Ovarian Cancer

Overview »

Overview

This comprehensive guide to ovarian cancer features advice from some of the nation's top gynecologic oncologists, to guide you through every stage of the diagnosis and treatment process

Ovarian Cancer Overview

Ovarian cancer has been called the “cancer that whispers,” because women often don’t experience symptoms until their cancer has already reached its late stages. The symptoms that do appear at first are hard to identify as cancer. This subtlety of symptoms makes it essential for women to know the warning signs, and report them to their doctor, say SurvivorNet’s experts.

The term ovarian cancer refers to a number of different tumors that grow in the ovary. The ovaries produce the sex hormone, estrogen, as well as eggs. Every woman has two ovaries, one on either side of her uterus. The fallopian tube picks up the egg from the ovary and carries it to the uterus for fertilization.

Many ovarian cancers actually begin in the fallopian tubes. A few cancerous cells first grow on the fallopian tubes and then, as the fallopian tubes brush over the ovary, these cells stick to the ovaries and eventually grow to form a tumor.

There isn’t just one ovarian cancer; there are many different types that occur at different stages of life. In fact, researchers have identified over 30 types, but these three are the most common:

  • Epithelial. About 90% of ovarian cancers are epithelial, which means the cancer cells are located on the outer layer of the ovary. Most epithelial tumors are not cancerous, but when they are cancerous, they can spread before they’re detected.
  • Stromal. This rare type of tumor forms in the connective tissue that holds the ovary together and produces estrogen and progesterone.
  • Germ cell. These tumors, which develop in the cells that produce the eggs, are more likely to affect a single ovary, rather than both ovaries. When a teen or young woman is diagnosed with ovarian cancer, it’s usually the germ cell type. The good news is that most women with these types of ovarian cancers can be cured.

 

What Increases Your Risk for Ovarian Cancer?

The jury is out on exactly what causes ovarian cancer. Considering that both pregnancy and taking birth control pills lower the risk for ovarian cancer, and both reduce the number of times a woman ovulates throughout her lifetime, some researchers think that there may be a link between ovulation and the risk of developing ovarian cancer.

A few factors might increase the risk for ovarian cancer. Having these factors doesn’t mean you will definitely get this cancer, only that your risk is slightly higher.

Your risk for ovarian cancer may be increased if you:

  • Have gone through menopause. Ovarian cancer is rare in women younger than 40.
  • Have a gene mutation. The BRCA1 and BRCA2 genes help cells repair their DNA damage. Having a change, or mutation, in one of these genes increases your risk of getting ovarian cancer. These gene mutations are commonly passed down in families. If one of your close relatives carries a BRCA gene mutation, there’s a 50-50 chance you could be carrying it, too.
  • Are overweight or obese. Being very overweight might not only affect your risk of getting ovarian cancer, but also your survival if you are diagnosed with this cancer.
  • Had your first pregnancy after age 35, or never carried a pregnancy to full-term. Of course, this doesn’t mean that women should have children just to protect themselves.
  • Have family members with cancer. Your risk might be higher if you have close family members (such as your mother, sister, aunt, or grandmother) who have had ovarian, breast, or colorectal cancer. Genes that increase the risk for these cancers run in families.
  • Used hormone replacement therapy. Women who take estrogen and progesterone after menopause are at slightly higher risk than are women who don’t use these hormones.

A few things might lower your risk for ovarian cancer, including:

  • Having children. Giving birth, particularly to two or more children if that is your choice to do, can significantly reduce your risk for ovarian cancer.
  • Using birth control pills for five or more years. However, hormonal birth control also comes with its own risks, which women should consider when making the choice to take them.
  • Breastfeeding. Breastfeeding for as little as one to three months can reduce the risk of the deadliest type of invasive ovarian cancer.
  • Having surgery. Surgery to get your tubes tied, remove both ovaries, or remove the uterus (hysterectomy), might lower your risk for ovarian cancer. However, surgery comes with its own risks.

Could taking birth control pills lower your risk for ovarian cancer? Nurse practitioner Barbara Dehn explains which factors might affect your chances of developing this cancer.

While these things may help reduce the chance of getting ovarian cancer, they are not recommended for everybody. Each one has risks and benefits worth considering, and discussing with your doctor.

 

Should You Get Screened?

