Alternate Names: Cancer - ovaries

Causes and Risks: The exact cause of ovarian cancer is unknown. Oddly enough, ovarian cancer is fairly uncommon, yet it is the 5th leading cause of cancer death in women. It is also the leading cause of death from gynecologic malignancies. This is a result of a number of factors. The symptoms of ovarian cancer are vague and nonspecific. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries. Ovarian cancers shed malignant cells which frequently implant on the uterus, bladder, bowel, and omentum. These cells can begin forming new tumor growths before cancer is even suspected. Because no cost-effective screening test for ovarian cancer exists, over 50 percent of women with ovarian cancer are diagnosed in the advanced stages of the disease.

Ovarian cancer is more common in industrialized nations, with the exception of Japan. In the United States, females have a 1.4 to 1.5% (1 out of 70 women) chance of developing ovarian cancer at some point in their lives. The incidence is higher in older women. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age. Approximately one quarter of ovarian cancer deaths occur in women between 35 and 54 years of age.

The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy and the use of oral contraceptive pills have also been shown to have a protective effect. In contrast, the use of fertility drugs has been associated with an increased chance of developing ovarian cancer. Familial syndromes may also increase the risk. Patients with a personal history of breast cancer, or a family history of breast and/or ovarian cancer may have an elevated risk. A family history of colon, lung, prostate, and uterine cancers may indicate the presence of a Lynch II syndrome, which may also confer a higher risk for developing ovarian cancer. Other factors that have been investigated, such as talc use, asbestos exposure, high dietary fat content, and childhood mumps infection are controversial and have not been definitively proven.

Prevention: Having regular pelvic examinations and avoiding the risk factors listed above may decrease the overall risk; however, no definitive prevention strategy is known.

Studies have shown that there may be a lower risk of ovarian cancer in patients who have used the oral contraceptive pill. After five or more years of use, there is a 60 percent reduction in the risk of ovarian cancer.

Symptoms:

• sense of pelvic heaviness
• vague lower abdominal discomfort
• vaginal bleeding
• weight gain or loss
• abnormal menstrual cycles
• increased abdominal girth
• non specific gastrointestinal symptoms:
  • increased gas, indigestion, lack of appetite, nausea and vomiting, inability to ingest usual volumes of food, bloating

• urinary frequency/urgency - increased
• hair - excessive on females

Signs and Tests: Physical examination may reveal increased abdominal girth and /or ascites (fluid within the abdominal cavity). Pelvic examination may reveal an ovarian or abdominal mass.

Tests include:

• CBC
• blood chemistry
• CA125
• quantitative serum HCG (blood pregnancy test)
• alpha fetoprotein
• urinalysis
• GI series
• laparotomy exploratory
• ultrasound
• an abdominal CT scan or MRI of abdomen

Treatment: Surgery is the preferred treatment and is frequently necessary for diagnosis. Chemotherapy is most frequently used as adjunctive therapy. Radiation therapy may be considered but is rarely used after surgery.

Support Groups: The stress of illness may be helped by joining a support group where members share common experiences and problems. See cancer - support group.

Prognosis: Ovarian cancer is rarely diagnosed in its early stages; it is usually quite advanced by the time diagnosis is made. The outcome is often poor. The 5-year survival rate for all stages is only 35 to 38%. If, however, diagnosis is made early in the disease, 5-year survival rates can reach 85%.

Complications:

• spread of the cancer to other organs
• progressive function loss of various organs

Call for an appointment with your health care provider if you are a woman over 40 years old who has not followed the recommendation for an annual Pap smear and pelvic examination. (Note: routine Pap smears and pelvic examinations are recommended for all women over 20 years old.)

Call for an appointment with your health care provider if symptoms appear.