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Ovarian cancer

Definition

Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs.

Alternative Names

Cancer - ovaries

Causes

Ovarian cancer is the fifth most common cancer among women. It causes more deaths than any other type of female reproductive organ cancer.

The cause of ovarian cancer is unknown.

Risk of developing ovarian cancer include any of the following:

  • The fewer children a woman has and the later in life she gives birth, the higher her risk of ovarian cancer.
  • Women who have had breast cancer or have a family history of breast or ovarian cancer have an increased risk of ovarian cancer (due to defects in the BRCA1 or BRCA2 genes).
  • Women who take estrogen replacement only (not with progesterone) for 5 years or more may have a higher risk of ovarian cancer. Birth control pills, though, decrease the risk of ovarian cancer.
  • Fertility medicine probably does not increase the risk of ovarian cancer.
  • Older women are at highest risk of developing ovarian cancer. Most deaths from ovarian cancer occur in women age 55 and older.

Symptoms

Ovarian cancer symptoms are often vague. Women and their doctors often blame the symptoms on other, more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries.

See your doctor if you have the following symptoms on a daily basis for more than a few weeks:

  • Bloating or swollen belly area
  • Difficulty eating or feeling full quickly (early satiety)
  • Pelvic or lower abdominal pain. The area may feel "heavy" (pelvic heaviness)

Other symptoms are also possible with ovarian cancer, but these symptoms are also common in women who do not have cancer:

  • Abnormal menstrual cycles
  • Digestive symptoms, such as no appetite, indigestion, nausea and vomiting, constipation, and increased gas
  • Back pain for unknown reasons that worsens over time
  • Vaginal bleeding that occurs between periods
  • Weight gain or loss

Other symptoms that can occur:

Exams and Tests

A physical exam is often normal. With advanced ovarian cancer, the doctor may find a swollen abdomen often due to accumulation of fluid (ascites).

A pelvic examination may reveal an ovarian or abdominal mass.

A CA-125 blood test is not considered a good screening test for ovarian cancer. But, it may be done if a woman has:

  • Symptoms of ovarian cancer
  • Already been diagnosed with ovarian cancer to determine how well treatment is working

Other tests that may be done include:

Surgery, such as a pelvic laparoscopy or exploratory laparotomy, is often done to find the cause of symptoms. A biopsy will be done to help make the diagnosis.

No lab or imaging test has ever been shown to be able to successfully screen for or diagnose ovarian cancer in its early stages, so no standard screening tests are recommended at this time.

Treatment

Surgery is used to treat all stages of ovarian cancer. For early stages, surgery may be the only treatment. Surgery may involve removing both ovaries and fallopian tubes, the uterus, or other structures in the belly or pelvis.

Chemotherapy is used after surgery to treat any cancer that remains. Chemotherapy can also be used if the cancer comes back (relapses). Chemotherapy can be given intravenously (through an IV). Or it can be injected directly into the abdominal cavity (intraperitoneal, or IP).

Radiation therapy is rarely used to treat ovarian cancer in the United States.

After surgery and chemotherapy, follow instructions about how often you should see your doctor and the tests you should have.

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made:

  • 3 of 4 women with ovarian cancer survive 1 year after diagnosis
  • Nearly half of women live longer than 5 years after diagnosis
  • If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the 5-year survival rate is high

When to Contact a Medical Professional

Contact your health care provider if you are a woman 40 years or older who has not recently had a pelvic exam. Routine pelvic exams are recommended for all women 20 years or older.

Call for an appointment with your provider if you have symptoms of ovarian cancer.

Prevention

There are no standard recommendations for screening for ovarian cancer. Pelvic ultrasound or a blood test, such as CA-125, has not been found to be effective and is not recommended.

BRCA1 or BRCA2 genetic testing may be recommended for women at high risk for ovarian cancer. These are women who have a personal or family history of breast or ovarian cancer.

Removing the ovaries and fallopian tubes in women who have a proven mutation in the BRCA1 or BRCA2 gene may reduce the risk of developing ovarian cancer. But, ovarian cancer may still develop in other areas of the pelvis.

References

Coleman RL, Ramirez PT, Gershenson DM. Neoplastic diseases of the ovary: screening, benign and malignant epithelial and germ cell neoplasms, sex-cord stromal tumors. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 33.

Morgan M, Boyd J, Drapking R, Seiden MV. Cancers arising in the ovary. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 89.

National Cancer Institute. BRCA1 and BRCA2: cancer risk and genetic testing. Updated 1/22/2014. Available at: www.cancer.gov/cancertopics/factsheet/Risk/BRCA. Accessed November 26, 2014.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Ovarian cancer: including fallopian tube cancer and primary peritoneal cancer. Version 3.2014. Available at: www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf. Accessed November 26, 2014.


Review Date: 11/26/2014
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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