David Fishman, MD, writes about ovarian cancer and how early detection can significantly increase the rate of survival. Learn more
At Mount Sinai in New York, we have a team of experts in the field of ovarian cancer detection, management, treatment and research. Our multi-disciplinary team includes gynecologic oncologists who are trained in complicated gynecologic surgery as well as in the delivery of chemotherapy and radiation, as well as groundbreaking researchers who are hard at work developing novel treatment strategies in the laboratory and advancing our understanding of the pathogenesis of ovarian malignancies. Our team also includes patient care coordinators, nutritionists, social workers and ovarian cancer survivor volunteers who are committed to providing the highest quality care to our patients.
About Ovarian Cancer
Ovarian cancer begins in your ovaries, which are located on each side of the uterus and produce female hormones and eggs. When detected in its early stages, ovarian cancer may be effectively treated.
Ovarian cancer generally strikes after age 40, with the greatest number of cases occurring in women age 60 and older. There are three 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.
Some tumors located next to ovarian tissues may be considered ovarian cancer. For example, extraovarian peritoneal carcinoma (intraperitoneal carcinomatosis) — cancer of the membrane lining the walls of the pelvic cavity next to the ovaries — is treated as if it were advanced ovarian cancer. The prognosis in patients with this condition is similar to that of women with advanced ovarian cancer.
The most common type of ovarian cancer is epithelial. Epithelial tumors are divided into subtypes, such as serous, endometrioid, mucinous, and clear cell tumors. These subtypes are further classified as benign (noncancerous) or malignant (cancerous).
- 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.
Mount Sinai is highly experienced at treating ovarian cancer of epithelial origin, including rare types such as Brenner tumors, undifferentiated tumors, transitional tumors and borderline ovarian tumors.
Germ Cell Tumors
Germ cell tumors are formed from egg-making cells within the ovaries. Germ cell tumors tend to occur in young women, with a peak incidence among women in their early 20s. These tumors are usually curable.
Unlike patients with common epithelial tumors, 75% of whom are Stage 3 or 4 at diagnosis, between 60% and 70% of patients with germ cell tumors are Stage 1; most remaining patients are Stage 3 (Stages 2 and 4 are relatively rare for this tumor type) (see also Ovarian Cancer Staging).
Sex Cord-stromal Tumors
Sex cord-stromal tumors develop from cells of the sex cord or mesenchyme (early connective tissue) within the embryonic gonad. They may contain gonad-related cells, such as granulosa
Types of Ovarian Cancer cells include Sertoli cells, thecal cells, and fibroblasts. Related tumors include lipid cell tumors and gynandroblastomas. Granulosa stromal cell tumors are the most prevalent of the sex cord-stromal tumors. They are more common in postmenopausal. Sex cord-stromal tumors are associated with hormonal effects, such as the development of male secondary sex characteristics (low voice, facial hair), precocious puberty, early sexual maturity, amenorrhea, the absence of menstruation, or postmenopausal bleeding.
There is no way to know for sure if you will get ovarian cancer. Most women with ovarian cancer are not at high risk. However, several factors may increase your risk for ovarian cancer, including if you:
- Are middle-aged or older
- Have close family members, such as your mother, sister, aunt, or grandmother, on either your mother's or your father's side, who have had ovarian cancer
- Have a genetic mutation (abnormality) called BRCA1 or BRCA2
- Have had breast, uterine, or colorectal (colon) cancer
- Have an Eastern European (Ashkenazi) Jewish background
- Have never given birth or have had trouble getting pregnant
- Have 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. Mount Sinai 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). In high-risk women, this can greatly decrease the risk of developing ovarian cancer.
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.
- Have had their "tubes tied" (tubal ligation)
- Have had both ovaries removed
- Have had a hysterectomy
- Have given birth
Signs and Symptoms
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.
Pay attention to your body, and know what is normal for you. If you have abnormal vaginal bleeding, see your doctor right away. Also see a doctor if you have any of the other signs for two weeks or longer and they are not normal for you. These symptoms may be caused by something other than cancer, but the only way to know is to see a doctor. The earlier ovarian cancer is found and treated, the more likely treatment will be effective.
There is no simple and reliable way to screen for ovarian cancer in women who do not have any signs or symptoms. However, early detection can lead to effective treatment.
Diagnostic tests are used once you begin experiencing symptoms or if you are a high-risk patient who has not yet demonstrated symptoms. Diagnostic tests are used to determine the cause of your symptoms.
Mount Sinai may perform the following tests and procedures to diagnose 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).
The Pap test does not check for ovarian cancer. The only cancer the Pap test screens for is cervical cancer. Since there is no simple and reliable way to screen for any gynecologic cancers except for cervical cancer, it is especially important to recognize warning signs and see your doctor.
The prognosis (chance of recovery) and treatment options 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)
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.
To make an appointment with a Mount Sinai gynecologic oncologist, please contact us at 212-427-9898.
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