Learn about ovarian cancer

Ovarian cancer is the most lethal gynecologic malignancy and the fifth leading cause of cancer death among women in the United States. In 2016, more than 22,000 new cases of ovarian cancer were estimated to have occurred and 14,000 women were predicted to die from the disease.

Ovarian cancer is not one disease but many different types, each with its own subtype. The most common type accounts for about 70 percent of all ovarian cancers.

Ovarian cancer can be either benign or malignant. Benign tumors do not metastasize (spread) to other organs and have a good prognosis. Malignant tumors spread to other organs and have a poor prognosis.

Ovarian cancer occurs when a cell in the ovary changes and begins to grow out of control. This can happen because of DNA damage from exposure to harmful substances in food, air, and water. It can also be caused by inherited genetic defects. These defects are not passed on from parent to child but occur randomly during the formation of an egg or sperm cell.

What causes ovarian cancer?

Ovarian cancer is mainly a disease of women over 50 years of age. The risk of developing ovarian cancer increases with age, but more than 40% of all cases are diagnosed in women who are younger than 50 years.

The exact cause of ovarian cancer is unknown. It is thought that some combination of genetic and environmental factors may contribute to the development of ovarian cancer. These factors include:

Age: Ovarian cancer occurs most often in older women; however, it can occur at any age. The average age at diagnosis is 60 years old in the United States, but the median age at diagnosis has been decreasing over time, with fewer cases occurring among women younger than 45 years old than in previous decades.

Genetic factors: A family history of ovarian or other gynecological cancers is associated with an increased risk of developing ovarian cancer; however, less than 5% of all cases result from inherited genetic mutations (a condition called hereditary non-polyposis colon cancer). Although research suggests that there may be a link between breast and ovarian cancer in BRCA1 mutation carriers, this connection has not been firmly established by clinical studies.

Who gets ovarian cancer?

Ovarian cancer affects all races equally and can affect anyone at any age. But it’s more common in older women. Ovarian cancer accounts for about 2 percent of cancers diagnosed in younger women (under age 45) and 20 percent of cancers diagnosed in older women (45 or older). It’s much less common before menopause than after menopause.

Risk factors for ovarian cancer include:

Age — The risk increases as you get older (under age 45: less than 1 percent; ages 45 to 64: 3 percent; ages 65 to 74: 7 percent; ages 75+: 13 percent).

Family history — A family history of breast, ovarian or endometrial cancers increases your risk of ovarian cancer by up to 100 times normal rates.

Types of ovarian cancer

Epithelial ovarian cancer accounts for 90% of all cases. It is the most common form of this cancer in women younger than 45 years old and the second most common form in women 45 to 64 years old. Epithelial ovarian cancers have a high rate of recurrence even after treatment, so doctors focus on treating them early.

Germ cell ovarian cancer accounts for about 10% of all ovarian cancers and occurs primarily in women over age 60. The symptoms tend to be vague and may include abdominal bloating, pelvic or abdominal pain and irregular vaginal bleeding.

Stromal (including sex cord-stromal) cancers make up about 5% of all ovarian cancers. They occur more often in women over age 65 than in younger women. Stromal (including sex cord-stromal) cancers may not cause symptoms until they spread outside the ovary or become more advanced.

Endometrioid carcinomas account for 3% to 5% of ovarian cancers and occur primarily in premenopausal women younger than 40 years old who don’t have children yet (nulliparous). This type usually spreads within the pelvis but rarely spreads outside the pelvis until it has progressed to stage III or IV disease.

Ovarian cancer symptoms

Most women with ovarian cancer have no symptoms. The first sign is often a pelvic exam or ultrasound that reveals a tumor.

Symptoms of ovarian cancer can include:

• Back pain. Many women with ovarian cancer have lower abdominal pain, which may be caused by the tumor pressing on the bladder and other organs in the pelvis, such as the bowel and uterus. This pain comes and goes slowly, usually lasting for more than six weeks at a time. It may also be worse around the time of your menstrual period. You may also feel bloated or experience constipation or diarrhea from time to time (often called irritable bowel syndrome). These symptoms are not specific to ovarian cancer, but they could be signs of it if they last longer than six weeks and occur more than once per month.
• Bloating and feeling full quickly when eating small amounts of food — either all the time or just after eating dinner — is another clue that something might be wrong. Some women also experience indigestion or nausea with bloating, but this isn’t common.
• Pain in your back could be caused by an enlarged kidney due to fluid buildup (called hydronephrosis) due to an enlarged tumor pressing on it; however, this symptom is rare.
• Fatigue (extreme tiredness)
• Abnormal vaginal bleeding
• Urinary urgency or frequency

Diagnosing ovarian cancer

Diagnosing ovarian cancer can be difficult because symptoms often don’t appear until the disease has reached an advanced stage.

If you have any symptoms that worry you, contact your GP or practice nurse straight away. Symptoms include:

• A persistent change in bowel habit that lasts more than two weeks
• Persistent abdominal bloating or swelling
• Persistent pain in the lower abdomen
• Persistent urinary symptoms (such as needing to urinate more often or feeling like you don’t empty your bladder properly)
• Tiredness for no obvious reason.

Ovarian cancer treatment options

Treatment for ovarian cancer depends on the stage of your cancer and any symptoms you’re experiencing. If you have advanced ovarian cancer, treatment may include surgery, chemotherapy, radiation therapy and targeted therapy.

Surgery. Surgery is the most common treatment for ovarian cancer. During surgery, your doctor removes your ovaries and fallopian tubes (bilateral salpingo-oophorectomy). This procedure is also called a hysterectomy with bilateral salpingectomy. The surgeon may remove some of your surrounding organs to get clear margins (freeing the tumor from nearby tissue) and prevent recurrence of the disease.

Chemotherapy and targeted therapy drugs. Targeted therapy drugs are designed to attack specific molecules within cancer cells that help them grow and spread. These drugs aren’t used to treat all cancers, but they are an option for treating certain types of advanced ovarian cancer that has spread outside the abdomen (peritoneum). Chemotherapy is another type of drug therapy used to treat many types of cancers, including ovarian cancer. It can be given in different ways depending on what’s best for you: Intraperitoneal chemotherapy — Administering chemotherapy directly into the abdominal cavity by putting it through a catheter into the abdomen.