What is ovarian cancer?
Cancer develops when cells in your body begin to grow abnormally. This can happen in any area of the body. When this abnormal growth occurs in the ovary, you develop ovarian cancer. All cells go through their own life cycles — growing, dividing and being replaced. They even undergo “programmed cell death” when they no longer function properly or have outlived their usefulness — at this point, the cells die. However, cells sometimes start to grow rapidly or no longer die when they should. This abnormal growth of cells can cause problems, typically leading to the formation of a tumor. A tumor can either be cancerous (malignant) or not cancerous (benign).
Benign and malignant tumors act differently in the body. A benign tumor doesn’t spread throughout the body. It stays in one place and slowly grows over time. Your healthcare provider may recommend watching it over time or removing a tumor surgically. Typically, benign tumors are not an immediate danger to your health. Malignant tumors are more aggressive. These tend to grow rapidly and can invade other parts of the body, causing more problems as they spread. When malignant (cancerous) cells develop in ovaries, it’s called ovarian cancer.
The ovaries are a part of your reproductive system. If you think of the organs of your reproductive system as an upside down triangle, the ovaries are a pair of round organs in the upper corners. Your ovaries — each about the size of a walnut — are connected to the uterus and there are two thin tubes called the fallopian tubes in between. The uterus makes up the bottom point of the triangle. During your reproductive years (time in your life when you could become pregnant), eggs are formed in the ovaries, travel down your fallopian tubes and then to the uterus.
Symptoms and Causes
What causes ovarian cancer?
The cause of ovarian cancer is not yet known. However, you may have a higher risk of ovarian cancer if you have:
- A family history of ovarian cancer (others in your family have had the disease) or have inherited a gene mutation (BRCA1 or BRCA2).
- An Eastern European (Ashkenazi) Jewish background.
- Never been pregnant.
- Had endometriosis.
- Had breast, uterine or colorectal cancer.
There is also an increased risk for developing ovarian cancer as you grow older.
Another risk factor is Lynch syndrome. This disorder runs through families and it can increase the risk of developing colon cancer. Lynch syndrome is linked to many other types of cancer. If you have Lynch syndrome, your risk of developing other cancers is increased. Lynch syndrome is an inherited condition, so talk to your family about any history of colon or colorectal cancer.
What are the symptoms of ovarian cancer?
Unfortunately, ovarian cancer can develop, become quite large and spread throughout the abdomen before it causes any symptoms. This can make early detection difficult. When you experience symptoms, they can include:
- Having pain, discomfort or bloating in your abdomen and pelvis.
- Experiencing changes in your eating habits, getting full early and losing your appetite. You may experience bloating and belching, sometimes even stomach pain.
- Having abnormal bleeding or vaginal discharge (especially if the bleeding is happening outside of your typical menstrual cycle or after you have gone through menopause) and, more often, changes in your bowels, such as diarrhea and constipation.
- Feeling any unusual lumps or finding increase in the size of your abdomen.
- Having urinary frequency or urinary urgency.
What are genes and what do they have to do with ovarian cancer?
Genes are a part of your DNA and are essentially the blueprint your cells use to reproduce themselves. You’re born with a particular genetic makeup. Your genes can be influenced by your family (inherited traits) and by changes that happen to your genes over time. These changes are called mutations. Two of the most common gene mutations that have been pinpointed as being related to ovarian cancer are BRCA1 and BRCA2.
The BRCA1 and BRCA2 genes are inherited — meaning you get part of each gene from each parent. Your genes are twin pieces (you have two parts that make up each gene, so two parts to BRCA1). You could have a mutation in one part of the gene without having cancer. However, if both parts of the gene are mutated, cancer can develop. BRCA1 and BRCA2 typically suppress the growth of cancerous cells. Mutations keep these genes from doing their job and preventing abnormal cell growth. BRCA1 and BRCA2 are also linked to breast cancer.
Gene mutations aren’t always inherited. Throughout your life, your genes can change. A somatic mutation is one that happens over time. One common genetic mutation that’s seen in ovarian cancer is a somatic mutation of the TP53 gene. The mutation changes part of the gene — the protein — called the p53 protein. This protein normally works to fight tumors and keep them from developing. However, when it’s changed by this mutation, it can’t keep the tumor from growing. This same process can happen to many different genes in your body and they can all contribute to cancer growth.
