The Facts About Ovarian Cancer

It can be difficult to detect ovarian cancer in its early stages. The range of symptoms matches many other less severe health conditions. Knowing the facts about this type of cancer could help save your life.

The ovaries are two small almond-shaped female reproductive glands on either side of the uterus that produce eggs (ova) and the hormones estrogen and progesterone. The ovary is made up of three types of cells.

Ovarian cancer occurs when abnormal cells in the ovaries multiply rapidly and form a tumor.

There are three types of ovarian cancer:

• Epithelial. The epithelial cells spawn tumors on the outer surface of the ovary.
• Stromal cell. The tumor develops on the connective tissues that hold an ovary together.
• Germ cell. The tumors begin in the ovarian cells that develop into eggs.

Tumors arising from the ovaries, fallopian tubes and peritoneum are all grouped as epithelial. About 85 to 90 percent of these cancers are epithelial ovarian carcinomas, according to the American Cancer Society.

High-grade serous carcinoma is the most common epithelial cancer, with 75 percent of cases falling into that category, according to Ovarian Cancer Research Alliance (OCRA) data.

There is another rare type of ovarian cancer known as primary peritoneal cancer (PPC), which originates in the thin layer of tissue inside the abdomen. It is more closely related to epithelial ovarian cancer.

Ovarian cancer is the fifth most common cancer in the United States and affects 1 in 75 women, according to Planned Parenthood. Although not as common as breast cancer, it is considered more deadly.

Ovarian cancer's higher mortality may be due to its symptoms mimicking other less dangerous health conditions in different parts of the body leading to a delay in diagnosis.

The wide list of symptoms of ovarian cancer includes:

• Bloating
• Abdominal swelling
• Difficulty eating or feeling full quickly
• Loss of appetite
• Weight loss
• Fatigue
• Pelvic, abdominal or back pain
• Heartburn or gastrointestinal (GI) upset
• Constipation
• Indigestion
• Menstrual changes
• Abnormal vaginal discharge
• Pain during sex
• Needing to urinate more frequently or feeling the sudden urge to urinate

A doctor may notice other signs, such as abdominal fluid or a lump in the abdomen.

Any new symptoms that last two weeks or more and are not relieved by lifestyle changes such as rest or dietary changes should be evaluated by a doctor.

In the later stages of ovarian cancer, when it has spread throughout the pelvic and abdominal cavity, symptoms become more noticeable, including pain and changes in eating and bowel or bladder function.

Ovarian cancer originates in cellular abnormalities in the fallopian tubes or ovaries that spread to the ovaries. There are some factors that lead to an increased risk of developing this cancer.

Most cases occur after menopause, particularly with epithelial ovarian cancer, the most common type.

Risk factors may include:

• Taking hormone therapy after menopause
• Starting to menstruate at an early age
• Beginning menopause at an older age

A family history of ovarian, breast or colorectal cancer also plays a part in the likelihood you will develop it, too. A personal history of endometriosis or inheriting certain gene mutations, including those in the BRCA1 and BRCA2 genes, can contribute to an increased risk of ovarian cancer.

Some people find it helpful to undergo genetic testing to better understand their potential risk.

Treatments for ovarian cancer include surgery, chemotherapy, hormone therapy, targeted therapies, immunotherapy and palliative care.

Most often, it is treated with a combination of surgery and chemotherapy. Surgery for early-stage cancer may include removing one or both ovaries, the fallopian tubes and, in some cases, the uterus.

Advanced cases may require chemotherapy before surgery to reduce the tumor size or enable a less-invasive procedure. Chemotherapy kills fast-growing cancer cells.

Recently, targeted therapies and immunotherapies have become viable and successful options for ovarian cancer patients, particularly for cases of relapse within six months.

The survival rate for ovarian cancer is highly dependent on when the cancer is diagnosed. According to American Cancer Society data, there is a five-year relative survival rate of 93 percent for Stage I epithelial ovarian cancers, but that falls to 31 percent for Stage III.

Unfortunately, due to a lack of identifiable symptoms early in the course of the disease, only about 17 percent of women with ovarian cancer are diagnosed in an early stage.

But survival is affected by a number of things, including the chosen treatment, how well the cancer responds to the treatment, and the age and general health of the patient.

A pelvic exam is a common first step in the evaluation of a person with symptoms consistent with ovarian cancer.. An abnormality could prompt further evaluation. However, ovarian tumors can also be small and difficult to feel via physical exam, so abdominal and pelvic imaging may be ordered to see if a suspicious mass is present.

Blood tests can flag particular biomarkers that may support a diagnosis of ovarian cancer. These markers are not seen in all ovarian cancers (and can be seen with other benign conditions). To confirm the diagnosis, a biopsy is required.

A pathologist analyzes the cells to confirm diagnosis and provides the grading, or description of the cells. Both the grading and staging are taken into account when determining the course of treatment.

If you have had surgery or treatments such as chemotherapy, it’s important to speak with your doctor about recovery time, as it varies from patient to patient. Most recover from surgery in about six weeks and are able to get back to most normal activities. Others undergo more invasive procedures that require a longer recovery time.

Avoid long periods of standing. If your cervix was removed, your doctor may recommend you avoid sex for three to four weeks to protect the stitches This is temporary; you can have sex after ovarian cancer.

Fatigue is very common. While you may be eager to get back to your regular daily routine, your body requires healing time before reintroducing activities such as driving, working, chores, bathing, exercising, preparing meals and having sex.

There is no known way to prevent cancer, but there are some factors associated with a lower chance of getting it.

To reduce your chances of developing ovarian cancer, consider the following lifestyle choices:

• Avoid smoking
• Maintain a healthy weight
• Use oral birth control pills

In addition, evidence suggests women who have undergone a tubal ligation procedure or have had a hysterectomy are at decreased risk of the disease. A hysterectomy (simple or with unilateral oophorectomy) reduces a woman's chances of developing ovarian cancer by 26 percent, while a tubal ligation can reduce risk by 30 percent, suggested a 2012 study.

It’s also a good idea to speak with your family members about their medical history to better understand your potential genetic risk factors. Having a family history of cancer doesn’t mean you will get cancer, but it is important for your doctor to know.

What is the ovarian cancer survival rate?

The survival rate for ovarian cancer is highly dependent on when the cancer is diagnosed. According to American Cancer Society data, there is a five-year relative survival rate of 93 percent for Stage I epithelial ovarian cancers, but that falls to 31 percent for Stage III.

Is ovarian cancer curable?

In the early stages, ovarian cancer is very treatable, usually via surgery and chemotherapy. However, according to the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER), only about 18 percent of cases in the United States are diagnosed during Stage I.

Ovarian cancer detected during Stage II usually requires hysterosalpingo-oophorectomy—surgical removal of the uterus, ovaries and fallopian tubes—and six or more cycles of chemotherapy. The five-year relative survival rate is 78 percent, 73 percent and 57 percent for stages IIA, IIB and IIC, respectively.

How fatal is ovarian cancer?

Ovarian cancer is the seventh most common cancer in women worldwide, but it is the fifth most common cancer-related cause of death. While not as common as breast cancer, it is considered more deadly.

Patients face an overall 50.8 percent five-year relative survival rate based on SEER data. Ovarian cancer has such a high mortality rate due largely to a lack of good screening tests (such as mammograms for breast cancer). Patients are often diagnosed in advanced stages, reducing survival odds.