Ovarian Cancer

What is ovarian cancer?

Ovarian cancer is a type of cancer that forms in a woman’s ovary. An ovary is one of two almond-shaped organs found on each side of the uterus that store eggs and produces the hormones estrogen and progesterone. Depending on the type and stage, malignant cells are found inside, near, or on the outer layer of the ovaries. Common areas where the cancer may spread from the ovary include the abdomen lining, bowel and bladder lining, lymph nodes, lungs, and liver. There are four types of ovarian cancers:

1. Epithelial tumors, which refer to the thin layer of tissue that covers the ovaries and account for 90% of ovarian cancer cases
2. Germ cell carcinoma tumors, in which the cancer begins in the cells that form the eggs and account for 5% of ovarian cancer diagnoses
3. Stromal carcinoma tumors, in which the cancer develops in the connective tissue cells that hold the ovary together and produce estrogen and progesterone and account for 5% of ovarian cancer diagnoses
4. Small cell carcinoma of the ovary (SCCO), which is a rare, highly malignant tumor that accounts for 0.1% of ovarian cancer diagnoses

The staging of ovarian cancers is the following:

• Stage I: Cancer is found in one or both ovaries
• Stage II: Cancer has spread to the pelvis
• Stage III: Cancer has spread to the abdomen
• Stage IV: Cancer has spread to other parts of the body

What is BRCA-mutated ovarian cancer?

A BRCA mutation is a mutation in either the BRCA1 or BRCA2 gene. (BRCA is an abbreviation for BReast CAncer.) These genes are normally tumor suppressor genes, but sometimes rare mutations prevent them from being able to effectively repair broken DNA, increasing the risk for certain types of cancer, most prominently, breast cancer and ovarian cancer. Thus, BRCA-mutated ovarian cancer is a rare, hereditary form of ovarian cancer caused by a mutated BRCA gene. Women with this mutation are about ten to thirty times more likely to develop ovarian cancer in their lifetime. BRCA1-related ovarian cancer usually appears at younger ages, and BRCA2-related ovarian cancer usually appears after menopause. Intensive screening is vital for women who have either BRCA mutation in order to detect new cancer as early as possible.

What are the symptoms of ovarian cancer?

The frequency and/or number of symptoms are key factors in the diagnosis of ovarian cancer, and symptoms become more noticeable as the cancer progresses. Common symptoms include:

• Bloating
• Pelvic pain
• Abdominal swelling
• Loss of appetite
• Urinary symptoms (urgency or frequency)

Symptoms of a cancer within the stromal carcinoma group include:

• Abnormal uterine bleeding
• Endometrial hyperplasia (thickening of the uterus that causes bleeding)
• Breast tenderness
• Vaginal secretions
• Virilizing symptoms due to increased testosterone
• Increased abdominal girth
• Enlarging abdominal mass
• Irregularities in the menstrual cycle

What causes ovarian cancer?

It is unclear what exactly causes ovarian cancer, though BRCA-mutated ovarian cancer in particular is known to be caused by the dominantly inherited BRCA gene mutation. In general, a cancer is formed when a genetic mutation turns normal, healthy cells into abnormal, cancer cells. These cancer cells multiply, forming a tumor, and they can even break off from the initial tumor to spread elsewhere (metastasizing).

How is ovarian cancer diagnosed?

The most common and the primary way to diagnose ovarian cancer is with a pelvic exam. This process includes:

• Inspecting the outer part of genitals
• Inserting two gloved fingers into the vagina and applying pressure on the abdomen to feel the uterus and ovaries.
• Inserting a speculum into the vagina to visually check for abnormalities

Other exams include:

• Imaging tests, such as ultrasounds or CT scans of the abdomen and pelvis
• Blood tests to detect a protein found in ovarian cancer cells.
• Surgery to remove a tissue sample and abdominal fluid and confirm a diagnosis of ovarian cancer.

What are the available treatments for ovarian cancer?

Treatment and disease management options are available depending on the time and stage of the cancer. The most comprehensive treatment is surgically removing the ovaries, fallopian tubes, uterus, nearby lymph nodes, and the omentum. Less invasive surgery may include only removing one ovary and/or fallopian tube. Chemotherapy, radiation, and drugs are also available to help treat and manage the cancer.

Where can I find out more about ovarian cancer?

• Mayo Clinic
• NIH
• National Ovarian Cancer Coalition (NOCC)
• Ovarian Cancer Research Fund Alliance (OCRFA)