Types of ovarian cancer
There are several types of ovarian cancer. They include:- epithelial ovarian cancer, which affects the surface layers of the ovary and is the most common type
- germ cell tumours, which originate in the cells that make the eggs
- stromal tumours, which develop within the cells that hold the ovaries together
The exact cause of ovarian cancer is unknown, although a number of possible factors are thought to be involved, such as the number of eggs the ovaries release and whether someone in your family has had ovarian cancer in the past. However, only one in 10 cases of ovarian cancer has a genetic link.
Risks factors
Cancer of the ovaries, usually referred to as ovarian cancer, is the fifth leading cause of cancer death in women, and, unfortunately, symptoms (such as abdominal pain and swelling) usually occur late in the disease process; fewer than one-third of ovarian cancers are detected before they have spread outside of the ovaries. There is no definitive evidence that screening reduces mortality from ovarian cancer, and given the poor prognosis of advanced ovarian cancer, there has been much research over recent years to increase understanding of this serious condition. There are recognized risk factors that increase the chance of developing ovarian cancer, such as increasing age, having fewer children, not having used oral contraceptives, and use of menopausal hormone therapy. Age and oral contraceptive use have by far the biggest impact on ovarian cancer risk. Ovarian cancer is also associated with height (increase) and, among never-users of hormone therapy, with body mass index (increase).
Symptoms
Digestive symptoms may occur early in ovarian cancer
Women are often diagnosed with ovarian cancer when it is late stage and more difficult to treat, partly because the earliest symptoms are vague and commonly experienced by otherwise healthy women. In the August 2005 journal “Cancer”, Dr. Lloyd Smith and colleagues reported that women with ovarian cancer experienced symptoms like abdominal pain and swelling before they were diagnosed more often than women with breast cancer or women who were cancer free.
Abdominal pain
While,
abdominal pain is something that almost everyone will experience at some
time, it can occasionally be the first symptom of ovarian cancer. In a
study conducted between 2000 and 2007, reported in “British Medical
Journal”, Dr. William Hamilton and colleagues reported that over half of
women diagnosed with ovarian cancer had abdominal pain in the months
before their diagnosis.
Abdominal distention or bloating
Abdominal distention (swelling of your abdomen) is often caused by something relatively minor like over-eating. Rarely,
it can be an early sign of something more sinister like ovarian cancer.
In the Hamilton study, about one-third of women with ovarian cancer
reported having abdominal distention before they were diagnosed. If you
have both abdominal distention and loss of appetite, the risk of this
being caused by ovarian cancer is higher.
Diarrhea
The
most common cause of diarrhea is a viral infection which is usually
mild and resolves quickly. However, just like the symptoms listed above,
diarrhea can rarely be an early symptom of ovarian cancer.
Weight loss
Most
women wouldn’t mind losing a little weight. However, when it occurs
unintentionally (not because you are dieting or exercising more), it is
concerning for things like cancer. Almost any type of cancer, including
ovarian cancer, is sometimes a cause of unintentional weight loss.
Other symptoms
Other
digestive symptoms you can experience with ovarian cancer include
difficulty eating, feeling full quickly, constipation, and loss of
appetite. Like the symptoms listed above, these are rarely caused by
ovarian cancer and are experienced at times by many women. You should
become concerned if they persist for months, get worse, or occur with
other digestive symptoms. If you are 70 years of age or older, you are
already at higher risk for ovarian cancer, so new digestive symptoms
should be reported to your doctor.
If you have any symptoms of ovarian cancer, it's important to see your GP as soon as possible.
Your GP will first ask about your symptoms, your general health and whether there is a history of ovarian or breast cancer in your family.
Your GP may also carry out a vaginal or internal examination to investigate your ovaries and womb. They may also take a blood sample or refer you for an ultrasound scan.
If necessary, your GP may then refer you to a specialist (a gynaecologist or gynaecological oncologist) at the hospital.
The specialist may carry out another internal examination. They will ask about your symptoms and general health. They may also do further tests to confirm the diagnosis of ovarian cancer, including a blood test and ultrasound.
However, this chemical is not specific to ovarian cancer and may also be raised in many benign conditions, so a raised level of CA125 does not definitely mean you have ovarian cancer.
The National Institute for Health and Care Excellence (NICE) has produced guidance that advises your GP to test for CA125 if you frequently experience:
The CA125 test is particularly important if you are 50 or over, or have these symptoms more than 12 times each month.
If you experience unexplained weight loss, fatigue or changes in your bowel habits such as diarrhoea or constipation, your GP may also test for CA125.
If you are 50 or over and have experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.
A significant proportion of women with early stage ovarian cancers have a normal CA125 level.
If you do have a raised CA125 level, your GP will arrange for you to have an ultrasound scan.
These other tests may include:
As with most types of cancer, the outlook largely depends on how far the cancer has advanced by the time it is diagnosed and your age at diagnosis. Ninety per cent of women diagnosed with early stage one ovarian cancer will be alive in five years' time (the five-year survival rate).
Read more information about how ovarian cancer is treated.