How would I know if gene mutations run in my family?
If you have a strong family history of ovarian cancer or breast cancer, your healthcare provider may suggest genetic testing. This type of testing will identify any mutations or changes you have in your genetic makeup. Understanding your family history and genetic makeup can help in early treatment of cancer. Talk to your healthcare provider about your family history of cancer and discuss what preventative measures you can take to protect your health.
Diagnosis and Tests
How is ovarian cancer diagnosed?
For many types of cancer, there are screening tests that detect pre-cancers or cancer at an early stage when it is curable before symptoms may develop. Pap smears, mammograms and colonoscopy are examples of screening tests that many people are familiar with. Unfortunately, there are no screening tests for ovarian cancer. Testing typically happens after you have symptoms. It’s important to know your body and reach out to your healthcare provider when you notice something unusual. Because the symptoms of ovarian cancer are varied, persistent symptoms lasting more than two to three weeks are important to discuss with your healthcare provider.
Your provider may start with a history and a physical exam, including a pelvic exam. This exam is used to check for any abnormal growths or enlarged organs in the pelvis. This first test may give your provider more information and help to decide what additional tests you may need.
Additional tests could include:
Pelvic ultrasound: An ultrasound is an imaging test that uses sound waves to create a picture of your internal organs. This can be done on top of your skin (typically your abdomen) or internally, with a wand. An internal ultrasound is called a transvaginal ultrasound. These imaging tests are painless and include no preparation on your part. Your provider will look at your ovaries during the test to see if they are enlarged or have any growths. The ultrasound will show all growths, not just cancerous ones. This test is typically followed by several more tests that will confirm your diagnosis.
Other imaging tests that can help diagnose ovarian cancer can include:
- MRI (magnetic resonance imaging).
- CT scan (computed tomography).
- PET scan (positron emission tomography).
- Chest X-ray.
Blood tests: Blood tests look for a substance called CA-125. High levels of CA-125 in the blood can be a sign of cancer. However, CA-125 levels can be normal, even when cancer is present, and higher in many conditions that are not cancer. Because of this, blood tests are used with other tests to diagnose ovarian cancer.
Surgical evaluation: Ovarian cancer can be diagnosed during a surgery. Ovarian cancer is also typically treated with both surgery and chemotherapy.
Laparoscopy: Laparoscopy is a type of surgery where a thin camera (laparoscope) is placed through a small cut (incision) made in the abdomen. Using the scope as a guide along with additional ports to hold instruments, the healthcare provider can assess the cancer, preform staging biopsies and, in some circumstances, remove ovarian tumors.
How is ovarian cancer staged?
Staging is a way of labeling how far your cancer has spread. When your provider stages cancer, several factors are considered, including:
- Which organs are impacted by the cancerous cells. Your provider will want to determine if the cancer is in one ovary, both, or in if it’s spread to other nearby organs in the pelvis, abdomen or elsewhere.
- Cancerous cells have a few ways that they can spread throughout your body. Ovarian cancer can spread directly through the pelvis and abdomen, through the lymph nodes, or through blood vessels.
There are four stages to ovarian cancer. The least severe is the lowest number. The more serious the condition, the higher the number.
- Stage I: This stage is divided into three sub-stages (stage IA, stage IB and stage IC). In the first stage, cancer is only in one ovary or one fallopian tube. Stage IB has cancer in both ovaries or fallopian tubes. In stage IC, cancer is in both ovaries or fallopian tubes and it’s found outside of the ovary (on the outside of the organ itself or in the space around the ovary, called the peritoneal cavity).
- Stage II: Stage II is also divided into a few additional stages. In stage IIA, the cancer is no longer only in the ovary, but has spread to the uterus. In stage IIB, the cancer has spread to other nearby organs in your abdomen (peritoneal cavity).
- Stage III: This stage includes three sub-stages. In stage IIIA, the cancer has spread beyond the peritoneum cavity (abdomen) through lymph nodes. The second stage (stage IIIB), the tumor is about 2 centimeters in size and has spread beyond the abdominal space. In stage IIIC, the cancer has moved outside of the pelvis area and is larger in size (more than 2 centimeters). It could impact other organs, like the liver, at this point.
- Stage IV: Stage IV cancer is the most severe. In this stage the cancer has spread throughout the body. In stage IVA, it’s found near the lungs and in stage IVB the cancer can be found in the lymph nodes of the groin.
