Ovarian Cancer: Introduction
What is cancer?
Cancer is when cells in the body change and grow out of control. To help you understand what happens when you have cancer, let's look at how your body works normally. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer.
Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasis).
What is ovarian cancer?
Ovarian cancer is cancer that starts in your ovaries. Only women have ovaries, so only women get this kind of cancer.
Many types of tumors can start growing in the ovaries. Some are benign. This means that they’re not cancer. Benign tumors don’t spread. They can usually be treated by removing one ovary or part of the ovary. Ovarian cancer, however, is a malignant (cancerous) tumor. If a cancerous tumor isn’t treated, it can grow and spread to other parts of your body.
The ovary is made up of many layers of cells. Cancer can affect any one or all of these layers. These are the main types of ovarian cancer.
Epithelial ovarian cancer
This is by far the most common type of ovarian cancer. It starts in cells on the surface of the ovary. Many epithelial ovarian cancers start in fallopian tube or peritoneal (the lining of the inside of the belly) epithelial cells. Then they go to the surface of the ovary.
Germ cell ovarian cancer
This cancer starts in the cells that form eggs in the ovary. These rare tumors are most common in women in their teens and early twenties. There are different sub-types of germ cell tumors.
Stromal cell cancer
This cancer forms in the tissue that makes certain female hormones and holds the ovaries in place. This is a very rare form of ovarian cancer.
Understanding the ovaries
To understand where the tumor is, it may help to know more about your ovaries. A woman's reproductive system has two ovaries. These are the other structures in that system:
Vulva. This is the external female genitals. These are the parts outside your body.
Vagina. This is the passage that connects the uterus to the outside of your body. It's also called the birth canal.
Cervix. This is the lower part of your uterus that connects it to the vagina.
Uterus. This is the hallow, pear-shaped organ that holds a growing baby. It's also called the womb.
Two fallopian tubes. These are the tubes through which an egg travels from the ovaries to the uterus.
Your ovaries are responsible for hormone and egg production. They are located on either side of the uterus, in your pelvis. Each month, one of the ovaries releases an egg. After the egg leaves the ovary, it goes down the fallopian tube. If the egg connects with a sperm, it’s fertilized and burrows into the wall of the uterus. There it grows to become a baby. If the egg isn’t fertilized, it leaves the body through the vagina along with the menstrual flow. The ovaries also make the hormones that control the development of certain parts of your body. These include the breasts, body shape, and body hair. These hormones also control your menstrual cycle.
When a woman reaches menopause, her ovaries stop releasing eggs. They also stop making certain hormones.
Talk with your healthcare provider
If you have questions about ovarian cancer, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer.
Ovarian Cancer: Diagnosis
How is ovarian cancer diagnosed?
If your healthcare provider thinks you might have ovarian cancer, you will need certain exams and tests to be sure. Diagnosing ovarian cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, reproductive history (such as if you've ever been pregnant), and family history of disease. Your healthcare provider will also give you a physical exam.
What tests might I need?
You may have one or more of the following tests:
CA-125 blood test
This is often the first exam done. It allows your healthcare provider to feel for any abnormal lumps (masses) or other problems. During a pelvic exam, you lie on your back on an exam table, with your feet in stirrups and your legs apart. Your healthcare provider puts 1 or 2 fingers of a gloved hand inside your vagina. He or she uses the other hand to press on your lower belly (abdomen) to feel for masses. Your healthcare provider may also put a finger in your rectum to feel for anything abnormal that might suggest that the cancer has spread.
This test allows your healthcare provider to see if there's a cyst or tumor on your ovary, or if there is fluid in your abdomen Your healthcare provider aims sound waves at your ovaries. He or she does this either by putting a small probe into your vagina (transvaginal ultrasound) or aiming them through the skin of your abdomen (abdominal ultrasound). The pattern of the echoes makes a picture on a video screen. This is called a sonogram. The echoes are different for healthy tissues, fluid-filled cysts, and tumors. The test can be uncomfortable, but it isn’t painful. It doesn’t use X-rays. You don’t need to be sedated.
