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Each year, about 22,000 women in the United States learn that they have ovarian cancer. Ovarian cancer begins in the ovaries, and the symptoms are often common and vague, which makes it difficult to diagnose.
Many types of tumors can start growing in the ovaries. Some are benign (non-cancerous) and do not spread beyond the ovary. Malignant (cancerous) tumors can spread to other parts of the body. There are more than 30 different types of ovarian cancer, which are categorized according to the cell type.
Currently, there is no effective means of detecting ovarian cancer early. As a result, it is usually diagnosed in advanced stages and only 50 percent of women survive longer than five years after diagnosis. If ovarian cancer is diagnosed early, which happens in about 25 percent of cases, the five-year survival is greater than 90 percent. Most patients with ovarian cancer have surgery followed by chemotherapy. Studies have shown that prognosis and survival depends largely on how much tumor is left at the time of initial surgery. Patients who have no remaining tumor or with only tumor nodules less than one centimeter in diameter have the best chance for cure and long-term survival.
If you have been diagnosed with ovarian cancer, you should be seen by a gynecological oncologist, a doctor who is specially trained to take care of women with gynecologic cancers. Most gynecologic oncologists perform surgery, administer chemotherapy and follow their patients closely after treatment has been completed. According to the National Ovarian Cancer Coalition, studies have shown that women who had their surgery performed by gynecological oncologist live longer than those who do not.
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Need-to-Know Anatomy
The ovaries are part of the female reproductive system. There are two ovaries located in the pelvis, one on each side of the uterus, the hollow, pear-shaped organ where a fetus grows. The ovaries produce eggs and female hormones (estrogen and progesterone). Every month, during the menstrual cycle, an egg is released from one ovary in a process called ovulation. The egg travels from the ovary through the fallopian tube, the site of conception. If conception occurs, the embryo moves on to the uterus and implants in the endometrium, the uterine lining.
Causes
The exact cause of ovarian cancer is not known. Like all cancers, ovarian cancer develops when abnormal cells grow out of control. Abnormal cells develop because of damage to DNA, a substance in every cell that directs its activities. DNA is like a "blueprint" for the activities of the cell. Damaged DNA may be inherited (passed from parent to child), or a person's DNA may be damaged by some environmental exposure. Normally, when DNA becomes damaged, the body is able to repair it. In cancer cells, the damaged DNA is not repaired. The cells begin to grow out of control. When they travel to other parts of the body and replace normal tissues, this is called metastasis (spread of cancer).
Risk Factors
Women with certain risk factors may be more likely to develop ovarian cancer.
- Family history: Women are at increased risk if a first-degree relative (mother, daughter, sister) or a second-degree relative (grandmother, aunt, cousin) has ovarian cancer. If you have a family history of breast or colon cancer, you may have inherited genes (BRCA1 or BRCA2) that may increase the risk of developing ovarian cancer.
- Age: The risk of ovarian cancer increases with age and most often is diagnosed in women over the age of 50, with the highest risk in women over 60.
- Childbearing: Women who have never had children have a higher risk of developing ovarian cancer than women with children. The more children a woman has, the less likely she is to develop ovarian cancer.
- Personal history: A woman who has had breast or colon cancer has a greater chance of developing ovarian cancer than a woman who has not had breast or colon cancer.
The link between the risk factors listed below and ovarian cancer are controversial and have not been definitively proven.
- Fertility drugs: Taking medicines to increase a woman's fertility may slightly increase a woman's chance of developing ovarian cancer. However, no reports have proven this association, and researchers are still studying whether there is a link.
- Talcum powder: Some studies suggest that women who used talcum powder in the genital area for many years may be at increased risk of developing ovarian cancer. At one time, talcum powder contained asbestos, a known cancer-causing agent. For more than 20 years, law has required that all powders be asbestos-free.
- Hormone replacement therapy: Some studies suggest that women who use hormone replacement therapy after menopause may have a slightly increased risk of developing ovarian cancer.
- Obesity: New data suggests that obesity and ovarian cancer may be linked. The association of obesity and cancer of the uterus is already well described, possibly because obesity leads to high levels of circulating hormones, which cause excessive growth of the uterine lining. Less is known of any direct link between obesity and ovarian cancer, but several studies have now demonstrated an increased risk.
Types of Ovarian Cancer
There are several types of ovarian cancer, which are classified according to the type of cell they originate from and whether the tumor is benign or cancerous. The three main types of ovarian tumors are:
Epithelial: Nearly 90 percent of ovarian cancers are epithelial, which means they occur in cells on the surface of the ovaries, called the epithelium. This kind of ovarian cancer occurs mostly in women over the age of 60, but women of any age can develop it.
Germ cell: Germ cell tumors are uncommon and account for less than 5 percent of ovarian tumors. Germ cell tumors begin in the cells that form eggs in the ovary and usually affect only one ovary. Germ cell cancers are typically diagnosed in adolescent girls and young women. Germ cell cancers cause pain and discomfort in the early stages.
Sex-cord stromal cell: This is an uncommon form of ovarian cancer that starts in the stromal cells, which make female hormones and connect the ovarian tissue together. It accounts for only 5 percent of all ovarian cancers. This type of cancer causes pain and discomfort in the early stages.
Last reviewed on 7/22/09
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