No routine screening tests are recommended for women who are at average or low risk for ovarian cancer. And because symptoms can be subtle and hard to distinguish from everyday ailments like a stomach bug, SurvivorNet’s medical experts say women need to know their family history, be vigilant for symptoms, and ask their doctor for testing if they have any unusual or persistent symptoms.

If you have a family history of breast or ovarian cancer, ask your doctor whether you should have genetic counseling and testing. Genetic testing for ovarian cancer can lead to life-saving actions, like tests for early detection. And when it comes to ovarian cancer, which has greater than a 90% survival rate when diagnosed in its earliest stages, genetic testing can be a valuable option.

Medical oncologist Dr. Derrick Haslem explains why women with a strong family history of ovarian cancer should talk to their doctor about genetic testing 

Screening is available for women with:

  • A family history of ovarian cancer
  • An inherited genetic condition like Lynch syndrome
  • A mutation in a gene called BRCA1 or BRCA2
  • A mutation in other genes associated with hereditary ovarian cancer
  • Recurring symptoms of ovarian cancer

Doctors recommend testing women in these situations with a transvaginal ultrasound or CA-125 blood test.

For women at lower risk, the best chance of catching ovarian cancer early is to go to your doctor with any symptoms—such as bloating, abdominal pain, and changes in bowel habits—immediately. It’s important that women not be afraid to ask about their symptoms, because the sooner doctors can diagnose this cancer, the better the outlook will be.

Gynecologic oncologist Dr. Beth Karlan, on why it’s important to push for a diagnosis if you have symptoms of ovarian cancer 

 

What are the Symptoms of Ovarian Cancer?

According to the medical oncologists SurvivorNet consulted, the symptoms of ovarian cancer can include:

  • A feeling of bloating or fullness
  • Pain in the pelvis or abdomen
  • Nausea
  • Vomiting
  • Changes in bowel habits

Any of these can be similar to symptoms many women experience monthly with their menstrual cycle, which makes distinguishing this cancer so difficult.

Gynecologic oncologist Dr. Lisa Diver explains why ovarian cancer is called “the cancer that whispers,” and why women need to advocate for themselves if they do have symptoms 

Additional ovarian cancer symptoms can include:

  • Bleeding from the vagina (especially after menopause)
  • Unusual discharge from the vagina
  • Pain or pressure in the pelvis
  • Belly or back pain
  • Feeling full too quickly, or having difficulty eating
  • A change in urinary or bowel habits, such as a more frequent or urgent need to urinate and/or constipation
  • Extreme fatigue
  • Pain during sex

If these symptoms are new for you, or they don’t go away after a week or so, call your doctor and schedule an appointment.

 

Getting a Diagnosis

One thing that various types of ovarian cancer have in common: They’re tricky to diagnose. Here’s what you can expect to happen during your workup, according to SurvivorNet’s specialists:

Medical history. Not only will your doctor ask you how long you’ve been experiencing these symptoms, but they will also want to know your family’s medical history. Did any of your relatives have ovarian cancer or other types of cancer?  About 15% of ovarian cancer cases have a hereditary connection, mostly due to mutations in the BRCA1 or BRCA2 gene (which can also factor into breast cancers).

Physical exam. Once you’re done talking, your doctor will examine you. Along with all the normal measurements — blood pressure, weight, etc. — they will most likely perform a pelvic exam. This should include a rectovaginal exam, so the doctor can feel the tissue behind the uterus where the ovaries are located.

Nurse navigator Cindy Cantril explains why it’s important for women who are diagnosed with ovarian cancer to seek a second opinion

Imaging tests. In order for your doctor to get a better picture of what’s happening, you may get a transvaginal ultrasound — an exam that uses ultrasound waves to help your doctor see your ovaries and other organs in your pelvis.

There’s also a chance your doctor will want to do more in-depth imaging and send you for a computed tomography (CT) scan. This imaging test takes highly detailed cross-sectional pictures of your body, and it can show your doctor whether the cancer, if present, has spread to other organs or if lymph nodes are enlarged.

Blood test. Your doctor may also take a blood sample as part of the exam. The CA-125 blood test is a barometer for many ovarian cancers. If your doctor suspects you might have ovarian cancer, it can be very helpful. You should get it early in the course of your diagnosis, so your oncologist can monitor the progression of your disease and evaluate the impact any treatments have on it.

Getting diagnosed with ovarian cancer can be an anxiety-provoking experience. Physician’s Assistant Marisa Gholson offers advice to help you manage your worries and be better equipped to handle your diagnosis.

