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Ovarian Cancer

Introduction:

This page is about ovarian epithelial cancer. It is the most common type of ovarian cancer. It begins in the tissue that covers the ovaries.

You will read about possible causes, symptoms, diagnosis, and treatment. You will also find lists of questions to ask your doctor. It may help to take this booklet with you to your next appointment

The Ovaries

The ovaries are part of a woman's reproductive system. They are in the pelvis. Each ovary is about the size of an almond.

The ovaries make the female hormones - estrogen and progesterone. They also release eggs. An egg travels from an ovary through a fallopian tube to the womb (uterus).

When a woman goes through her "change of life" (menopause), her ovaries stop releasing eggs and make far lower levels of hormones.

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer:
- Benign tumors are rarely life-threatening.
- Generally, benign tumors can be removed. They usually do not grow back.
- Benign tumors do not invade the tissues around them.
- Cells from benign tumors do not spread to other parts of the body.
Malignant tumors are cancer:
- Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
- Malignant tumors often can be removed. But sometimes they grow back.
- Malignant tumors can invade and damage nearby tissues and organs.
- Cells from malignant tumors can spread to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the lymphatic system or bloodstream. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

Benign and Malignant Cysts

An ovarian cyst may be found on the surface of an ovary or inside it. A cyst contains fluid. Sometimes it contains solid tissue too. Most ovarian cysts are benign (not cancer).

Most ovarian cysts go away with time. Sometimes, a doctor will find a cyst that does not go away or that gets larger. The doctor may order tests to make sure that the cyst is not cancer.

Ovarian Cancer

Ovarian cancer can invade, shed, or spread to other organs:

Invade: A malignant ovarian tumor can grow and invade organs next to the ovaries, such as the fallopian tubes and uterus.
Shed: Cancer cells can shed (break off) from the main ovarian tumor. Shedding into the abdomen may lead to new tumors forming on the surface of nearby organs and tissues. The doctor may call these seeds or implants.
Spread: Cancer cells can spread through the lymphatic system to lymph nodes in the pelvis, abdomen, and chest. Cancer cells may also spread through the bloodstream to organs such as the liver and lungs.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if ovarian cancer spreads to the liver, the cancer cells in the liver are actually ovarian cancer cells. The disease is metastatic ovarian cancer, not liver cancer. For that reason, it is treated as ovarian cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease

Risk Factors

Doctors cannot always explain why one woman develops ovarian cancer and another does not. However, we do know that women with certain risk factors may be more likely than others to develop ovarian cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for ovarian cancer:

Family history of cancer: Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer.

If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer.

Personal history of cancer: Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer.
Age over 55: Most women are over age 55 when diagnosed with ovarian cancer.
Never pregnant: Older women who have never been pregnant have an increased risk of ovarian cancer.
Menopausal hormone therapy: Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.

Scientists have also studied whether taking certain fertility drugs, using talcum powder, or being obese are risk factors. It is not clear whether these are risk factors, but if they are, they are not strong risk factors.

Having a risk factor does not mean that a woman will get ovarian cancer. Most women who have risk factors do not get ovarian cancer. On the other hand, women who do get the disease often have no known risk factors, except for growing older. Women who think they may be at risk of ovarian cancer should talk with their doctor