Cancer

Ovarian Cancer

Symptoms

There are usually no obvious symptoms of ovarian cancer. Women complain about vague symptoms including abdominal swelling or bloating, generalized abdominal discomfort, anxiety, lack of appetite, dyspepsia, malaise, urinary frequency, or weight change (either gain or loss). Women may develop unexplained fluid in the abdominal cavity that contributes to the abdominal discomfort. Because the symptoms are not unique to ovarian cancer, the disease can be difficult to identify and diagnose.

Diagnosis

A definitive diagnosis of ovarian cancer requires surgery. The initial surgery has two aims. First, to remove any cancer that exists (or as much as possible), including removing the ovaries, the uterus and the omentum. The best results for survival are in those women in whom all the cancer can be removed. The second aim of the surgery is to take samples of the tissue and surrounding nodes to determine if and where the tumor has spread which determines the stage of the disease. In pre-menopausal women, a more limited surgery may be appropriate depending upon the cell type of the tumor.

Treatment options for ovarian cancer

After the initial diagnosis has been established at surgery, additional therapy will depend on several factors, including the cell type, the stage and extent of the cancer, and the residual tumor remaining at the end of the initial surgery. Treatment typically includes chemotherapy (usually a combination of drugs) or radiation. Other treatment options may include immunotherapy or, in the future, gene therapy.

Risk factors for ovarian cancer

The causes of ovarian cancer are unknown. The disease tends to be more common in women from western industrialized countries, especially white women, who have had no full-term pregnancies. There also have been noted associations with exposure to talc or asbestos. In addition, there is an association with infertility. It appears that factors that decrease ovulation have been associated with a lower risk of ovarian cancer in the general population. Women who have had multiple pregnancies or who have breast-fed have fewer ovulations and have been noted to have a decreased occurrence of ovarian cancer. The use of oral contraceptives has also been associated with a decrease in the development of ovarian cancer. The protection provided by oral contraceptives appears to be real and increases as the duration of pill use increases. A risk reduction of up to 60% may occur when oral contraceptives are used for longer than five years. Recent studies have noted that there is a decreased incidence of ovarian cancer in women with a history of tubal ligation. The mechanism of this is unclear. The use of powders containing talc should be avoided on the external female genitals.

Heredity and ovarian cancer

Most ovarian cancers are random and not inherited. However, five to ten percent of individuals who develop ovarian cancer have an inherited genetic susceptibility to the disease. Generally, the risk of developing ovarian cancer increases as the number of family members affected by ovarian cancer increases. Having a first-degree relative affected by ovarian cancer (for example, a mother or a sister) increases a woman’s lifetime risk from 1.4% to 3.1%. Those at greatest risk for inherited genetic susceptibility have a personal or family history of ovarian and/or breast cancer. Histories that include cancers with early age of onset, multiple primary (new) cancers and Jewish ancestry reflect greater risk.

There are three different syndromes that fall under the heading of familial ovarian cancer. The first, is a site-specific, hereditary ovarian cancer syndrome in which only ovarian cancer develops. More commonly, however, there is the hereditary breast-ovarian cancer syndrome in which both ovarian cancer and breast cancer may occur in the same family. And finally, there is the Lynch II syndrome in which breast, ovarian, colon, endometrial and other cancers occur throughout the family. Again, though, cases of familial ovarian cancer account for only five to ten percent of ovarian cancers. Those people who are interested in learning more about their hereditary risks should speak to their health care providers about the option of genetic counseling and testing.

Prevention

There are no known methods to guarantee prevention of ovarian cancer. Women who are diagnosed in an early stage, however, have a higher survival rate. Unfortunately, ovarian cancer is usually not diagnosed at an early stage. There are currently no effective early diagnosis methods for ovarian cancer in women to allow for early intervention. There is much research being conducted to develop early diagnosis strategies. (click here to learn more about CA-125 and ovarian cancer screening.)

Risk reduction for those at highest risk

Women at a very high risk of developing ovarian cancer can consider removal of the ovaries. Such a "preventive" removal of the ovaries appears to lower the risk of developing ovarian cancer, but does not eliminate the risk. Women with one first-degree relative with ovarian cancer have a risk of developing the disease, which are approximately 3.1%. A preventive oophorectomy (removal of the ovaries) as an independent operation is not recommended, in general, for these women. With two first-degree relatives, the risk of developing ovarian cancer is approximately seven percent and a preventive removal of the ovaries may be considered. In general, women found to be carriers or who have a family history highly suggestive of the disease may be appropriate candidates for preventive removal of the ovaries. Removal of the ovaries results in lost hormone production, which can have side effects. A woman considering preventive removal of the ovaries should discuss possible side effects with her clinician.