Understanding the Different Types of Ovarian Cancer
- There are three different types of ovarian cancer: epithelial, stromal and germ cell
- The different types tend to affect woman at different ages and often, treatment approaches will vary depending on the type
- Epithelial, which tends to be diagnosed in women over 50, is the most common type of ovarian cancer — making up about 90 percent of all cases
The three types of ovarian cancer are epithelial, stromal and germ cell, with epithelial being the most common.
Epithelial Ovarian CancerRead More
Epithelial carcinomas arise from the surface layer of cells covering the uterus, and within this category, there are subgroups, with serous tumors being the most common. This type of cancer is usually treated with a combination of surgery and chemotherapy, although hormone therapy may also be prescribed.
Understanding epithelial subgroups
Another kind of epithelial ovarian cancer is called endometrioid. Dr. Lynn Parker, a gynecologic oncologist with the Norton Cancer Institute in Louisville, Kentucky, told SurvivorNet in a previous conversation that this “is the same kind of cancer that can be in the lining of the uterus as well.”
Dr. Lynn Parker explains the different types of ovarian cancer and how they may be treated differently.
This type of tumor can sometimes be associated with endometriosis, although most women with endometriosis do not have any malignancy.
A third type of epithelial ovarian cancer is called mucinous, which makes mucous-like fluid. Dr. Parker explained that doctors believe these cancers come from the glands that surround the ovary.
Two other types of epithelial tumors — clear cell and undifferentiated — are fairly rare.
Regardless of the subgroup, epithelial ovarian cancers are usually treated with a combination of surgery and chemotherapy.
Stromal Ovarian Cancer
Stromal ovarian cancers grow in hormone-producing cells, and make up about 5 percent of all ovarian cancers. These tumors can occur at any age, though some occur more commonly during adolescence. However, unlike some epithelial cancers, the majority of these tumors are diagnosed at an early stage, and can be treated with surgery alone.
There are several types of sex-cord stromal tumors, but the most common type is called a granulosa or theca cell tumor. Unlike epithelial tumors, these tumors usually develop in women in their 30s and 40s, though they can also be in older women or even young girls.
Dr. Parker explained that this type of tumor tends to make hormones. “Granulosa cell tumors can make estrogen, and they can actually cause a uterine cancer by secreting a lot of estrogen.”
If a woman has a mass and bleeding, doctors will consider the possibility of stromal ovarian cancer.
Dr. Heidi Gray, a gynecologic oncologist at the Seattle Cancer Care Alliance, explains important decisions ovarian cancer patients should make before surgery.
Stromal ovarian cancer is usually treated with surgery. However, since the disease is often diagnosed in younger woman, the topic of fertility preservation is an important one to discuss with your doctor before treatment begins, if that’s something that is important to you.
“If a woman is young and wants to preserve fertility, we can manage that with fertility-sparing surgery and staging,” Dr. Parker said. “And a lot of patients in that category have early stage disease, and don’t need further treatment after surgery.”
Germ Cell Ovarian Cancer
The third group of ovarian cancer tumors is germ cell tumors, and they account for about 5 percent of all primary ovarian cancer diagnoses. These tumors develop in the egg-producing cells. This type of disease also tends to be diagnosed in younger women — including women in their early 20s.
Diagnosing Germ Line Tumors
Doctors can test women with suspected germ cell tumors for elevated levels of three different markers:
- Alpha-fetoprotein (AFP)
- Lactate dehydrogenase (LDH)
- Human chorionic gonadotropin (hCG)
Germ cell ovarian cancers also tend to be diagnosed early and treated with surgery. Chemotherapy isn’t generally necessary unless the cancer is diagnosed at a later stage. For young women with this type of disease, doctors may be able to perform fertility preserving surgery.
Dr. Michael Ulm explains how fertility preserving surgery works.
Dr. Michael Ulm, a gynecologic oncologist at West Cancer Center in Memphis, Tennessee, told SurvivorNet in a previous conversation that he tries to encourage his patients hoping to preserve fertility to see a fertility specialist before they begin any type of treatment.
“Patients with stage I ovarian cancer, where it’s just confined to the ovary, are candidates for what’s called a fertility-sparing staging,” Dr. Ulm explained.
“That’s where we try to leave the other ovary and [fallopian] tube…Our goal is normally to debulk the disease and stage the ovarian cancer in a way that spares the remaining tube and ovary, as well as the uterus and cervix.”
Another option for fertility preservation is to freeze your eggs or embryos before surgery through a method called cryopreservation. This involves collecting eggs. Then, either the eggs themselves are frozen, or they’re fertilized through in vitro fertilization (IVF) and then the resulting embryo is frozen. After treatment is complete, the egg can be thawed and fertilized, or the embryo can be thawed and implanted into your uterus.
Diagnosing Ovarian Cancer
One thing that three types of ovarian cancer have in common is that they can be difficult to diagnose. Though stromal and germ line tumors are more likely to be caught early, all three categories can present non-specific symptoms that might be attributed to a number of other issues — from menopause to over-eating. Unfortunately, most women don’t take their symptoms to a doctor until they become severe.
Because there’s no widely available screening for ovarian cancer — like a mammogram for breast cancer or a Pap smear for cervical cancer — it’s important to be aware of the signs and symptoms of the disease.
Symptoms to look out for include:
- Feeling bloated or full
- Pain in the pelvis or abdomen
- Changes in bowel habits
If you begin experiencing some of these symptoms, professionals say it’s better to be safe that sorry.
“We don’t have a good screening method, but if you have symptoms, it’s very important that you go to your physician because there might be an opportunity that we can detect it when it’s still early stage,” Dr. Jose Alejandro Rauh-Hain, a gynecologic oncologist at MD Anderson Cancer Center, told SurvivorNet
“It’s very important that patients are not afraid to ask questions to their physicians. Because the sooner we can diagnose the cancer, the better that prognosis.”