Cancer of the Ovary (Ovarian Cancer)

What is cancer of the ovary (ovarian cancer)?

Ovarian cancer is the uncontrolled growth of abnormal cells in a woman's ovaries. The ovaries are glands located on either side of the uterus (womb) in a woman's lower abdomen. They are part of the reproductive system and are about the size and shape of an almond. They are the main source of the female hormones estrogen and progesterone, and before menopause they also produce eggs.

Cancer growth may start in the ovary and spread to other parts of the body such as the liver or lungs. The sooner ovarian cancer is discovered and treated, the better the chances are for recovery. Currently, there are no screening tests to predict the development of or detect ovarian cancer.

How does it occur?

The cause of ovarian cancer is not known. Most ovarian cancer occurs in women over age 50. You may have an increased risk of ovarian cancer if:

• Your mother, sister, or daughter had ovarian cancer.
• You or members of your family have had breast or colon cancer.
• You have never given birth to a child.

Some studies suggest that women who use birth control pills, have a tubal sterilization, or breast-feed have a lower risk of getting ovarian cancer. Also, the more children you have had, the less likely it is you will have ovarian cancer.

What are the symptoms?

Ovarian cancer is very hard to detect in its early stages because at first there are often no obvious symptoms. When symptoms do appear, they may include:

• an ongoing feeling of abdominal discomfort or pain (gas, indigestion, bloating, swelling, cramps)
• nausea, diarrhea, constipation
• loss of appetite
• feeling full even after a light meal
• unexplained weight loss or gain
• frequent urination or leaking of urine (incontinence)
• abnormal vaginal bleeding
• fatigue
• pelvic or back pain
• pain with sexual intercourse

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history. You will have a physical exam. Other exams and tests you may have are:

• pelvic exam
• ultrasound scan, which is the use of sound waves to create a picture of the ovaries
• if an abnormal ovarian cyst is seen on ultrasound, a blood test to measure the level of a substance called CA-125 may be done. CA-125 is sometimes found in higher-than-normal amounts in the blood of women with ovarian cancer, but is not reliable because there are other conditions that may cause the CA-125 to be high
• lower GI series, or barium enema, which is a series of X-rays of the colon and rectum taken after you are given an enema with a solution containing barium (the barium outlines the colon and rectum on the X-ray, making tumors or other abnormal areas easier to see)
• computed tomography (CT) scans, which is a series of detailed pictures of areas inside the body created by a computer linked to an X-ray machine

It may be necessary to examine a small sample of tissue (biopsy) under a microscope to confirm that cancer is present. This requires surgery with anesthesia. A sample may be taken through a viewing tube (laparoscope) inserted through the abdominal wall. Another option is to remove the affected ovary surgically for examination. Samples of nearby lymph nodes can be taken at the same time to check for spread of cancer beyond the ovary.

How is it treated?

You will have one or more of the following treatments:

• surgery
• radiation therapy
• chemotherapy
• any combination of the above

Usually both ovaries, the uterus, the fallopian tubes (tubes from the ovaries to the uterus), and nearby lymph nodes are removed. After surgery, you may have radiation or anticancer drugs (chemotherapy) to kill the cancer cells. Chemotherapy may also be given to relieve cancer symptoms. Sometimes anticancer medication is put into the abdomen at the time of surgery. Also, a tube may be placed into the abdomen at the time of surgery, open to the outside, to inject anticancer medications into the abdomen after surgery.

How long will the effects last?

The earlier ovarian cancer is found and treated, the better are the chances for your long-term survival. The 5-year survival rate is over 90% when the cancer is identified and treated at an early stage. For those whose cancer has spread beyond the ovaries the survival rates are much lower.

Women who have had ovarian cancer may be at increased risk of developing breast or colon cancer. In addition, treatment with certain anticancer drugs may increase the risk of second cancers, such as leukemia.

How can I take care of myself?

Make sure that you keep all follow-up appointments with your healthcare provider. Follow-up exams to check for the return or spread of cancer are very important. Your provider will schedule regular checkups that generally include a physical exam, a pelvic exam, and Pap test. You may have other tests, such as a chest X-ray, CT scan, urine tests, and blood tests.

Eat a balanced diet, get plenty of rest, and follow your provider's advice.

Joining a cancer support group can be very helpful. The support group can help you learn a lot about your care, treatment, and the cancer. Your local chapter of the American Cancer Society (ACS) may offer support groups. Look in the phone book for your local chapter.

For more information on cancer, you can contact:

• American Cancer Society, Inc.
  Phone: 800-ACS-2345 (800-227-2345)
  Web site: http://www.cancer.org
• AMC Cancer Research Center and Foundation
  Phone: 800-525-3777
  Web site: http://www.amc.org
• Cancer Information Service
  Phone: 800-4-CANCER (800-422-6237)
  Web site: http://www.cancer.gov/cancer_information

How can help prevent ovarian cancer?

At this time there is no known way of preventing ovarian cancer. However, early detection and treatment greatly improve your chances of survival:

• Have a pelvic exam every year, or as often as your healthcare provider recommends, so that your ovaries are checked regularly.
• Tell your provider as soon as possible if you have any ongoing abdominal discomfort or pain including gas, bloating, indigestion, cramps, or swelling.
• Tell your provider if you lose or gain weight without a known reason.
• See your provider right away if you have unusual vaginal bleeding, including bleeding after menopause.

Some women who have an increased risk of ovarian cancer may choose to have their healthy ovaries removed so that cancer cannot grow in them. This is called prophylactic oophorectomy. The pros and cons of this surgery should be discussed with your healthcare provider.