Ovarian Cancer – Cedars-Sinai

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 inches 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 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.

Symptoms

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 suggest the disease is present. A national consensus statement of ovarian cancer symptoms include:

Bloating
Pelvic or abdominal pain
Difficulty eating or feeling full quickly
Urinary symptoms, such as urgency or frequency

These symptoms are more likely to occur in women with ovarian cancer than in the general population, and are persistent and progressive over a short period of time. Importantly, they typically represent a change from normal. Development of these symptoms should prompt women to see a qualified health care provider and undergo evaluation for a potential ovarian cancer.

Risk Factors

Several risk factors are known to increase the likelihood for ovarian cancer development. These include:

Genetic predisposition through deleterious gene 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, obesity, and/or a diagnosis of infertility; it remains unclear whether these are indeed true risk factors.

Diagnosis

Women with risk factors for ovarian cancer and persistent/progressive symptoms should undergo evaluation by a qualified health care provider. This evaluation should initially involve a comprehensive medical history and physical exam, including examination of the pelvis with rectal exam. Additionally, testing may include imaging studies of the pelvis (and abdomen) via ultrasonography (US) or computed tomography (CT). Transvaginal ultrasonography, 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 the spread of cancer. It may also be a recommendation for you to receive an OVA1 test, which may help your gynecologist know to refer you to a gynecologic oncologist for further evaluation.

If cancer is suspected, blood tests may be drawn to measure levels of a specific protein known as 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.

Treatments

Women with a known or suspected ovarian cancer should be referred to a gynecologic oncologist for further evaluation. 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.