Being diagnosed with ovarian cancer can affect daily life in many ways. However, there is support available for many aspects of living with ovarian cancer, including emotional, financial and long-term health issues.
Diagnosing ovarian cancer
If you have any symptoms of ovarian cancer, it's important to see your GP as soon as possible.
Your GP will first ask about your symptoms, your general health and whether there is a history of ovarian or breast cancer in your family.
Your GP may also carry out a vaginal or internal examination to investigate your ovaries and womb. They may also take a blood sample or refer you for an ultrasound scan.
If necessary, your GP may then refer you to a specialist (a gynaecologist or gynaecological oncologist) at the hospital.
The specialist may carry out another internal examination. They will ask about your symptoms and general health. They may also do further tests to confirm the diagnosis of ovarian cancer, including a blood test and ultrasound.
Blood test (CA125)
You may have a blood test to look for a chemical called CA125 in the blood. This chemical is produced by some ovarian cancer cells. A very high level of CA125 in the blood may mean you have ovarian cancer.However, this chemical is not specific to ovarian cancer and may also be raised in many benign conditions, so a raised level of CA125 does not definitely mean you have ovarian cancer.
The National Institute for Health and Care Excellence (NICE) has produced guidance that advises your GP to test for CA125 if you frequently experience:
- bloating
- feeling full quickly
- loss of appetite
- pelvic or abdominal pain
- needing to urinate urgently or frequently
The CA125 test is particularly important if you are 50 or over, or have these symptoms more than 12 times each month.
If you experience unexplained weight loss, fatigue or changes in your bowel habits such as diarrhoea or constipation, your GP may also test for CA125.
If you are 50 or over and have experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.
A significant proportion of women with early stage ovarian cancers have a normal CA125 level.
If you do have a raised CA125 level, your GP will arrange for you to have an ultrasound scan.
Ultrasound
Ultrasound uses high frequency sound waves to produce an image of your ovaries. You may have an internal ultrasound (known as a transvaginal ultrasound), where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach. The image produced can show the size and texture of your ovaries, as well as any cysts that may be present.Further tests
If you've been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and whether it has spread. This is called staging.These other tests may include:
- chest X-ray – this can see if the ovarian cancer has spread to your lungs or caused a build-up of fluid around the lungs (called a pleural effusion).
- CT scan or MRI scan – these imaging techniques are used to look for signs of cancer elsewhere in your chest, abdomen and pelvis.
- abdominal fluid aspiration – if there is a build-up of fluid in your abdomen and it looks swollen, it could mean your ovarian cancer has spread. To find out, a thin needle is passed into your abdomen to take a sample of fluid to be tested for cancer cells.
- laparoscopy – this small operation may be performed if the gynaecologist wants to take a better look at the ovaries. A thin tube with a camera on the end (a laparoscope) is inserted through a small cut in your lower abdomen (stomach) in order to examine your ovaries. A small sample of tissue may be taken from your ovaries for testing (this is known as a biopsy).
Stages and grades of ovarian cancer
Staging
When your ovarian cancer is diagnosed, the doctors will give it a stage. This is often based on surgical findings. The stage describes the size of the cancer and how far it has spread. Ovarian cancer has four commonly used stages:- stage 1 – the cancer only affects one or both of the ovaries
- stage 2 – the cancer has spread from the ovary and into the pelvis or uterus
- stage 3 – the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis
- stage 4 – the cancer has spread to other parts of the body such as the liver, spleen or lungs
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| Stage 1 ovarian cancer. Cancer Research UK |
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| Stage 2 ovarian cancer. Cancer Research UK |
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Stage 2 ovarian cancer. Cancer Research UK |
Grading
The grade of cancer refers to the appearance of cells under a microscope.- low grade – although abnormal, cells appear to be slow-growing
- moderate grade – cells look more abnormal than low-grade cells
- high grade – cells look very abnormal and are likely to be fast-growing
Treating ovarian cancer
The best treatment for ovarian cancer depends on several things, such as the stage of your cancer and your general health. Treatment will usually involve a combination of surgery and chemotherapy.As with most types of cancer, the outlook largely depends on how far the cancer has advanced by the time it is diagnosed and your age at diagnosis. Ninety per cent of women diagnosed with early stage one ovarian cancer will be alive in five years' time (the five-year survival rate).
Read more information about how ovarian cancer is treated.
Being diagnosed with ovarian cancer can affect daily life in many ways. However, there is support available for many aspects of living with ovarian cancer, including emotional, financial and long-term health issues.
Ovarian cancer screening
There are methods of screening for ovarian cancer but, at the moment, they are not yet fully tested. Screening is only available for women who are at high risk of developing the disease due to a strong family history or inheritance of a particular faulty gene. Clinical trials in the UK are currently assessing the effectiveness of screening in high-risk women and in the general population.A cervical screening test (which used to be called a smear test) cannot detect ovarian cancer.
Sources:
-Dr Jennifer Frank Family University of Wisconsin School of Medicine and Public Health Appleton, Wisconsin 2010-04-28
-Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom PLos Medicine 2012-04-03
-NHS. UK