Epithelial Ovarian Cancer

Epithelial ovarian cancer is the most common type of ovarian cancer. It develops in your epithelial tissue. This is a thin lining that covers the outside of your ovaries. It may also form in the lining of your fallopian tubes or in your peritoneum (the tissue that covers your abdominal organs). Because of their similarities, medical experts classify fallopian tube cancers and peritoneal cancers as epithelial ovarian cancers.

This type of cancer can be hard to detect because you may not notice symptoms. Most people receive a diagnosis once it’s already spread. Getting regular exams with your gynecologist and knowing the warning signs are important for early detection of epithelial ovarian cancer.

Epithelial ovarian cancer is the most common type of ovarian cancer. It accounts for about 90% of all ovarian cancer diagnoses.

What are the types?

There are several subtypes of epithelial ovarian cancer.

High-grade serous carcinoma (HGSOC) is the most common and aggressive subtype. It accounts for 3 out of 4 epithelial ovarian cancers. Experts believe HGSOC grows slowly at first. It starts in your fallopian tubes. Once the cancer is in your ovaries, it spreads quickly. Nearly 70% of cases are stage 3 or 4 at the time of diagnosis. This means cancer has spread to nearby organs and lymph nodes.

Less common types of epithelial ovarian cancer include:

• Endometrioid carcinoma: This cancer is more common in people who have endometriosis. It affects the lining of your uterus. It responds better to chemotherapy than some other types do.
• Low-grade serous ovarian carcinoma (LGSOC): This cancer mainly affects people in their mid-forties. It accounts for about 1 in 10 epithelial ovarian cancers. Low-grade carcinomas grow slowly but for a long time. The disease doesn’t respond well to chemotherapy. You might need surgery to treat it.
• Mucinous carcinoma: These tumors are more distinct and respond well to treatments. They tend to be large (around 8 inches or 20 centimeters). Typically, they only affect your ovaries.
• Ovarian clear cell carcinoma (OCCC): People who are Asian and people with endometriosis are most at risk for this cancer. The disease is often advanced at diagnosis. It doesn’t respond well to chemotherapy.
• Primary squamous cell carcinoma (SCC) of the ovary: SCC typically develops from noncancerous conditions. It may form from ovarian cysts, endometriosis or Brenner tumors (solid growths on your ovaries). It responds well to treatment when caught early.

Symptoms of epithelial ovarian cancer

Epithelial ovarian cancer rarely causes symptoms in its early stages. Symptoms become more noticeable as the disease progresses. As it spreads into your peritoneum, fluid accumulates in your abdomen.

This can cause symptoms like:

• Abdominal pain
• Bloating
• Difficulty eating or feeling full quickly
• Nausea and vomiting
• Pelvic pain

Less common symptoms include:

• Changes in poop habits
• Strong urge to pee or peeing more frequently
• Vaginal bleeding

Epithelial ovarian cancer causes

Epithelial ovarian cancers develop for no known reason. Experts believe many ovarian cancers start in cells at the end of your fallopian tubes. Then, they spread to your ovaries.

Risk factors

More than half of ovarian cancer diagnoses occur in people over 65 who have gone through menopause.

Certain factors may increase your risk of ovarian cancer:

• Family history of ovarian cancer, breast cancer or colon cancer
• Having a BRCA gene mutation
• Having a gene linked to family cancer syndromes like Lynch syndrome
• Hormone therapy for menopause
• Having a baby after age 35 or never having a full-term pregnancy
• Obesity

How doctors diagnose epithelial ovarian cancer

There aren’t any screening tests to detect ovarian cancer early. Your healthcare provider may start by performing a pelvic exam to check for unusual growths or enlarged organs. If you’re at high risk for ovarian cancer, your healthcare provider may recommend the following tests:

• CA-125 blood test
• Transvaginal ultrasound
• CT scan
• MRI
• PET scan
• Chest X-rays (to look for metastatic cancer in your lungs)

You may also need a laparoscopy. This less invasive procedure lets your surgeon view your reproductive organs. Your healthcare provider may take tissue samples of a tumor to biopsy for cancer cells. A biopsy is the only way to diagnose ovarian cancer.

