Ovarian Cancer Overview

• Ovarian cancer begins in the ovaries when abnormal cell growth occurs. These cells accumulate and form tumors or lumps that may invade, compress or destroy normal tissue.
  
  
• Some tumors that grow in the ovaries are benign, or noncancerous, and never spread beyond the ovary. Patients can be cured by the surgical removal of part or the entire ovary that contains the tumor.
  
  
• Complex tumors can be malignant, or cancerous, and have the potential to spread to other parts of the body (i.e., metastasize).

Ovarian Cancer Incidence Rates

For more details, please refer to:

1. Gynecologic Cancer Foundation Womens Cancer Network
2. American Cancer Society
3. National Cancer Institute
   

• Ovarian cancer is the fifth most common cancer among women. It causes more deaths than any other cancer of the female reproductive system.
  
  
• In 1999, it is estimated that 25,400 new cases of ovarian cancer were diagnosed in the United States and 14,200 women died as a result of ovarian cancer.
  
  
• Over 70% of all women with ovarian cancer will not be diagnosed until the disease has spread beyond the ovary and the cancer is in Stages III or IV. At these stages, the rate of fatality is over 80%.
  
  
• If the cancer is diagnosed and treated while still in the ovary (Stage I) the five-year survival rate is 95%. Currently, only 25% of all ovarian cancers are diagnosed during Stage I.
  
  
• About 76% of ovarian cancer patients survive one year after diagnosis and roughly 50% survive longer than five years after diagnosis.
  
  
• Most ovarian cancers develop after menopause. Half of all ovarian cancers are found in women over the age of 65.

Ovarian Cancer Risk Factors

• Family history of breast, ovarian, uterine, prostate and colon cancer, from either the maternal or paternal family lineage, put a woman at an increased risk for developing ovarian cancer.
  
  
• A woman with a mutated BRCA-1 or BRCA-2 gene is at high risk for developing this disease. About 5% to 10% of ovarian cancers occur in women with these mutated genes.
  
  
• A woman who has had breast cancer or any other cancer in the body has an increased risk
  for ovarian cancer.
  
  
• A diet high in meat and animal fat has been associated with the development of ovarian cancer.
  
  
• Women who have their first child after age 30 have a slightly greater risk of developing ovarian cancer than those who have their first child before age 30.
  
  
• Prolonged use of the fertility drug clomiphene citrate, especially without achieving pregnancy, may increase a womans risk for ovarian cancer.
  
  
• Infertility increases the risk of ovarian cancer.
  
  
• Using birth control pills for five years decreases the incidence of ovarian cancer.
  
  
  

Ovarian Cancer Diagnosis

Clinicians are now being advised that they do not have to rely solely on risk factor assessment. Although ovarian cancer has been referred to as the Silent Killer, 95% of women with ovarian cancer do have symptoms, but they are generally vague and not gynecologic. The symptoms are as follows:

• Pelvic or abdominal pain or discomfort;
  
  
• Vague, but persistent gastrointestinal upsets such as gas, nausea and indigestion;
  
  
• Frequency and/or urgency of urination in absence of an infection;
  
  
• Unexplained changes in bowel habits;
  
  
•  Unexplained weight gain or weight loss, particularly weight gain in the abdominal region;
  
  
• Pelvic and/or abdominal swelling, bloating, and/or feeling of fullness;
  
  
• Pain during intercourse;
  
  
• Ongoing fatigue;
  
  
• Abnormal postmenopausal bleeding (this symptom is rare).
  

Through physical examination, a doctor may feel a mass or cyst on either side of the uterus. If a physical examination suggests ovarian cancer, a series of diagnostic tests will be performed. The tests are:

CA-125 Blood Test

Indicated only for the monitoring of ovarian cancer patients for the re-occurrence of the disease. An elevated level of the protein CA-125 in the blood may suggest ovarian cancer. The test alone may not be accurate since elevated levels of CA-125 are also seen in benign or noncancerous conditions, during the first trimester of pregnancy, and in some normal women.

Ultrasound

This is the most effective non-invasive way to evaluate the size, shape, configuration and consistency of the ovaries to determine if pelvic masses are cystic, solid or both.

Transvaginal Color Flow Doppler

This technology allows doctors to identify the blood vessels that supply cancerous tumors and determine if surgery is needed.

Computerized Axial Tomography (CAT) Scan

CAT scans help doctors determine if the cancer has spread beyond the ovaries.

Surgical Biopsies

This is the only way a doctor can confirm the existence of ovarian cancer. During surgery, a biopsy is taken from the tumor and examined.

Ovarian Cancer Treatment Options

• Surgery to remove the tumor is necessary in all cases, and will usually include the removal of one or both ovaries, the fallopian tubes and the uterus.

• Adjuvant therapy with chemotherapeutic agents is required in most cases.
  
  

Ovarian Cancer - Current Research

Advances in the understanding of the molecular and cellular biology of ovarian cancer have the potential to identify both new tools for early detection and new therapeutic agents.

New directions in prevention, detection and therapy:

Determining the role of oral contraceptives in decreasing the risk of ovarian cancer. Early-stage diagnosis and screening blood tests to identify bioactive lipid growth factors present in blood of ovarian cancer patients with active disease. Serum blood tests to increase the efficacy of screening techniques. High doses of chemotherapy followed by autologous bone marrow transplantation. High dose chemotherapy in conjunction with stem cell support. Gene therapy Antibody-mediated therapy Immunological therapies Intraperitoneal therapy