In the United States, the fifth most common cancer among women is ovarian cancer. It is the leading cause of death of cancers of the female reproductive organs. It is estimated that approximately 21,880 women were diagnosed with ovarian cancer in 2010, in the US, and that approximately 13,500 died of ovarian cancer in 2010.
The ovaries are two small organs located in the pelvis on either side of the uterus. The ovaries are responsible for the production of hormones and eggs for fertilization. Ovarian cancer occurs when cells of the ovary grow out of control and produce one or multiple abnormal growths called tumors. There are three categories of cancer or tumor growths that arise from the ovary. The most common ovarian cancer arises from the cells that line the ovarian surface and is called ovarian epithelial cell carcinoma and accounts for 90% of ovarian cancers. Another category is the ovarian germ cell cancer that arises from the cells that produce eggs for fertilization.
The third category of cancer arises from the cells responsible for hormone production and is called ovarian stromal cancer.
Women with early ovarian cancer may have a nonspecific stomach or pelvic discomfort, an irregular menses, an urge to urinate frequently, bloating of the stomach and constipation. These same symptoms may be present with more advanced disease in addition to shortness of breath, vomiting, sensation of fullness, poor appetite and weight loss.
The average age at diagnosis is 59 for epithelial ovarian cancers. A woman whose parent or sibling has ovarian cancer has an increased risk for the development of ovarian cancer. Women from families with multiple cases of breast and/or ovarian cancer should consider genetic testing to determine whether or not they carry a genetic mutation that predisposes them to ovarian or breast cancer.
Other risk factors for ovarian cancer include a diet high in animal fat, never having a baby, first birth after 35, late onset of menopause and early start of menses. Oral contraceptive use is associated with a decreased risk of ovarian cancer.
There is no data to support the use of ovarian cancer screening in the general population. Until a screening test is developed the best thing to do is be aware and report to your doctor new symptoms that develop.
For the majority of women of childbearing age, a large number of ovarian masses are functional cysts that decrease in size after several menstrual cycles. These cysts can be further evaluated with an ultrasound.
In the older woman a palpable pelvic mass may indicate the presence of an ovarian cancer. If ovarian cancer is suspected then tests are performed to further evaluate the mass and may include body scans and blood test to check for a tumor marker (CA125) that if elevated can be specific for ovarian cancer.
The definitive diagnosis of ovarian cancer is through surgical exploration. If cancer is present upon surgical exploration then an effort is made to remove the cancer through what is called a debulking surgery. This surgery involves of removal of the uterus, fallopian tubes, ovaries, sampling of lymph nodes in addition to removing the majority of tumor present. The prognosis is determined by the amount of residual tumor left behind after the debulking surgery. If ovarian cancer is found at its earliest stage the 5-year survival is around 90%.
Following surgery the woman may receive chemotherapy based upon the stage of the cancer.
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Catherine Jones, M.D.