Stages

Cancer staging helps healthcare providers track cancer’s growth. It tells them if the cancer has spread and helps them plan the best treatment. The same tests that help diagnose cancer can determine the cancer stage.

There are four stages of ovarian cancer. A higher number means a more advanced cancer. The stages are:

• Stage 1: Cancer is in one ovary or one fallopian tube.
• Stage 2: Cancer has spread to your uterus, bladder or your peritoneal cavity.
• Stage 3: Cancer has spread outside of your pelvis to other organs, lymph nodes or both.
• Stage 4: Cancer cells are in your lungs, liver and lymph nodes in your groin.

There are substages to these main stages. They mostly provide greater detail about where exactly the cancer is.

Can epithelial ovarian cancer be cured?

Possibly. It depends on when it’s found. Early-stage cancers tend to respond better to treatment.

Your healthcare provider will likely use a combination of surgery and chemotherapy to treat epithelial ovarian cancer. Debulking surgery removes as much of the cancerous tumor as possible. Chemotherapy kills remaining cancer cells.

People with advanced cancers often undergo debulking surgery to remove more areas, like your:

• Fallopian tubes
• Ovaries
• Uterus
• Fatty tissue covering your abdomen (omentectomy)
• Nearby lymph nodes
• Small intestine, large intestine or spleen

Your healthcare provider can discuss treatment options with you and which surgery would give you the best chance at remission.

What are other treatments?

Depending on the type of cancer, you may need one or more of these treatments after surgery:

• Intraperitoneal chemotherapy to treat stage 3 ovarian cancer. Your provider injects cisplatin and paclitaxel directly into your abdominal cavity through a catheter.
• Targeted therapies like bevacizumab (Avastin®) to stop cancer cells from growing and multiplying.
• Radiation therapy to destroy cancer cells with high-energy X-ray beams.

When should I see my healthcare provider?

Call your healthcare provider if you have:

• Changes in frequency or urgency of urination
• Loss of appetite or feeling of fullness
• Unexplained abdominal or pelvic pain

What should I ask my healthcare provider?

You may want to ask your healthcare provider:

• Should I have a BRCA test?
• What type of epithelial ovarian cancer do I have?
• What’s the best treatment for me?
• What are the treatment side effects?
• Am I at risk for metastatic cancer? How can I lower this risk?

What can I expect if I have epithelial ovarian cancer?

More than 13,000 people die from ovarian cancer every year. It’s the fifth leading cause of cancer deaths among females. But promising new treatments are under development in clinical trials. And researchers are making progress in detecting the disease earlier.

Recovery from chemo and surgery can be difficult. It may be hard to manage the side effects that come with cancer treatment, too. But your healthcare team is there to support you. Finding a support group or seeking counseling can also be an important part of your recovery. You’ll need follow-up appointments with your oncologist to monitor for cancer recurrence. Know that you aren’t alone in your cancer journey and that there are resources available to help you.

What is the survival rate?

When epithelial ovarian cancer is detected before it spreads, the five-year survival rate is more than 90%. This is the number of people who are alive five years after diagnosis. This number drops to about 30% when the cancer has spread.

Many factors affect survival rate, like:

• Cancer stage
• Your overall health and age
• How effective the treatment is

Can you prevent epithelial ovarian cancer?

There isn’t one way to prevent it. But some factors may lower your risk.

Studies show that people who take the pill for five or more years may cut their risk of ovarian cancer in half. There’s also an association between breastfeeding and reduced risk of epithelial ovarian cancer.

If you have a high genetic risk for ovarian cancer (like BRCA gene mutation) you could choose to have preventive surgery. This involves removing your fallopian tubes and ovaries. It can be done with or without a hysterectomy. But experts recommend taking these actions only if it’s medically necessary. These procedures also don’t eliminate cancer risk. Removing your ovaries can start early menopause, which has its own side effects on your body.

Is it possible to have noncancerous epithelial ovarian tumors?

Yes. In fact, most epithelial ovarian tumors aren’t cancerous. Some tumors are borderline. This means the cells look abnormal but don’t spread or grow deeper. These cells usually stay in your ovary and rarely become cancer.