Ovarian cancer can start in the ovary’s germ, stromal, or epithelial cells. Germ cells are the cells that become eggs. Stromal cells make up the substance of the ovary. Epithelial cells are the outer layer of the ovary.
Symptoms of ovarian cancer
Early stage ovarian cancer may not have any symptoms. That can make it very difficult to detect. However, some symptoms may include:
- frequent bloating
- quickly feeling full when eating
- difficulty eating
- a frequent, urgent need to urinate
- pain or discomfort in the abdomen or pelvis
These symptoms have a sudden onset. They feel different from normal digestion or menstrual discomfort. They also don’t go away. Learn more about how these early signs of ovarian cancer may feel and what you should do if you think you may have this form of cancer.
Other symptoms of ovarian cancer can include:
- lower back pain
- pain during intercourse
- constipation
- indigestion
- fatigue
- a change in the menstrual cycle
- weight gain
- weight loss
- vaginal bleeding
- acne
- back pain that worsens
If you have these symptoms for longer than two weeks, you should seek medical attention.
You can find a primary care doctor near you through the Healthline FindCare tool.
Causes of ovarian cancer
Researchers do not yet understand what causes ovarian cancer to form. Different risk factors can increase a woman’s chances of developing this type of cancer, but having those risk factors doesn’t mean you will develop the cancer. Read about each risk factor and its role in determining your risk for ovarian cancer.
Cancer forms when cells in the body start growing and multiplying abnormally. Researchers studying ovarian cancer are trying to identify which genetic mutations are responsible for the cancer.
These mutations may be inherited from a parent or they can also be acquired. That is, they occur during your lifetime.
Types of ovarian cancer
Epithelial carcinoma of the ovary
Epithelial cell carcinoma is the most common type of ovarian cancer. It makes up 85 to 89 percent
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of ovarian cancers. It’s also the fourth most common cause of cancer death in women.
This type often doesn’t have symptoms in the early stages. Most people aren’t diagnosed until they’re in the advanced stages of the disease.
Genetic factors
This type of ovarian cancer can run in families and is more common in women who have a family history of:
- ovarian cancer and breast cancer
- ovarian cancer without breast cancer
- ovarian cancer and colon cancer
Women who have two or more first-degree relatives, such as a parent, sibling, or child, with ovarian cancer are at the highest risk. However, having even one first-degree relative with ovarian cancer increases the risk. The “breast cancer genes” BRCA1 and BRCA2 are also associated with ovarian cancer risk.
Factors that are linked to increased survival
Several factors are linked to increased survival in women who have epithelial carcinoma of the ovary:
- receiving a diagnosis at an earlier stage
- being a younger age
- having a well-differentiated tumor, or cancer cells that still closely resemble healthy cells
- having a smaller tumor at the time of removal
- having a cancer caused by BRCA1 and BRCA2 genes
Germ cell cancer of the ovary
“Germ cell cancer of the ovary” is a name that describes several different types of cancer. These cancers develop from the cells that create eggs. They usually occur in young women and adolescents and are most common in women in their 20s.
These cancers can be large, and they tend to grow quickly. Sometimes, tumors produce human chorionic gonadotropin (HCG). This can cause a false-positive pregnancy test.
Germ cell cancers are often very treatable. Surgery is the first-line treatment. Chemotherapy after the surgery is highly recommended.
Stromal cell cancer of the ovary
Stromal cell cancers develop from the cells of the ovaries. Some of these cells also produce ovarian hormones including estrogen, progesterone, and testosterone.
Stromal cell cancers of the ovaries are rare and grow slowly. They secrete estrogen and testosterone. Excess testosterone can cause acne and facial hair growth. Too much estrogen can cause uterine bleeding. These symptoms can be quite noticeable.
This makes stromal cell cancer more likely to be diagnosed at an early stage. People who have stromal cell cancer often have a good outlook. This type of cancer is usually managed with surgery.
Treatment for ovarian cancer
Treatment of ovarian cancer depends on the type, stage, and whether you want to have children in the future.
Surgery
Surgery can be done to confirm the diagnosis, determine the stage of the cancer, and potentially remove the cancer.
During surgery, your surgeon will try to remove all tissue that contains cancer. They may also take a biopsy to see if the cancer has spread. The extent of the surgery may depend on whether you want to be pregnant in the future.
If you want to become pregnant in the future and you have stage 1 cancer, surgery can include:
- removal of the ovary that has cancer and a biopsy of the other ovary
- removal of the fatty tissue, or omentum attached to some of the abdominal organs
- removal of abdominal and pelvic lymph nodes
- biopsies of other tissues and collection of fluid inside of the abdomen
Advanced ovarian cancer surgery
Surgery is more extensive if you don’t want to have children. You also may need more surgery if you have stage 2, 3, or 4 cancer. Complete removal of all areas involved with cancer may prevent you from becoming pregnant in the future. This includes:
- removal of the uterus
- removal of both ovaries and fallopian tubes
- removal of the omentum
- removal of as much tissue that has cancer cells as possible
- biopsies of any tissue that might be cancerous
Chemotherapy
Surgery is usually followed by chemotherapy. Medications can be given intravenously or through the abdomen. This is called intraperitoneal treatment. Side effects of chemotherapy can include:
- nausea
- vomiting
- hair loss
- fatigue
- problems sleeping
Treatment of symptoms
While your doctor prepares to treat or remove the cancer, you may need additional treatment for the symptoms the cancer is causing. Pain is not uncommon with ovarian cancer.
