Ovarian Cancer

Ovarian cancer occurs when cancer cells form in the tissues of the ovary. There are two main types of ovarian cancer: Ovarian epithelial carcinomas, where the cancer cells begin on the surface of the ovary, and malignant germ cell tumors, where cancer begins in the egg cells. Though not as common as some cancers, ovarian can be one of the mostly deadly, because it often spreads before it is diagnosed. In the U.S., ovarian cancer ranks as the fifth leading cause of cancer death in women, although the number of deaths from the disease has decreased slightly since 2002.

5 steps to protect your ovaries

  1. Maintain a healthy weight. Being obese (having a body mass index of 30 or more) raises your risk of almost all forms of cancer, but there seems to be a specific danger with ovarian cancer. One study from the National Cancer Institute of more than 94,500 women found that obesity was associated with an almost 80 percent higher risk of ovarian cancer among women who had never taken hormones after menopause. Other studies have also supported a link between obesity and ovarian cancer. Keeping your weight at a healthy level (a BMI between 18.5-24.9) not only lowers your cancer risk, it also slashes your chance of developing many other chronic ailments, from heart disease to diabetes.
  2. Know your family history. According to the National Cancer Institute, the single greatest ovarian cancer risk factor is a family history of the disease. A large meta-analysis of 15 published studies estimates a woman with at least one first-degree relative (mother, sister or daughter) who has had ovarian cancer has about three times more odds of developing the disease. Of course, other lifestyle factors also come into play, and having a relative with a history of the disease does not mean you are guaranteed to get it.
  3. Consider the risks of certain medications. Research has shown that women who have taken estrogen-only hormone replacement therapy after menopause have an increased risk of ovarian cancer; the longer the medication is used, the greater the risk. Scientists are less certain about the risks associated with hormone replacement therapy that contains both estrogen and progestin. If you’re trying to conceive and are considering taking fertility drugs, talk to your doctor about the risks involved: Studies show some of these drugs may also be linked to an increased risk of ovarian cancer.
  4. Think about oral contraceptives. If family planning is not in your immediate future, you may want to consider taking oral contraceptives as your form of birth control. Taking birth control pills for five years has been shown to reduce ovarian cancer risk by 50 percent. This protective effect seems to last for years after you’ve stopped taking the drugs—in some cases up to 25 years later. However, oral contraceptives do carry their own side effects, including an increased risk of blood clots (higher in women who smoke). There’s also some evidence linking oral contraceptives to a slight increase in breast cancer risk, although this diminishes over time.
  5. Breastfeed your babies. There are loads of good reasons to breastfeed your infant, and you can add ovarian cancer risk reduction to the list. Research shows the longer a mother breastfeeds, the less likely she is to develop the disease. Breastfeeding typically delays ovulation, and the more times you ovulate, the higher risk of developing some sort of cell mutation. One recent Chinese study found women who breastfed for 20 months decreased their risk of ovarian cancer by 50 percent, although benefits can be seen with as little of 12 months of breastfeeding.

Ask Your Doctor

Ovarian cancer is often deadly because, unlike mammograms for breast cancer or colonoscopies for colorectal cancer, there’s really no good screening test to clearly detect the disease in its early stages. Currently, doctors use a combination of procedures or tests to help increase the odds of catching the cancer before it spreads:

  • A transvaginal ultrasound, a procedure used to examine the vagina, uterus, fallopian tubes and bladder by placing an ultrasound probe into the vagina. High-energy sound waves (ultrasound) then bounce off internal organs and tissues; the echoes form a picture that can help outline any abnormal growths.
  • A CA-125 assay, a blood test that measures levels of CA125. This is a substance released by cells into the bloodstream; increasing levels of CA-125 can sometimes signal the presence of cancer cells. This test is used to follow the course of this disease.
  • If you have a family history of ovarian cancer, you may want to talk to your doctor about getting a genetic test. A woman who has the genetic mutation known as BRCA1 has an average lifetime risk of developing ovarian cancer of 39 percent; a woman with a BRCA2 mutation has an average of 11 percent lifetime risk of the disease. Both men and women with these altered genes also have higher risk of breast, prostate, pancreatic, laryngeal and stomach cancers, as well as melanoma. Women with a BRCA1 or BRCA2 mutation may wish to have their breasts and/or ovaries removed to reduce their cancer risk.

Although early ovarian cancer may not cause any symptoms, later stages of the disease can sometimes include pain or swelling of the abdomen, pain in the pelvis, and gastrointestinal problems (such as gas, bloating or constipation).

If your doctor does suspect cancer, additional tests such as a CT scan or biopsy may be ordered to provide a clearer diagnosis. Once cancer is diagnosed, tests are usually done to find out if the cancer cells have spread within the ovaries or to other parts of the body. Ovarian cancer ranges from stage 1 (cancer found inside one or both ovaries) to stage 4 (cancer is found in one of both ovaries and has spread beyond the abdomen to other parts of the body).

Treatment Options

Treatment for ovarian cancer varies depending on the stage and type, but generally most patients have surgery to remove as much of the tumor as possible. This may include removing one or both ovaries, one or both fallopian tools, the uterus and sometimes the cervix. Following surgery treatment may include radiation therapy and/or chemotherapy to kill cancer cells or keep them from growing.

Find a cancer specialist at the North Shore-LIJ Cancer Institute.