 

Ovarian Cancer Treatment Options

If your doctor diagnoses you with ovarian cancer, you might be referred to a gynecologic oncologist. The following treatments are available for ovarian cancer:

Surgery Then Chemotherapy, or Vice-Versa

Surgery and chemotherapy both factor into treatment for most women with ovarian cancer. The only variation is the sequence in which women get them, according to SurvivorNet’s experts.

Several factors go into deciding what kind of treatment is best, depending on the type and stage of ovarian cancer, your age, and whether you are planning to have children in the future. Surgery is usually the first treatment recommended, with chemotherapy afterward to get rid of any cancer that may have been left behind. The other option is to have chemotherapy first, called neoadjuvant chemotherapy, to shrink the tumor so that it’s easier to remove surgically.

Should you get surgery first, or chemotherapy? Gynecologic oncologist Dr. John Nakayama outlines your options.

If a doctor is confident that he or she can remove the ovarian tumor completely without initial cycles of chemotherapy, they will go ahead with a surgical procedure. Doctors who are not confident they can perform successful surgical tumor removal will go with chemotherapy initially, then proceed with surgery once tumors have shrunk.

 

Chemotherapy

Chemotherapy can shrink ovarian cancers. The standard chemotherapy regimen for ovarian cancer is made up of two drugs in combination:

  • a platinum-based chemotherapy drug like carboplatin or cisplatin
  • a taxane chemotherapy drug such as paclitaxel (Taxol) or docetaxel (Taxotere)

Women with ovarian cancer typically get these treatments through an IV every three to four weeks. The usual course of chemotherapy is made up of three to six treatment cycles, based on the cancer stage, but different drugs have different treatment cycles.

Gynecologic oncologist Dr. Adam ElNaggar, on what you can expect if you get chemotherapy for ovarian cancer

 

Maintenance Therapy

After the initial treatment with surgery and chemotherapy got rid of as much of the cancer as possible, the next goal is to extend the amount of time before the cancer comes back. Doctors call this maintenance therapy, and for ovarian cancer it can include two drugs:

PARP inhibitors work by preventing cancer cells from repairing their damaged DNA. They have shown great promise in keeping the cancer from returning. These drugs can also now be used in the initial treatment of ovarian cancer.

Dr. Ursula Matulonis, chief of gynecologic oncology at Dana-Farber Cancer Institute, discusses how doctors are using PARP inhibitors to treat their patients with ovarian cancer

 

Late-Stage Ovarian Cancer Treatment

With stage IV ovarian cancer, the cancer cells have spread beyond the abdominal cavity to other organs. There may be tumors inside the liver (not just on the surface), inside the spleen, in and around the lungs or other organs outside the abdomen and pelvic region, and possibly in the bones, say SurvivorNet’s experts.

Stage IV ovarian cancer can be treated like stage III, with surgery to remove the tumor and debulk the cancer, followed by chemo (and possibly the targeted drug Avastin). Another option is to try chemo first. Then, if the tumors shrink from the chemo, surgery may be done, followed by more chemo.

Can women with stage IV ovarian cancer be treated with surgery? Mayo Clinic gynecologic oncologist, Dr. Amanika Kumar, explains how your cancer’s stage might affect the type of surgery you get to treat it 

 

Palliative care, which is aimed at improving comfort (but not at fighting the cancer), is another option. It doesn’t replace chemotherapy, surgery, and other active treatments. You get palliative care along with these treatments to make you more comfortable.

Palliative care is a whole-patient approach to care, according to gynecologic oncologist, Dr. Daniel Metzinger 

The chemo drug carboplatin puts most of the women who receive it into remission, according to the medical oncologists SurvivorNet consulted. However, during the next five years, 70 to 80 percent of women who’ve gone into remission may have a recurrence, when their cancer comes back.

That’s why post-treatment living entails surveillance visits every three months or so for the first two years of remission. These visits can help your doctors and care team monitor your body for any early signs of recurrence.

Typically, a surveillance visit for ovarian cancer will include the following:

  • A physical exam, during which a doctor checks your body for any signs of recurrence
  • A conversation about symptoms, including changes in bowel habits or an increase in pain
  • A CA-125 blood test, which can indicate recurrence in cases where a woman does not have symptoms

Many women will be able to push these visits to every six months after the two-year mark, and then once a year after the five-year mark.