|
Home
> Health Information
> All Categories >
Ovarian Cancer - Women's Health Information
Ovarian Cancer - Women's Health Information
By: American Cancer Society
What Is Ovarian Cancer?
Most cancers are named after the part of the body where the cancer first starts. Ovarian cancer starts in a woman's ovaries. There are two ovaries, one on each side of the pelvis. The ovaries produce eggs and are the main source of the female hormones estrogen and progesterone.
Many kinds of tumors can start in the ovaries. Some are benign, and some are malignant. The outlook for a person who has a malignant tumor depends on the kind of tumor and how far it has spread.
There are three main types of ovarian tumors. They are named for the kind of cells they start from.
- The most common type of tumor begins in the cells that cover the surface of the ovary, called the epithelial cells. Most epithelial ovarian tumors are harmless, but some are cancerous. Most ovarian cancers are the epithelial type.
- The second kind of tumor starts in the germ cells that form the eggs in the ovary. As used here, the word germ refers to an early or seed cell. Most germ cell tumors are also benign, although some are cancerous. Germ cell cancers account for about 5% of ovarian cancers.
- The third type of tumor starts from the tissue that holds the ovary together and produces female hormones. These are called stromal cell tumors. Stromal tumors are fairly rare, accounting for only about 5% of ovarian cancers.
Back to top
How Many Women Get Ovarian Cancer?
Ovarian cancer is the sixth most common cancer (other than skin cancer) in women. It ranks fifth as the cause of cancer death in women. The American Cancer Society estimates that there will be about 23,300 new cases of ovarian cancer in this country in 2002. About 13,900 women will die of the disease. Ovarian cancer causes more deaths than any other reproductive organ cancer. Most women who have ovarian cancer are older.
The chances of survival from ovarian cancer are better if the cancer is found early. If the cancer is found and treated before it has spread outside the ovary, 95% of women will survive at least five years. However, only 25% of ovarian cancers are found at this early stage.
About 78% of all women with ovarian cancer survive at least one year after the cancer is found, and over half survive longer than five years.
Back to top
What Causes Ovarian Cancer? Can It Be Prevented?
We do not yet know what causes ovarian cancer. But we do know some of the risk factors involved. A risk factor is something that increases a person's chance of getting a disease. Some risk factors, such as smoking, can be controlled. Others, like a person's age or race, can't be changed.
Most cases of ovarian cancer are not explained by any known risk factors. It is important to remember that while risk factors increase the odds of getting a disease, they do not guarantee it will occur. For example, we know that on the average, women who have their first child after age 30 have a slightly greater risk of developing ovarian cancer than women who had their first child before age 30. This does not mean that most women with ovarian cancer who had their first child after age 30 could have prevented the cancer by having that child earlier.
Here are some of the risk factors for the most common type of ovarian cancer:
- Age: Most ovarian cancers occur after change of life (menopause). Half of all ovarian cancers are found in women over 65.
- Fertility drugs: Studies have found that long-time use of the fertility drug clomiphene citrate, without achieving pregnancy, may increase a woman's risk for having a type of tumor called LMP tumor (low malignancy potential). But infertility also increases the risk of ovarian cancer, even without use of fertility drugs. A woman taking this drug should discuss the issues with her doctor.
- Menstrual history: There seems to be a relationship between the number of menstrual cycles in a woman's lifetime and her risk of having ovarian cancer. More monthly periods may be linked to an increased risk. Women who started having periods at an early age (before age 12), who go through menopause late, who have no children (or who had their first child after age 30), may have an increased risk of ovarian cancer. Breastfeeding may lower the risk since menstrual periods may not occur during nursing.
- Family history of ovarian cancer: Having a mother, sister, or daughter with ovarian cancer increases the risk, especially if they developed the cancer at a young age. A woman can inherit a higher risk for ovarian cancer from either her mother's or her father's side of the family. About 7% of ovarian cancers result from inherited risks. Gene changes (mutations) are involved in these cancers.
- Breast cancer: Women who have had breast cancer are more likely to have ovarian cancer.
- Diet: The American Cancer Society recommends choosing most foods from plant sources (fruits, vegetables, whole grain products) and limiting intake of high fat foods, especially those from animal sources.
Most women will have one or more of these risk factors, but that does not mean they will develop ovarian cancer. So far, knowledge about risk factors has not been translated into practical ways to prevent most cases of ovarian cancer. Some of the actions listed below may reduce the risk only slightly, while others may decrease it much more. If you are concerned about your risk of ovarian cancer, especially if you have a family history of this cancer, you should discuss this information with your doctor.
- Birth control pills: Women who have taken birth control pills for at least five years have a lower risk of ovarian cancer.
- Tubal ligation or hysterectomy: Women who have had their tubes "tied" to prevent pregnancy or who have had a hysterectomy (removal of the uterus) may have a lower risk of ovarian cancer. However, these operations should only be done when there is a valid medical reason, and not simply for their effect on ovarian cancer risk.
- Pregnancy and breastfeeding: Pregnancy and breastfeeding seem to lower the risk of ovarian cancer, especially when a woman has her first baby before age 30. But choices about when to have a child should not be made just for the purpose of reducing ovarian cancer risk, especially since using birth control pills will have a similar impact.
Women with a family history of ovarian cancer might want to consider genetic counseling and possibly testing. Before deciding on testing, a woman should discuss the benefits and possible drawbacks with her doctor. Genetic testing can tell if a woman carries certain gene changes (mutations) that cause a higher risk of ovarian cancer. Learning that they do not have the mutation can be a great relief, while finding out that they do can be quite stressful. But the information can be helpful in looking at methods to prevent cancer.
