Ovarian Cancer

Ovarian cancer is the fifth leading cause of cancer deaths in women. About 1 in 70 women will develop ovarian cancer. There are approximately 20,000 new cases of ovarian cancer each year in the United States. Because there are no specific early warning symptoms and effective screening tests do not exist, 75% of all ovarian cancers are diagnosed after the disease has spread beyond the pelvis.

What causes ovarian cancer?
We do not know exactly what causes ovarian cancer, but we do know what increases or decreases ovarian cancer risk. Ovarian cancer can either be sporadic (random) or familial (hereditary). Ninety percent of all ovarian cancers are sporadic, occurring by chance. The following factors increase your risk of ovarian cancer.

Ovarian Cancer Risk Factors

The following can increase your risk of developing ovarian cancer:

  • Older women are diagnosed more often with ovarian cancer.
  • You have a close relative (mother, sister, daughter on either parents’ side) that has or had a family history of ovarian, breast or colorectal cancer.
  • You have a personal history of breast cancer.
  • You had your first child after age 35 or never had children.

Risk Factors for Familial Ovarian Cancer

Up to 25% of all ovarian cancer is familial, meaning that it is passed through genes. People with familial ovarian cancer have mutations in the BRCA1 or BRCA2 gene (or both). Changes in these genes significantly increase the risk for developing ovarian cancer (and breast cancer).

If you have two or more close relatives who have had ovarian cancer, you have a higher risk of developing ovarian cancer. A family history of breast, endometrial, pancreatic, prostate, or colon cancer, may also mean your family could have certain gene mutations that increase the risk for ovarian cancer.

Syndromes passed in families and linked to increased risk of ovarian cancer include:

  • Lynch syndrome or hereditary nonpolyposis colon cancer (HNPCC). This increases a woman's risk of having ovarian, uterine, colon, and other cancers at a much younger age than normal.
  • Peutz-Jeghers syndrome (PJS)- This rare genetic syndrome is caused by a certain gene mutation (gene STK11). It’s linked with a higher risk for ovarian, breast, uterine, esophagus, stomach, colon, and lung cancer.
  • MUTYH-associated polyposis-This causes polyps in the colon and small intestine. It’s linked with a high risk for colon cancer. It also puts people at a higher risk for other cancers, including ovary and bladder cancers.

If you are concerned about your family's history of cancer and that it might be linked to an increased risk of ovarian cancer, talk with your provider about genetic counseling. The genetic counselors at Northside’s Cancer Genetics Program can help determine if you carry the mutation of the BRCA1 or BRCA2 genes, or any other mutations.   

Ovarian Cancer Prevention

Some steps may reduce your risk of getting ovarian cancer:

  • Women who took birth control pills for three or more years are 30-50% less likely to develop ovarian cancer.
  • Breastfeeding your baby lowers your risk.
  • Women who have been pregnant are less likely to develop ovarian cancer.  
  • See your gynecologist once a year for a full exam. Remember, Pap tests detect cervical cancer NOT ovarian cancer.
  • Talk with your doctor about genetic testing if a close relative has or had ovarian cancer or breast cancer.

Warning Symptoms of Ovarian Cancer

It is very important for women to know the early warning signs of ovarian cancer and to see their healthcare provider if they experience the symptoms.

  • Vague abdominal and pelvic discomfort
  • Bloating
  • Unexplained gastrointestinal symptoms like excess gas, indigestion and back pain
  • A feeling of pressure in the pelvic area
  • Unexplained weight gain or loss
  • A feeling of fullness, even after a small meal
  • Fatigue
  • Pain during intercourse

If, after reviewing the risk factors and warning symptoms you feel you are at risk, you should be screened for ovarian cancer. If your gynecologist examines you and there is an indication that you have a suspicious ovarian mass, you should see a gynecologic oncologist for evaluation and possible surgery. Ovarian cancer cannot be diagnosed without tissue sampling; this happens at the time of surgery.

Surgical Treatment of Ovarian Cancer

Your treatment options depend on how much cancer there is, if and how far it has spread (stage), and gene changes in the cancer cells. Your age, overall health, desire to have children, and preferences are also key.

Your provider may advise a combination of treatments. For instance, in most cases, ovarian cancer is treated with surgery followed by chemotherapy (chemo). But sometimes chemo is given before surgery. This is done to shrink the cancer and make it easier to remove.

