The ovary is a female reproductive organ that produces both hormones and eggs. The ovaries are located adjacent to each side of the uterus within the pelvis, are oval shaped, and typically measure approximate 2 by 2 inches long. They are in close proximity to the fallopian tubes, and are connected to the uterus via the utero-ovarian ligament.
Cancers of the ovary may arise from three different cell types: germ cells, sex cord-stromal cells, and the surface epithelial cells. Germ cell ovarian cancers originate from the egg-producing cells, and are typically seen in young women less than 20 years of age. Sex cord-stromal cell ovarian cancers develop from cells that may produce hormones, such as estrogen or testosterone. Epithelial ovarian cancers, the most common type, arise from the surface of the ovary, and are typically seen in women over the age of 50 years.
While epithelial ovarian cancer has been called “the silent disease” for its lack of symptoms, more recent evidence indicates that several signs may develop which could be suggestive of this disease. A national consensus statement of ovarian cancer symptoms include:
- pelvic or abdominal pain
- difficulty eating or feeling full quickly
- urinary symptoms, such as urgency or frequency
Several risk factors are known to increase the likelihood for ovarian cancer development. These include:
- Genetic predisposition through deleterious mutations
- Family history of breast and/or ovarian cancer, especially in a mother, daughter, or sister
- Age over 55 years
- Never having had children
Other studies have suggested weak correlations between increased risk of ovarian cancer and such factors as use of hormone therapy, a diagnosis of infertility, and obesity; it remains unclear whether these are indeed true risk factors.
Women with risk factors for ovarian cancer and persistent/progressive symptoms should undergo evaluation by their health care provider. This evaluation should initially involve a comprehensive medical history and physical exam, including examination of the pelvis with a rectal exam. Additional testing may include imaging studies of the pelvis (and abdomen) via ultrasonography (US) or computed tomography (CT). Transvaginal US, utilizing high-frequency sound waves, is typically the best way to identify growths and cysts on the ovary. CT imaging, which involves a series of computerized X-rays, can identify masses outside of the ovaries and in the abdomen suggestive of spread of cancer.
Blood tests may be drawn to measure levels of a specific protein known as the CA-125. While ovarian cancer cells produce this protein, women with small cancers confined to the ovary may not show any elevation in blood tests. Furthermore, elevated levels are seen with a variety of benign and normal conditions, such as fibroids, endometriosis, simple ovarian cysts, as well as gastritis, hepatitis, and diverticulitis. New blood tests, such as HE4, may also be used in the future to determine the likelihood of ovarian cancer.
Women with a known or suspected ovarian cancer should be evaluated by a gynecologic oncologist. Surgery, with removal of the affected ovarian mass, is typically the initial intervention. If cancer is found, the gynecologic oncologist will remove other affected organs to determine the stage of the disease (where the cancer has spread). Chemotherapy may also be indicated as part of the treatment plan.