chemotherapy
In all stages of ovarian cancer,
chemotherapy is usually given after surgery. This phase of treatment uses drugs
to target and kill any remaining cancer in the body. The drugs may be given by
mouth, through an IV, or directly into the belly (intraperitoneal
chemotherapy). Women with LMP tumors usually don't need chemo unless the tumors
grow back after surgery.
Targeted Therapies
Researchers are working on
therapies that target the way ovarian cancer grows. A process called
angiogenesis involves the formation of new blood vessels to feed tumors. A drug
called Avastin blocks this process, causing tumors to shrink or stop growing
(seen in the illustration here).
After Treatment: Moving On
Women may find that it takes a
long time for their energy to return after treatments end. Fatigue is a very
common problem after treatment for cancer. Beginning a gentle exercise program
is one of the most effective ways to restore energy and improve emotional
well-being. Check with your health care team to determine which activities are
right for you.
Risk Reducer: Pregnancy
Women who have biological children
are less likely to get ovarian cancer than women who have never given birth.
The risk appears to decrease with every pregnancy, and breastfeeding may offer
added protection.
Risk Reducer: 'The Pill'
Ovarian cancer is also less common
in women who have taken birth control pills. Women who have used the pill for
at least five years have about half the risk of women who never took the pill.
Like pregnancy, birth control pills prevent ovulation. Some researchers think
ovulating less often may protect against ovarian cancer.
Risk Reducer: Tubal Ligation
Getting your tubes tied, formally
known as tubal ligation, may offer some protection against ovarian cancer. The
same goes for having a hysterectomy -- removing the uterus.
Risk Reducer: Removing the Ovaries
For women with genetic mutations
that put them at high risk for ovarian cancer, removing the ovaries is an
option. This can also be considered in women over 40 getting a hysterectomy.
Risk Reducer: Low-Fat Diet
While there is no definitive diet
to prevent ovarian cancer, there is evidence that what you eat can make a
difference. In one recent study, women who stuck to a low-fat diet for at least
four years were less likely to develop ovarian cancer. Some researchers report
the cancer is also less common in women who eat a lot of vegetables, but more
studies are needed.
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