This test makes detailed 3-D pictures of organs and tissues in your pelvis or abdomen. An X-ray machine linked to a computer takes several pictures. You may get contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly.
CA-125 blood test
This blood test shows how much of a protein called CA-125 is in your blood. A high (elevated) CA-125 may be a sign of tumor cells. But it also can be elevated in many noncancer conditions. This is called a false positive result. After a diagnosis of ovarian cancer, your healthcare provider may use this blood test to see if you’re responding to treatment. Or the test can be used to check if the cancer has come back.
Unlike many other types of cancer, a biopsy is rarely used to diagnose ovarian cancer before surgery. If a cancer is present and just in the ovary, doing a biopsy breaks the covering of the ovary. This may allow the cancer to spread. Sometimes your healthcare provider may recommend a biopsy of a tumor or lymph node that is not near the ovary. This is done to see if the cancer has spread to another area. A diagnosis of ovarian cancer is often confirmed at the time of surgery. At that time, the surgeon removes the tumor or tumors and takes samples of nearby tissues to find out if the cancer has spread. In a lab, a pathologist looks at the removed tissues to see if cancer is present.
Getting your test results
When your healthcare provider has the results of your tests, he or she will contact you with the results. Your provider will talk with you about other tests you may need if ovarian cancer is strongly suspected. Make sure you understand the results and what follow-up you need.
Ovarian Cancer: Treatment Choices
This information focuses on treatment for epithelial ovarian cancer. Other types of ovarian cancer are rare. The type of treatment you receive depends on how far the cancer has spread (stage).
Cancer may just be in the ovary or may spread only to nearby areas. If so, it’s called local or early-stage cancer. If the cancer has spread to distant areas in the body, it’s called metastatic or advanced ovarian cancer. It’s important that your findings be put into context by an expert. Gynecologic oncologists are specialists with advanced training in the diagnosis, treatment, and surveillance of female cancers. These include ovarian cancer.
Learning about your treatment options
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.
Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than 1, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.
Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process.
Types of treatment for ovarian cancer
Your healthcare provider may suggest a combination of treatments. Healthcare providers most often treat ovarian cancer with surgery followed by chemotherapy (chemo). In some cases, your healthcare provider may suggest that you receive chemo before surgery. This is done to shrink the cancer and make it easier to remove.
These are the treatments most often used for ovarian cancer. They are listed from the most common to least common.
You may have surgery to diagnose and stage ovarian cancer and to treat it. Your surgeon removes tissue and looks at it for signs of cancer. The main goal of surgery is to attempt a cure by taking out all of the tumor or tumors. Your healthcare provider may remove one or both ovaries and surrounding tissue and lymph nodes. Even if the ovarian cancer has spread beyond the ovaries, surgically removing as much of the cancer as possible can give you a better chance for survival.
This treatment uses medicines to slow the growth of or kill the cancer. It also reduces the chance of it coming back. Chemo is recommended in most cases, even for early stage disease. It may be given by IV (intravenously). Or it may be placed directly into your belly (abdomen). This is called IP (intraperitoneal) chemo.
This treatment uses high-energy X-rays to kill cancer cells. It’s rarely used to treat ovarian cancer. Healthcare providers use it most often to ease cancer symptoms. Women getting radiation for ovarian cancer often have external radiation. This type of radiation comes from a machine that directs rays of energy at the tumor from outside of the body.
Making treatment decisions
It’s a good idea to learn all you can about your cancer and treatment choices. This can help you make decisions about your care. One of the best ways to get the information you need is to ask your healthcare providers.
Make sure you ask how the treatment may affect your life. Ask how it may affect your diet, appearance, mood, energy level, sexual function, and sleep habits. Find out if treatment will put you into menopause. Ask how successful the treatment usually is. Find out about the risks and possible side effects, both short and long term. The American Cancer Society, the National Cancer Institute , and the Foundation for Women's Cancer also offer information about ovarian cancer. You may want to get second opinion from a gynecologic oncologist.