Ovarian Cancer

In the female body, two ovaries (each about an inch-and-a-half long) are located on the left and right sides of the uterus in the pelvic region. Ovaries produce hormones and hold egg cells, which can develop into a fetus when fertilized.

Each year more than 22,000 women in the United States learn that they have ovarian cancer.

When cancer cells are found in the lining of the ovary, the condition is called epithelial ovarian cancer. When malignant cells or tumor are found in the egg-producing cells, the condition is called germ cell ovarian cancer. Genetic screening can help determine if a woman is a carrier of a mutated (changed) gene and, therefore, at greater risk of developing the disease.

Symptoms

Often no symptoms are evident in the early stages of the disease. When symptoms appear, they may include:

  • Gas, nausea, indigestion that does not go away
  • Frequent urination
  • Unexplained change in bowel habits
  • Abnormal postmenopausal bleeding
  • Weight gain or loss
  • Pain during intercourse
  • Abdominal swelling and/or pain, bloating or a feeling of fullness. Ovarian cancer may spread to the sac inside the abdomen that holds the intestines, uterus and ovaries - causing fluid to accumulate and the abdomen to swell.
  • Shortness of breath caused by the spread of the disease to the muscle under the lung. Fluid buildup in the area makes it difficult for the patient to breathe.
If symptoms continue for longer than four to six weeks, patients should insist on a thorough pelvic examination by their doctor.

Risk Factors

  • A family history of the disease, especially in a mother, daughter or sister
  • Family history of breast or colon cancer
  • Being a woman who has had breast or colon cancer
  • Being a women older than age 50
  • Never having had children
  • Having taken certain fertility drugs
Diagnosis

A comprehensive medical history is taken, and a physical exam (including a pelvic examination) is performed. For this, the doctor inserts one gloved finger in the rectum and one in the vagina at the same time. The vagina, rectum and lower abdomen are probed for masses and growths. Taking a mild laxative or enema before the pelvic exam can be helpful. Other tests include:

  • A Pap smear (a common test for cancer of the cervix) is often part of the pelvic exam, though it does not offer a reliable way to diagnose ovarian cancer. Every woman should undergo regular rectal and vaginal pelvic examinations.
  • Transvaginal sonography and tumor markers are alternative ways of diagnosing ovarian cancer.
  • Ultrasonography aims high frequency sound waves at the ovaries. The echo pattern produced creates a picture called a sonogram. Healthy tissues, fluid-filled cysts and tumors produce different echoes.
  • A computed tomography (CT or CAT) scan, a series of computerized X-rays, allows doctors to see cancer cells.
  • A lower GI series, or barium enema, is a series of X-rays of the colon and rectum. Pictures are taken after the patient is given an enema with a white chalky solution containing barium. The barium outlines the colon and the rectum on the X-ray, which helps the doctor see tumors or other abnormal areas.
  • An intravenous pyelogram (IVP) is an X-ray of the kidneys and uterus taken when dye is injected into the body.
  • Blood tests measure a substance in the blood called CA-125. Ovarian cancer cells can produce this tumor marker. CA-125 is not always present in women with ovarian cancer, though it may be present in women who have benign ovarian conditions. This blood test cannot be used alone to diagnose cancer.
A biopsy (removing and examining tissue) of the ovaries is the only way to definitively diagnose cancer. If cancer is suspected, the surgeon removes the entire ovary (oophorectomy) because infected cells could escape and spread when cutting through the outer layer of the ovary. The surgeon also removes nearby lymph nodes, samples of tissue from the diaphragm and other organs and fluid from the abdomen. A pathologist examines these cells to identify cancer. This process, called surgical staging, is needed to find out whether the cancer has spread and to determine a plan for treatment.

Treatment

Treating ovarian cancer depends on a number of factors, including the stage of the disease and the woman's age and general health. Oncologists who specialize in this disease can best determine the treatment plan. Because treatment decisions are complex, more than one doctor's advice can be helpful.

When talking about choices, the patient may want to ask about taking part in a research study or clinical trial. These scientific studies are designed to find new and better ways to treat cancer. Ovarian cancer treatment possibilities are:

  • Surgery to remove the uterus, both ovaries and the fallopian tubes
  • Chemotherapy (anti-cancer drugs)
  • Radiation therapy (also called radiotherapy)

Resources at Cedars-Sinai
Back to Top