Obstetrics and Gynecology

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Ovarian Cancer

What is Ovarian, Fallopian Tube, and Peritoneal Cancer?

Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs. Cancer of the fallopian tubes and peritoneum are often referred to as ovarian cancer also since they are treated in the same manner.

What Causes Ovarian Cancer?

A woman has a 1 in 67 chance of developing ovarian cancer. Ovarian cancer is the fifth most common cancer among women, and it causes more deaths than any other type of female reproductive cancer. The cause is unknown. The risk for developing ovarian cancer appears to be affected by several factors. The more children a woman has and the earlier in life she gives birth, the lower her risk of ovarian cancer. Certain genes (BRCA1, BRCA2, mismatch repair genes (Lynch II syndrome)) are responsible for a small number of ovarian cancer cases. Fallopian tube and peritoneal cancer are also closely related to BRCA1 and BRCA2 gene changes also. Women with a personal history of breast cancer or a family history of breast or ovarian cancer also have a greatly increased risk for ovarian cancer. The use of fertility drugs may be associated with an increased chance of developing ovarian cancer, although this is a subject of ongoing debate. The links between ovarian cancer and talc use, asbestos exposure, a high-fat diet, and childhood mumps infection are controversial and have not been definitively proven. Older women are at highest risk. About two-thirds of the deaths from ovarian cancer occur in women age 55 and older. About 25% of ovarian cancer deaths occur in women between 35 and 54 years of age.  

Symptoms of Ovarian Cancer?

Ovarian cancer symptoms are often vague and non-specific, so women and doctors often blame the symptoms on other, more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries. Bloating Symptoms:

  • Sense of pelvic heaviness
  • Changes in urinary habits (frequency, urgency)
  • Vague lower abdominal discomfort
  • Vaginal bleeding or discharge
  • Weight gain or loss especially with expanding abdominal girth
  • Abnormal menstrual cycles
  • Unexplained back pain that worsens over time
  • Increased abdominal girth 

Non-specific gastrointestinal symptoms:

  • Increased gas
  • Indigestion
  • Lack of appetite
  • Nausea and vomiting
  • Inability to ingest usual volumes of food

Ovarian Cancer Exams and Tests Available:

A physical examination may reveal increased abdominal girth and ascites (fluid within the abdominal cavity). A pelvic examination may reveal an ovarian or abdominal mass. A bimanual rectovaginal examination is a key element in the physical examination.

Tests include:

  • Complete blood count
  • CA125
  • Nutritional markers (albumin, prealbumin)
  • Ultrasound
  • Abdominal/pelvic CT scan
  • In young patients
  • Quantitative serum HCG (blood pregnancy test), Alpha fetoprotein and Lactate dehydrogenase

Ovarian Cancer Treatment Options:

Surgery is the preferred first-line treatment and is often needed to diagnose ovarian cancer. Multiple studies have shown that primary surgery performed by a gynecologic oncologist (a specifically trained women’s cancer doctor who does 3 or more years of fellowship training after an ob/gyn residency) results in a higher cure rate. The key to surgery is the removal of all visible or palpable disease if possible (complete cytoreduction). Surgery is also performed for recurrent disease in specific patients. Surgery is usually performed by laparotomy (open incision) except for rare cases. Chemotherapy is often used as after surgery to treat women with ovarian cancer. Chemotherapy can also be used if the cancer comes back. Controversy still exists as to whether it is better to have chemotherapy in the veins (intravenous) or in the abdomen (intraperitoneal). Results from surgery help to determine what the best method is for each individual patient. Chemotherapy before surgery (neoadjuvant chemotherapy) is only beneficial in patients unable to tolerate initial debulking surgery. Radiation therapy is rarely used in ovarian cancer in the United States. It is most commonly used for palliative purpose to decrease pain at the end of life.

Ovarian Cancer Prognosis:

Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made.

  • If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the 5-year survival rate is about 94%.
  • The key to long term survival in advanced disease is complete removal of all visible or palpable disease by a trained gynecologic oncologist.  With proper surgery and proper chemotherapy, 60% of patients with stage III and IV cancer will survive five years and beyond.

Ovarian cancer is often described as being a chronic disease. It is a disease that is rarely cured (like diabetes) but with proper care by a gynecologic oncologist, women can survive many years after the diagnosis of disease.

Possible complications of ovarian cancer:

  • Spread of the cancer to other organs
  • Loss of organ function (liver or kidney failure)
  • Defects in bowel or bladder
  • Fluid in the abdomen (ascites)
  • Blockage of the intestines (bowel obstruction)
When to contact a medical professional:

Routine Pap smears and pelvic examinations are recommended for all women over 20 years old. However, these tests do not diagnose ovarian cancer. Rectovaginal examinations are recommended yearly in all women over 30 years old. A woman with ovarian cancer or at risk for ovarian cancer because of a known genetic mutation or family history should see a gynecologic oncologist (a women’s cancer specialist) for management of her disease.

Ovarian Cancer Prevention:

Having regular pelvic examinations may decrease the overall risk. Screening tests for ovarian cancer remains a very active research area. To date, there is no cost-effective screening test for ovarian cancer, so more than 50% of women with ovarian cancer are diagnosed in the late stages of the disease. Recent research has shown that surgery to remove the ovaries, fallopian tubes, uterus, and biopsy the omentum and peritoneal surfaces. In women with mutation in the BRCA1, BRCA2, or mismatch repair genes can dramatically reduce their risk of developing ovarian cancer.  

Ovarian Cancer Support Groups:

Last Updated: 4/12/17