These methods could include surgery to remove the ovaries or the use of birth control pills. Removing the ovaries lowers the risk of ovarian cancer a great deal but does not eliminate it entirely since cancer can still form in the cells lining the pelvic cavity where the ovaries were located.
Back to top
How Is Ovarian Cancer Found?
Early cancers of the ovary often have no symptoms. Because the ovaries lie deep within the pelvis, early tumors are hard for even skilled doctors to find. Tumors on the ovary cannot usually be found through the Pap test. For all these reasons, only 25% of ovarian cancers are found at an early stage.
All women should have a yearly pelvic exam beginning at age 18 or when they become sexually active. During this exam the doctor will feel the ovaries and uterus, checking their size and shape.
The following can be symptoms of ovarian cancer and should be reported to the doctor right away. But these problems are often caused by something other than cancer.
- swelling of the stomach (abdomen)
- problems such as gas, bloating, long-term stomach pain, or indigestion
- bleeding between periods or after menopause
- pelvic pain
- feeling of pressure in the pelvis
- leg pain
If there is any reason to suspect ovarian cancer, the doctor will use one or more methods to find out if the disease is really present.
- Imaging studies: CT scans (computed tomography), MRI scans, and ultrasound can show whether there is a mass in the pelvis. But they cannot tell if the mass is cancer.
- Biopsy: the only way to tell for certain if a growth in the pelvis is cancer involves a biopsy. A sample of tissue or fluid is removed and looked at under a microscope to see if cancer cells are present.
If a pelvic exam or other tests point to ovarian cancer, the best course of action is to consult with a doctor or surgeon who specializes in treating women with this type of cancer. This kind of doctor is called a gynecologic oncologist. Back to top
How Is Ovarian Cancer Treated?
There is a lot for you to think about when choosing the best way to treat or manage your cancer. There may be more than one treatment to choose from. You may feel that you need to make a decision quickly. But give yourself time to absorb the information you have learned. Talk to your doctor. Look at the list of questions at the end of this paper to get some ideas. Then add your own.
You may want to get a second opinion. Your doctor should not mind your doing this. In fact, some insurance companies require you to get a second opinion. You may not need to have tests done again since the results can often be sent to the second doctor. If you are in an HMO (health maintenance organization), find out about their policy concerning second opinions.
Each type of treatment has benefits and drawbacks. There may be side effects. Your age, your overall health, and the stage of your cancer are all factors to consider when deciding on a treatment plan.
The main treatments for ovarian cancer are surgery, chemotherapy, and radiation therapy. In some cases two or even three of these treatments will be used.
Surgery
How much surgery is done depends on how far the cancer has spread and on the woman's general health. The best way to treat the disease may be to remove one or both ovaries and any other involved organs in the pelvis. A young woman with early-stage ovarian cancer may still have plans to have a family. In this case, the cancer care team will try to treat the disease without removing both ovaries and the uterus. Don't be afraid to ask the doctor to explain your condition and recommended treatments in simple, nonmedical terms.
Side Effects of Surgery
If a woman is still having periods and both ovaries and/or the uterus are removed, she will begin menopause. She will not be able to become pregnant.
Chemotherapy
Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. This treatment is especially useful when cancer has spread beyond the ovaries. Chemotherapy is usually given in cycles of treatment followed by a rest period.
Chemotherapy can have some side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Temporary side effects might include nausea and vomiting, loss of appetite, hair loss, mouth and vaginal sores, changes in the menstrual cycle, bruising, increased bleeding after minor cuts, and an increased chance of infection. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.
Radiation Therapy
Radiation therapy is treatment with high energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in or near the tumor (internal or implant radiation). However, radiation therapy is rarely used in this country as the main treatment for ovarian cancer.
Side Effects of Radiation Therapy
External beam radiation therapy may cause side effects. The skin in the area treated may look and feel sunburned. The skin returns to normal within six to 12 months. Many women also feel tiredness, nausea or diarrhea. Be sure to talk with the doctor about any side effects. Often there are ways to help.
Treatment for Epithelial Ovarian Cancer
The treatment for epithelial ovarian cancer depends on how far the cancer has grown. Usually the first option is surgery to remove one or both ovaries. The doctor may also advise surgery to remove other female organs. Treatment may include chemotherapy or radiation therapy for early stage cancers. For later stage (III and IV) cancers, surgery can reduce the size of the tumor. Chemotherapy is often given after surgery. If cancer returns after treatment, more surgery and chemotherapy may be given.
Treatment for epithelial tumors of low malignant potential (LMP or borderline tumors): The ovary with the tumor and the fallopian tube on the affected side are usually removed. In certain cases, just the ovarian cyst with the tumor is removed. If the woman might want to become pregnant in the future, and if there appears to be no cancer beyond the one ovary, no further surgery is done at that time.
If the woman is not concerned about being able to have children, both ovaries, the fallopian tubes, and the uterus are removed. Chemotherapy and radiation are not generally used in the initial treatment of these tumors, although they may be used if the tumor comes back after surgery.
Treatment for Germ Cell Tumors of the Ovary
Germ cell tumors grow from the cells that normally form the eggs. These tumors tend to occur in girls and young women and usually are benign. Benign tumors are cured by removing a part of the ovary or, rarely, the entire ovary. The treatment for germ cell cancers of the ovary depends on the stage of the cancer. Surgery will reveal the stage and which organs should be removed. Most women with germ cell cancers will also have chemotherapy.
Treatment for Stromal Cell Tumors
Most stromal cell tumors are benign, but if a stromal cell tumor is malignant, the doctor will remove as much of the tumor as possible. If the tumor returns, chemotherapy may also be used.
Back to top
American Cancer Society
http://www.cancer.org/eprise/main/docroot/CRI/content/CRI_2_2_1X_What_is_ovarian_cancer_33?sitearea=CRI
|
