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Ovarian Cancer

Ovarian Cancer

  • Female reproductive organs

Definition

Ovarian cancer develops in either of a woman's two ovaries, the organs within the pelvis that produce eggs for reproduction and several hormones.

What is going on in the body?

The ovaries are inside the woman's pelvis—one on each side of the pear-shaped uterus (womb). From puberty to menopause, the ovaries produce female hormones. These hormones regulate the menstrual cycle, or menstruation. The ovary also contains eggs. The female hormones regulate the release of eggs during the cycle.
When an ovarian cell becomes malignant, it will begin multiplying rapidly. A growth, or tumor, on the ovary forms as the cells multiply. This growth may or may not interfere with the function of the ovary.
Cancer cells can break off from the tumor and spread directly to other areas inside the pelvis and the abdomen. They can also metastasize through the bloodstream to other areas of the body.

Risks

What are the causes and risks of the disease?

No one knows what causes ovarian cancer. Women who have used birth control pills may be at lower risk than other women. The use of hormone replacement therapy at menopause has not been proven to increase risk. There is no proven link between diet and ovarian cancer.
Heredity may play a part,although most women who develop ovarian cancers do not have relatives who have had this disease. Our knowledge of the role of genetics in ovarian cancer is still being developed.
Genetic mutations called BRCA 1 or BRAC2 results in increased risk for both breast and ovarian cancer. Testing may be indicated when three or more closely related members of a family have had premenopausal breast cancer or ovarian cancer.
Although it is much more common in women over 50 years of age,different types of ovarian cancer can occur even in childhood
Other factors that might increase the risk of ovarian cancer include:
  • a diet high in fat
  • exposure to asbestos, talc, and industrial toxins
  • having had no children
  • a history of uterine or breast cancer

Prevention

What can be done to prevent the disease?

There is no way to prevent ovarian cancer, other than the controversial practice of preventive ovary removal. Women at high risk may have transvaginal ultrasounds and other tests to help detect disease early. The healthcare professional may recommend more frequent pelvic exams.
Women who are not at high risk should have a yearly pelvic exam. Pap smears should be done as recommended by the healthcare professional. However, a Pap smear is positive in only a small number of women with ovarian cancer.

Diagnosed

How is the disease diagnosed?

The discovery of a lump or mass during a pelvic exam does not mean that the woman has cancer. Tests such as special X-rays or ultrasounds may be done to better define the type of mass that is present.
A small sample of blood will be drawn to test for a tumor marker that some ovarian cancers produce called CA-125. This marker is not present in every ovarian cancer, and sometimes can appear from sources other than ovarian cancer cells..
After these tests are completed, surgery is done to remove a piece of the tumor to test for cancer.
If the pathology examination shows cancer, the surgery is extended and testing will be done of the tissue near by and the lymph nodes to determine the stage or extent of the malignancy.

Long Term Effects

What are the long-term effects of the disease?

Untreated ovarian cancer leads to death. Treatment can be effectivein the early stages, but because the cancer is so often silent, few cases are diagnosed at this stage..

Other Risks

What are the risks to others?

Ovarian cancer is not contagious and poses no risk to others.

Treatments

What are the treatments for the disease?

Surgery to remove the cancer and the surrounding tissues is an important part of treatment. This will get rid of most of the cancer.
Any remaining cancer may be treated in another way. Chemotherapy involves a combination of special medicines given in the veins. It can be very effective in killing any remaining tumor.
The medicines travel in the bloodstream to places where the cancer may have spread. Some of the more common ones are taxanes, such as paclitaxel (i.e., Taxol) and docetaxel (i.e., Taxotere). Platinum-based medicines, such as cisplatin (i.e., Platinol) and carboplatin (i.e., Paraplatin), are also used. Sometimes the chemotherapy is given directly into the abdomen through a special tube.
Radiation therapy has only limited use with this type of cancer. It may be used if the cancer has spread to the abdomen. Sometimes it is used along with chemotherapy.
Psychological, relational and spiritual support is important for the patient and her family. Social workers, psychologists and clergy and other members of the healthcare team are available for consultation as needed.

Side Effects

What are the side effects of the treatments?

Surgery involves removal of one or both ovaries. When both ovaries are removed, the woman may be given hormone replacement therapy to prevent the symptoms of menopause. The uterus may also be removed. This will make the woman unable to bear children.
The side effects of chemotherapy depend on the specific medicines used and may include:
  • fatigue
  • increased risk of infection
  • nausea
  • temporary hair loss

After Treatment

What happens after treatment for the disease?

The woman will be followed closely to make sure the cancer is under control.

Monitor

How is the disease monitored?

Sometimes ovarian cancer produces a tumor marker called Ca-125. If this was present at diagnosis, a small blood sample will be checked regularly to see if the level is changing. A rising Ca-125 level may indicate that additional treatment is needed.
CT scans of the abdomen and pelvis may also be done regularly. The results of these studies will indicate how well the cancer responded to treatment.
Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Ozols, R.F., Schwartz, P.E., and Eifel, P. J.(1999). Ovarian cancer, fallopian tube carcinoma, and peritoneal carcinoma in Cancer: Principles and Practice of Oncology. 5th Edition DeVita, V.T. (ed). J.B. Lippincott:Phildephia. Pp.1502-1540.

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