Surgery: The goal of surgery in ovarian cancer is to remove the organs and tissues where the cancer usually spreads to see if there is cancer present (called staging) and to remove as much cancer as possible (called debulking). For many patients, surgery can be done robotically with a few small incisions and a quick return to normal activity.

Ovarian Cancer Staging: Staging removes tissue where ovarian cancer is often found but might be too small to be seen with just the eye at surgery. Staging includes removing the uterus, fallopian tubes, ovaries and appendix (if it has not already been removed). The omentum, an apron of fat tissue that hangs down from the colon (large intestine) and drapes over the small intestine, is also removed. Everyone has this apron of fat, and ovarian cancer often spreads there. Lastly, your physician checks the lymph nodes in the pelvis and sometimes higher up toward the heart (in the para-aortic region).

Lymph nodes are found throughout the body as part of the filtration system. They “catch” cancer cells that break off from the original tumor. Finding cancer cells in the lymph nodes tells us that the cancer has begun to spread. Even if we cannot see or feel any other cancer, the lymph nodes may have cancer cells inside them. The pathologist looks at all tissues we remove to see if the cancer has spread. This tells us the stage of the cancer and whether chemotherapy is needed.

Debulking: If cancer has spread beyond the ovaries, further surgery, called debulking, may be necessary. The goal of debulking is to remove all visible tumor or to remove as much tumor as possible. (“Optimal debulking” means removing all visible tumor or leaving tumor that is less than 1.5 centimeters in diameter.) The most common debulking procedures are to remove parts of the small or large intestine since those areas are often involved with ovarian cancer. The pre-operative bowel prep enables the surgeon to safely reattach the intestines. Rarely, you may need a colostomy or ileostomy which is done only if absolutely necessary. Other rare procedures involve the liver, spleen, and bladder.

For any additional procedure, your surgeon performs only what is in your best interest. Your physician considers the benefits and risks of the procedure. Only if the benefits for the patient outweigh the risks will the procedure be done. If the risks and benefits seem equal or if the risks outweigh the benefits, the procedure is not performed.

Learn more about Ovarian Cancer Treatment Options.

Before Your Surgery

  • Prior to your surgery, we will perform a few other tests. These may include:
  • Blood tests to determine anemia and check kidney and liver function
  • Chest X-ray
  • CT (computed tomography) scan of abdomen and pelvis and possibly chest
  • Colonoscopy (depending on age and symptoms)
  • Consultation with a urologist for possible cystoscopy (depending on age and symptoms)
  • Consultation with primary care physician or specialist to determine your risk for surgery (depending on age and your medical history and symptoms) 

You will also have a teaching visit with one of our nurses to talk to you about what to expect from your surgery, how to prepare for the surgery, what to expect from your recovery, and to answer any questions you may have. The day before surgery, we ask you to clean out your intestines (called a "bowel prep"). This helps your surgeon to safely move the intestines out of the way during surgery or operate on them if needed.

Stages of Ovarian Cancer

All gynecologic cancers, including ovarian cancer, are staged. Staging is a way of talking about how far a cancer has spread from where it started and helps guide our recommendations for treatment.  If ovarian cancer is diagnosed, your physician can inform you of the stage of your disease.

Stage I. The cancer is contained in the ovaries.

  • IA: The cancer is completely contained in one ovary,
    and there are no cancer cells in the washing of the abdomen and pelvis.
  • IB: The cancer is completely contained in both ovaries, and there are no
    cancer cells in the washing of the abdomen and pelvis.
  • IC: The cancer is present in one or both ovaries and on the surface of the
    ovaries. Washing of the abdomen and pelvis show cancer cells present.

Stage II. The cancer has spread to other organs in the pelvis.

  • IIA: The cancer has spread to the uterus, fallopian tubes, or both.
    The washings of the abdomen do not show cancer cells.

Stage III. The cancer has spread beyond the pelvis and is present in the lining of the abdomen or lymph nodes.

  • IIIA: During surgery there was no visible sign of involvement in the abdomen or
    lymph nodes. However, biopsies show microscopic disease in the lower abdomen.
  • IIIB: The cancer has spread to the abdomen and is up to 2 cm (3/4") across.

Stage IV. This is the most advanced stage and the cancer has spread (metastasized) to other organs outside the peritoneal cavity, usually the space outside the lung.

  • IVA: The cancer is found in fluid around the lungs.
  • IVB: The cancer has spread to the liver, spleen or organs in the chest.

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