Ovarian Cancer

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Introduction

What is ovarian cancer?

The ovaries are almond-sized pelvic organs that store and release eggs and produce estrogen and progesterone. Ovarian cancers can start in any of the cells in the ovaries, but most are epithelial cancers that start in the cells on the surface of the ovaries. Around 22,000 women in the United States are diagnosed with ovarian cancer annually (Source: NCI).

At first, ovarian cancer may show no symptoms. As the cancer grows, you may have vague symptoms such as gas, bloating, diarrhea or constipation, and you may suffer from fatigue. These symptoms may be accompanied by pain or a sensation of pressure in the pelvis, abdomen, back or legs. Less commonly, some women may also experience shortness of breath, abnormal vaginal bleeding, or the need to urinate frequently.

The cause of ovarian cancer is not known, but it does seem to run in some families. Having children at an early age and having multiple children reduces the risk of ovarian cancer, as does taking birth control pills. Certain inherited genetic mutations also increase the risk of developing ovarian cancer.

The extent of spread (stage) of ovarian cancer is typically determined by surgery. Early ovarian cancers may be treated with surgery alone, with an excellent prognosis. Chemotherapy may also be recommended, depending on the stage of the cancer.

The earlier ovarian cancer is caught and treated, the better its prognosis. Seek prompt medical care if you have symptoms suggestive of ovarian cancer, especially if symptoms persist for more than a couple of days. Some complications of ovarian cancer, such as ovarian torsion (twisting of the ovary) or bowel obstruction, can be severe or even life threatening. Seek immediate medical care (call 911) if you, or someone you are with, experience severe symptoms such as the inability to urinate or have a bowel movement, severe abdominal or pelvic pain, or uncontrolled or heavy bleeding.

Symptoms

What are the symptoms of ovarian cancer?

Early ovarian cancer may not produce any symptoms at all. In other cases, initial symptoms of ovarian cancer can be vague and may include gas, bloating, abdominal swelling, changes in bowel movements, and fatigue. You may also experience a sensation of pressure or pain in the abdomen or pelvis as the cancer progresses. Other symptoms may include feeling full early in a meal, shortness of breath, abnormal vaginal bleeding, and urinary frequency.

Common symptoms of ovarian cancer

Early ovarian cancer symptoms are often nonspecific and may seem to be gastrointestinal in origin. As the cancer progresses, you may experience more pronounced symptoms. Common symptoms of ovarian cancer include:

Serious symptoms that might indicate a life-threatening condition

In some cases, complications of ovarian cancer can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these potentially life-threatening symptoms including:

  • Inability to urinate or have a bowel movement

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing

  • Severe abdominal, pelvic or back pain

  • Uncontrolled or heavy bleeding

Causes

What causes ovarian cancer?

The cause of ovarian cancer is not known. Although it does seem to run in certain families, it can occur in women who have no family history of cancer. Early age at first delivery, multiple pregnancies, and birth control pills seem to lower the risk of ovarian cancer, while unopposed estrogen replacement (without complementary progesterone replacement therapy) may increase the risk.

What are the risk factors for ovarian cancer?

A number of factors increase the risk of developing ovarian cancer. Not all women with risk factors will get ovarian cancer. Risk factors for ovarian cancer include:

  • Age 55 or older

  • BRCA1 or BRCA2 genetic mutations (gene changes that increase the risk of developing breast cancer and other cancers)

  • Family history of ovarian or breast cancer

  • First pregnancy after the age of 35

  • Nulliparity (having had no children)

  • Obesity

  • Smoking

  • Unopposed estrogen therapy (estrogen without progesterone)

Treatments

How is ovarian cancer treated?

The goal of ovarian cancer treatment is to permanently cure your cancer or bring about a complete remission of the disease. Remission means that there is no longer any sign of the disease in the body, although it may recur later.

Surgery is the primary treatment of ovarian cancer. During surgery, the abdominal and pelvic cavities are explored for any evidence of cancer spread. The extent of the surgery depends upon the stage of the cancer. Your doctor may use chemotherapy to treat any remaining cancer, even if none is seen during surgery. Radiation therapy is not commonly used to treat ovarian cancer, but may be used to relieve symptoms in recurrent cancer. After your treatment is complete, it is important to continue regular follow-up visits with your doctor as recommended.

It is also very important to follow your treatment plan carefully to ensure the best chance for a cure and to identify any possible recurrence early.

Common treatments for ovarian cancer

Common treatments for ovarian cancer include:

  • Biologic therapy to recruit the body's immune system to fight cancer

  • Chemotherapy to attack cancer cells

  • Participation in a clinical trial testing promising new therapies and treatments for ovarian cancer

  • Radiation therapy to relieve symptoms

  • Surgery to remove the cancer and determine the extent of any spread

Supportive treatments

Other therapies may be added to help boost your general state of health and offset any side effects of treatment. These treatments may include:

  • Antinausea medications

  • Blood cell growth factors to increase the number of healthy blood cells

  • Dietary counseling to help you maintain strength and nutritional status

  • Pain medications as needed

Complementary treatments

Some complementary treatments may help some women to better deal with ovarian cancer and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

Hospice care

In cases in which ovarian cancer has progressed to an advanced stage and has become unresponsive to treatment, the goal of your treatment may shift from curing the disease to focusing on measures to keep you comfortable and maximize your quality of life. Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient’s family members.

What are the potential complications of ovarian cancer?

Complications of untreated ovarian cancer can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of ovarian cancer include:

  • Adverse effects of treatment
  • Ascites (fluid buildup in the abdomen)
  • Bowel or bladder obstruction
  • Electrolyte disturbances
  • Malnutrition
  • Ovarian torsion (twisting of the ovary)
  • Pleural effusion (fluid buildup around the lungs)
  • Spread of cancer
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 21
  1. Ovarian cancer. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001891/.
  2. Ovarian cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/types/ovarian.
  3. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013; 63:11.
  4. Shanbhogue AK, Shanbhogue DK, Prasad SR, et al. Clinical syndromes associated with ovarian neoplasms: a comprehensive review. Radiographics 2010; 30:903.
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