Staging is important because it will help your healthcare provider craft a treatment plan for you. Your healthcare provider will discuss this plan with you and talk about the best types of treatment for you.
Management and Treatment
How is ovarian cancer treated?
The goal in treating cancer is to remove as much, if not all, cancer from your body as possible. If you have ovarian cancer, this most often involves the removal of your reproductive organs and any organ that has cancer on it, including segments of the intestine and the omentum — a fatty material covering the intestines.
Surgical removal of ovarian cancer can be done through a procedure called a laparoscopy (a minimally-invasive surgery also used for diagnosis of the cancer) or during a laparotomy. A laparotomy is a procedure where the doctor opens the abdomen using a larger incision and is able to remove the ovaries. Other organs where the cancer may have spread can also be removed during this procedure.
Your healthcare provider may recommend chemotherapy either before or after surgery depending upon multiple factors including the extent of your cancer at the time of diagnosis. Chemotherapy are drugs designed to target and kill cancerous cells.
After ovarian cancer has been treated, your healthcare provider will want to regularly see you for observation. You may have routine appointments to check and make sure the cancer hasn’t returned over time. During these appointments, your provider may go through any possible symptoms and do an exam. Be mindful of any symptoms you may be having and tell your provider about them. Sometimes, your provider may order imaging tests, typically a CT scan.
Are there different types of chemotherapy?
Two types of chemotherapy your healthcare provider may suggest include chemotherapy for platinum-sensitive disease and chemotherapy for platinum-resistant disease. People who had a good response to initial platinum-based chemotherapy and recur six months or more after completion of therapy are considered to have platinum-sensitive or drug-sensitive disease and have the greatest likelihood of responding to the same or similar treatment again.
In general, the longer the chemotherapy-free interval (CFI), the greater the response to second-line chemotherapy, although this treatment may not last as long as the first. The goals of second-line chemotherapy for recurrent ovarian cancer (cancer that comes back) include:
- Improving your quality of life.
- Delaying the time for further cancer progression and development of symptoms.
- Prolonging survival.
People that did not respond favorably to initial chemotherapy or with disease that recurred within six months of completion of initial platinum-based chemotherapy (a short chemotherapy-free interval, CFI), are considered to have platinum-resistant or drug-resistant disease.
Can I prevent ovarian cancer?
There is no way to prevent ovarian cancer completely. You may be able to decrease your risk of getting cancer later in life by maintaining a healthy weight and practicing good lifestyle habits (exercising, having a balanced diet, limiting alcohol). Currently, there are no screening tests that can positively identify ovarian cancer. Many women don’t realize they have it until symptoms have started.
However, knowing your family history can help you prepare for any heightened risk of developing ovarian cancer. If this type of cancer runs in your family, talk to your healthcare provider about it. If you have a genetic mutation such as BRCA mutation, risk reducing surgery to remove your ovaries and tubes before they become cancerous may be warranted.
What can lower my risk of developing ovarian cancer?
Women who have had children or who use oral contraceptives (birth control pills) are less likely to develop ovarian cancer. If you have used birth control pills for a longer period of time (at least five years), you may have a lower risk of developing ovarian cancer.
Outlook / Prognosis
What’s the outlook of ovarian cancer?
After you have been treated for ovarian cancer, your healthcare provider will still have you come in for regular appointments. These appointments will be used to check in on any symptoms you may have and discuss any concerns. It’s important to pay close attention to your body and let your provider know if anything unusual is happening. Observation is key after ovarian cancer treatment.
A note from Cleveland Clinic
Ovarian cancer can be difficult to identify because it often develops without any symptoms. Without these signs that something is wrong, the cancer can grow without you knowing it’s there. There are also currently no tests that screen for ovarian cancer. Because of this, it’s important to know your family history and talk to your healthcare provider about any possible risk factors you may have for ovarian cancer. Knowing your risk factors can help your provider know what to look for and possibly do genetic testing. If you experience any symptoms of ovarian cancer, reach out to your healthcare provider right away.
Where can I learn more about ovarian cancer?
For more information, visit:
- National Cancer Institute Information Contact Center: https://www.cancer.gov/contact.
- American Cancer Society: https://www.cancer.org/about-us/online-help/contact-us.html.