The tumor can put pressure on nearby organs, muscles, nerves, and bones. The larger the cancer, the more intense the pain may be.
Pain may also be a result of treatment. Chemotherapy, radiation, and surgery can leave you in pain and discomfort. Talk with your doctor about ways you can manage ovarian cancer pain.
Diagnosing ovarian cancer
Diagnosing ovarian cancer starts with a medical history and physical exam. The physical exam should include a pelvic and rectal examination. One or more blood tests may also be used to diagnose this condition.
An annual pap smear test does not detect ovarian cancer. Tests that may be used to diagnose ovarian cancer include:
- a complete blood count
- a test for cancer antigen 125 levels, which may be elevated if you have ovarian cancer
- a test for HCG levels, which may be elevated if you have a germ cell tumor
- a test for alpha-fetoprotein, which may be produced by germ cell tumors
- a test for lactate dehydrogenase levels, which may be elevated if you have a germ cell tumor
- a test for inhibin, estrogen, and testosterone levels, which may be elevated if you have a stromal cell tumor
- liver function tests to determine if the cancer has spread
- kidney function tests to determine if the cancer has obstructed your urine flow or spread to the bladder and kidneys
Other diagnostic studies can also be used to check for signs of ovarian cancer:
Biopsy
A biopsy is essential for determining if cancer is present. During the procedure, a small tissue sample is taken from the ovaries to look for cancer cells.
This can be done with a needle that’s guided by a CT scan or by an ultrasound. It can also be done through a laparoscope. If fluid in the abdomen is present, a sample can be examined for cancer cells.
Imaging tests
There are several types of imaging tests that can look for changes in the ovaries and other organs that are caused by cancer. These include a CT scan, MRI, and PET scan.
Checking for metastasis
If your doctor suspects ovarian cancer, they may order other tests to see if the cancer has spread to other organs. These tests may include the following:
- A urinalysis can be done to look for signs of infection or blood in the urine. These can occur if cancer spreads to the bladder and kidneys.
- A chest X-ray can be done to detect when tumors have spread to the lungs.
- A barium enema can be done to see if the tumor has spread to the colon or rectum.
Ovarian cancer risk factors
While a cause for ovarian cancer is not known, researchers have identified several risk factors that may increase your risk for developing this type of cancer. They include:
- Genetics: If you have a family history of ovarian, breast, fallopian tube, or colorectal cancer, your risks for developing ovarian cancer are higher. That’s because researchers have identified certain genetic mutations that are responsible for these cancers. They can be passed from parent to child.
- Personal medical history: If you have a personal history of breast cancer, your risk for ovarian cancer is higher. Likewise, if you’ve been diagnosed with certain conditions of the reproductive system, your odds of developing ovarian cancer are higher. These conditions include polycystic ovary syndrome and endometriosis, among others.
- Reproductive history: Women who use birth control actually have a lower risk of ovarian cancer, but women who use fertility drugs may have a higher risk. Likewise, women who’ve been pregnant and breastfed their infants may have a lower risk, but women who’ve never been pregnant are at an increased risk.
- Age: Ovarian cancer is most common in older women; it’s rarely diagnosed in women under age 40. In fact, you’re more likely to be diagnosed with ovarian cancer after menopause.
- Ethnicity: Non-Hispanic white women also have the highest risk of ovarian cancer. They’re followed by Hispanic women and black women.
- Body size: Women with a body mass index over 30 have a higher risk for ovarian cancer.
Ovarian cancer survival rates
Survival rates are an indication of how many people with the same type of cancer are alive after a specific period of time. Most survival rates are based on five years. While these numbers do not tell you how long you may live, they do provide an idea of how successful treatment for a particular type of cancer is.
For all types of ovarian cancer, the five-year survival rate is 47 percent
However, if ovarian cancer is found and treated before it spreads outside the ovaries, the five-year survival rate is 92 percent
Can ovarian cancer be prevented?
Ovarian cancer rarely shows symptoms in the early stages. As a result, it’s often not discovered until it has progressed into advanced stages.
These factors include:
- taking birth control pills
- having given birth
- breastfeeding
- tubal ligation (also known as “getting your tubes tied”)
- hysterectomy
Tubal ligation and hysterectomy should only be performed for valid medical reasons. For some, a valid medical reason may be reducing your risk of ovarian cancer. However, you and your doctor should discuss other prevention options first.
You should talk to your doctor about early screening for ovarian cancer if you have a family history of it. Specific gene mutations can put you at risk for ovarian cancer later. Knowing if you have these mutations can help you and your doctor stay vigilant for changes.
At Amrita Medical Center, our staff is happy to answer any of your questions and help you decide if the right fit for you. We even offer same day appointments for your convenience. Contact us here!