Ovarian cancer begins in the ovaries, which are located on each side of the uterus and produce female hormones and eggs. Some tumors located next to ovarian tissues are considered ovarian cancer, such as cancer of the membrane lining the walls of the pelvic cavity next to the ovaries.
There are three common types of ovarian cancer:
- Epithelial tumors arise from cells that line or cover the ovaries.
- Germ cell tumors originate from cells that form eggs.
- Sex cord-stromal cell tumors begin in the connective cells that hold the ovaries together and produce female hormones.
Epithelial Tumors: The most common type of ovarian cancer, epithelial tumors are divided into subtypes that are further classified as benign (noncancerous) or malignant (cancerous). At time of diagnosis, 75 percent of patients with common epithelial tumors are stage III or IV. At Mount Sinai, our specialists are highly experienced at treating ovarian cancer of epithelial origin. Common epithelial tumors are:
- Serous tumors are the most widespread form of ovarian cancer. About half are malignant.
- Endometrioid tumors are less common, but most are malignant.
- Clear cell tumors account for only a small number of epithelial tumors, but nearly all of these tumors are malignant. Approximately half are associated with endometriosis.
- Mucinous tumors are even less common but are most often benign.
Germ Cell Tumors: Germ cell tumors are formed from egg-making cells within the ovaries and tend to occur in young women, with a peak incidence among women in their early twenties. These tumors are usually curable with 60 percent and 70 percent of patients diagnosed with stage I germ cell tumor ovarian cancer.
Sex Cord-stromal Tumors: Sex Cord-stromal Tumors are developed from cells of the sex cord or mesenchyme (early connective tissue) within the embryonic gonad. They may contain gonad-related cells, such as granulosa.
You know your body best, so it is important that if you notice a symptom such as vaginal bleeding that is unusual for you, or if you have change in your body that lasts for two weeks, you can arrange to see your doctor. The earlier ovarian cancer is found and treated, the more likely the treatment will be effective. Ovarian cancer may cause one or more of these signs and symptoms:
- Vaginal bleeding or abnormal discharge from your vagina
- Pelvic or abdominal pain (the area below your stomach and between your hip bones)
- Back pain
- Feeling full quickly while eating
- A change in bathroom habits, such as having to pass urine very badly or very often, constipation, or diarrhea
Ovarian cancer generally strikes after age 40, with the greatest number of cases occurring in women age 60 and older.
The following factors may increase a woman’s risk for ovarian cancer:
- Middle-aged or older
- Close family members, such as a mother, sister, aunt, or grandmother, on either the mother's or your father's side, who have ovarian cancer
- A genetic mutation or abnormality called BRCA1 or BRCA2
- Breast, uterine, or colorectal or colon cancer
- An Eastern European (Ashkenazi) Jewish background
- No births or trouble getting pregnant
- Endometriosis, a condition in which tissue from the lining of the uterus grows elsewhere in the body
Ovarian cancer has a hereditary element that can be detected through genetic testing. At Mount Sinai, our specialists may perform these tests for women at high risk of ovarian cancer. Women, who find they are genetically predisposed to ovarian cancer and who have other risk factors may choose to have their ovaries removed before cancer takes root (prophylactic oophorectomy).
Factors that May Reduce Risk
There is no known way to prevent ovarian cancer. However, lower rates of ovarian cancer have been detected in women who have:
- Used birth control pills for more than five years.
- Had their "tubes tied" (tubal ligation)
- Had both ovaries removed
- Had a hysterectomy
- Given birth
While there is no simple, reliable way to screen for ovarian cancer in women who do not have any signs or symptoms, there are diagnostic tests to detect ovarian cancer once you begin experiencing symptoms, or if you are a high-risk patient who has not yet demonstrated symptoms.
Tests and Procedures to Diagnose Ovarian Cancer
Your doctor may use one of the following diagnostic tests to determine the cause of your symptoms and to determine if you have ovarian cancer.
- Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. Your doctor or nurse inserts one or two lubricated, gloved fingers into your vagina while placing the other hand over your lower abdomen to feel the size, shape, and position of your uterus and ovaries. Using a speculum to hold open the vagina, your doctor examines the vagina and cervix for signs of disease. A Pap test (Pap smear) is usually performed in conjunction with the pelvic exam, as is a digital rectal exam, in which your doctor or nurse inserts a lubricated, gloved finger into your rectum to feel for lumps or other abnormalities.
- Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs to create echoes. The echoes form a picture of your body tissues (sonogram). An abdominal ultrasound or a transvaginal ultrasound may be done.
- CA 125 assay: A test that measures the level of CA 125 in the blood. An increased CA 125 level is sometimes a sign of cancer or another condition.
- Barium enema: A series of X-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.
- Intravenous pyelogram (IVP): A series of X-rays of the kidneys, ureters, and bladder to find out if your cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, X-rays are taken to see if there are any blockages.
- CT scan (CAT scan): A procedure that creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or given orally to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The tissue is removed in a procedure called a laparotomy (a surgical incision made in the wall of the abdomen).
To plan the best treatment, your doctor needs to know the grade of the tumor and the extent or stage of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body. Staging requires sample tissue to look for cancer and to determine if it has spread. Your doctor may order these diagnostic tests to stage your cancer: barium enema, chest X-ray, colonoscopy, or CT scan.
Staging refers to the extent that your cancer has spread. Stages of ovarian cancer are defined as:
- Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.
- Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found in the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen.
- Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.
- Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs.
Your treatment options and chance of recovery (prognosis) depend on the following:
- The stage of the cancer
- The type and size of the tumor
- Patient age and general health
- Whether the cancer has just been diagnosed or has recurred (come back)
When detected in its early stages, ovarian cancer may be effectively treated. At Mount Sinai, we have a team of experts in the field of ovarian cancer detection, management, treatment, and research. If your doctor says that you have ovarian cancer, ask to be referred to a gynecologic oncologist, a doctor who has been trained to treat cancers of a woman's reproductive system. This doctor will work with you to create a treatment plan that may include surgery, radiation therapy, chemotherapy or a combination of these treatments.
Most patients have surgery to remove as much of the tumor as possible. The type of surgery will be part of your overall treatment plan, based on your type of ovarian cancer and its stage, such as:
- Hysterectomy: A surgical procedure to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
- Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.
- Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.
- Omentectomy: A surgical procedure to remove the omentum — a piece of the tissue lining the abdominal wall.
- Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
- Laparoscopic Treatment: This minimally-invasive surgical procedure may be used to evaluate and remove complex ovarian cysts, and to treat early and certain advanced or recurrent ovarian cancers.