The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a baby grows). Each ovary is about the size and shape of an almond. The ovaries have two functions: they produce reproductive eggs and female hormones (chemicals that control the way certain cells or organs function).

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 to the uterus.

The ovaries are also the main source of the female hormones estrogen and progesterone. These hormones influence the development of a woman's breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy.

A malignant tumor that begins in the ovaries is called ovarian cancer. There are several types of ovarian cancer. Ovarian cancer that begins on the surface of the ovary (epithelial carcinoma) is the most common type. Other Ovarian cancer that begins in the egg-producing cells are called germ cell tumors, and cancer that begins in the supportive tissue surrounding the ovaries are called stromal tumors.

Ovarian cancer cells can break away from the ovary and spread to other tissues and organs in a process called shedding. When ovarian cancer sheds, it tends to seed (form new tumors) on the peritoneum (the large membrane that lines the abdomen) and on the diaphragm (the thin muscle that separates the chest from the abdomen). Fluid may collect in the abdomen. This condition is known as ascites. It may make a woman feel bloated, or her abdomen may look swollen.

Ovarian cancer cells can also enter the bloodstream or lymphatic system (the tissues and organs that produce and store cells that fight infection and disease). Once in the bloodstream or lymphatic system, the cancer cells can travel and form new tumors in other parts of the body.

Ovarian cancer can develop in one or both of the ovaries.

About 1 in 55 women will be diagnosed with ovarian cancer in her lifetime. However, because it is not discovered until it has spread
beyond the ovary, it is the fourth leading cause of cancer death in women (after lung, breast, and colon cancer).

 

RISK FACTORS

Having a relative with ovarian cancer increases a women’s risk of getting it. Generally, the closer the relative, the greater the risk. However, only about 10% of all ovarian cancers can be linked to a family history of the disease.

Women who have has breast cancer are twice as likely to develop ovarian cancer.

Women who have not been pregnant, either by choice or due to infertility, are more likely to develop ovarian cancer.

Other possible risk factors being studied are a diet high in fat; exposure to asbestos; and the use of talc (a mineral found in talcum powder) near the vaginal area.

 

SYMPTOMS

Often the symptoms may be vague and can be confused with other conditions.

A woman should see her doctor if she had any of the following symptoms for a month or more:

• Feeling bloated
• Abdominal discomfort and/or backaches
• Gas or indigestion that can’t be otherwise explained
• A feeling of fullness, even after a light meal
• Nausea or loss of appetite
• Shortness of breath or difficulty breathing
• Pain during intercourse
• Change in menstrual flow
• Feeling Tired
• Slight fever

As the tumor grows, it can put pressure on other organs and may cause frequent urination, constipation, and weight change. However, these symptoms may also be caused by fibroids and other non-cancerous conditions.

  DIAGNOSIS

There is no single test to detect ovarian cancer. A health care provider may recommend these special tests to rule out ovarian cancer in women who have a family history of breast/ovarian cancer, are found to be genetically at-risk through a DNA test, or have had symptoms for a month or more:

A rectovaginal pelvic exam is given so that the doctor can feel if there is a mass or growth inside the abdomen. The doctor will insert one finger into the vagina, and one finger into the rectum, and then press down on the abdomen with the other hand.

A transvaginal sonogram (ultrasound) is a painless test that uses sound waves to check for growths inside the pelvis.

A CA 125 test for a substance often found in the blood and urine of women with ovarian cancer. However, other non-cancerous conditions can also cause an increase in CA 125, so a cancer diagnosis cannot be made from this test alone. 

TREATMENT

Treatment depends on a number of factors, including the stage of the disease, and the general health of the patient. A team of specialists, which often include a gynecologist, a gynecologic oncologist, a medical oncologist, and/or a radiation oncologist, usually treats patients. Many different treatments and combinations of treatments are used to treat ovarian cancer.

Surgery is the usual initial treatment for women diagnosed with ovarian cancer. The ovaries, the fallopian tubes, the uterus, and the cervix are usually removed. This operation is called a hysterectomy with bilateral salpingo-oophorectomy. Often, the surgeon also removes the omentum (the thin tissue covering the stomach and large intestine) and lymph nodes (small organs located along the channels of the lymphatic system) in the abdomen.

Staging during surgery (to find out whether the cancer has spread) generally involves removing lymph nodes, samples of tissue from the diaphragm and other organs in the abdomen, and fluid from the abdomen. If the cancer has spread, the surgeon usually removes as much of the cancer as possible in a procedure called tumor debulking. Tumor debulking reduces the amount of cancer that will have to be treated later with chemotherapy or radiation therapy.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control tumor growth, or to relieve symptoms of the disease.

Most drugs used to treat ovarian cancer are given by injection into a vein (intravenously, or IV). The drugs can be injected directly into a vein or given through a catheter (a thin tube). The catheter is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are taken by mouth. Whether they are given intravenously or by mouth, the drugs enter the bloodstream and circulate throughout the body.

Another way to give chemotherapy is to put the drug directly into the abdomen through a catheter. With this method, called intraperitoneal chemotherapy, most of the drug remains in the abdomen.
After chemotherapy is completed, second-look surgery may be performed to examine the abdomen directly. The surgeon may remove fluid and tissue samples to see whether the anticancer drugs have been successful.

Radiation therapy - also called radiotherapy, involves the use of high-energy rays to kill cancer cells. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation). Some women receive a treatment called intraperitoneal, in which radioactive liquid is put directly into the abdomen through a catheter.