The ovaries
The ovaries are part of a woman's reproductive system. They are in the pelvis. Each ovary is about the size of an almond.
The ovaries make the female hormones -- estrogen and progesterone. They also release eggs. An egg travels from an ovary through a fallopian tube to the womb (uterus).
When a woman goes through her "change of life" (menopause), her ovaries stop releasing eggs and make far lower levels of hormones. Ovarian cancer Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.
Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Tumors can be benign or malignant: Benign tumors are not cancer:
Benign tumors are rarely life-threatening.
Generally, benign tumors can be removed. They usually do not grow back.
Benign tumors do not invade the tissues around them.
Cells from benign tumors do not spread to other parts of the body.
Malignant tumors are cancer:
Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
Malignant tumors often can be removed. But sometimes they grow back.
Malignant tumors can invade and damage nearby tissues and organs.
Cells from malignant tumors can spread to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the lymphatic system or bloodstream. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
Benign and malignant cysts
An ovarian cyst may be found on the surface of an ovary or inside it. A cyst contains fluid. Sometimes it contains solid tissue too. Most ovarian cysts are benign (not cancer).
Most ovarian cysts go away with time. Sometimes, a doctor will find a cyst that does not go away or that gets larger. The doctor may order tests to make sure that the cyst is not cancer.
Ovarian cancer
Ovarian cancer can invade, shed, or spread to other organs:
Invade: A malignant ovarian tumor can grow and invade organs next to the ovaries, such as the fallopian tubes and uterus.
Shed: Cancer cells can shed (break off) from the main ovarian tumor. Shedding into the abdomen may lead to new tumors forming on the surface of nearby organs and tissues. The doctor may call these seeds or implants.
Spread: Cancer cells can spread through the lymphatic system to lymph nodes in the pelvis, abdomen, and chest. Cancer cells may also spread through the bloodstream to organs such as the liver and lungs.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if ovarian cancer spreads to the liver, the cancer cells in the liver are actually ovarian cancer cells. The disease is metastatic ovarian cancer, not liver cancer. For that reason, it is treated as ovarian cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.
Risk factors
Following risk factors for ovarian cancer:
Family history of cancer: Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer.
Personal history of cancer: Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer.
Age over 55: Most women are over age 55 when diagnosed with ovarian cancer.
Never pregnant: Older women who have never been pregnant have an increased risk of ovarian cancer.
Menopausal hormone therapy: Women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.
Symptoms
Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows, symptoms may include:
Pressure or pain in the abdomen, pelvis, back, or legs
A swollen or bloated abdomen
Nausea, indigestion, gas, constipation, or diarrhea
Feeling very tired all the time
Less common symptoms include:
Shortness of breath
Feeling the need to urinate often
Unusual vaginal bleeding (heavy periods, or bleeding after menopause)
Most often these symptoms are not due to cancer, but only a doctor can tell for sure. Any woman with these symptoms should tell her doctor. Diagnosis
Your doctor may ask about your personal and family medical history.
You may have one or more of the following tests. Your doctor can explain more about each test:
Physical exam: Your doctor checks general signs of health. Your doctor may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
Pelvic exam: Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but it is not used to collect ovarian cells. The Pap test detects cervical cancer. The Pap test is not used to diagnose ovarian cancer.
Blood tests: Your doctor may order blood tests. The lab may check the level of several substances, including CA-125. This test is approved by the Food and Drug Administration for monitoring a woman's response to ovarian cancer treatment and for detecting its return after treatment.
Ultrasound: The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis. The waves bounce off the organs. A computer creates a picture from the echoes. The picture may show an ovarian tumor. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound).
Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen.
Although most women have a laparotomy for diagnosis, some women have a procedure known as laparoscopy. The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.
A pathologist uses a microscope to look for cancer cells in the tissue or fluid. If ovarian cancer cells are found, the pathologist describes the grade of the cells. Grades 1, 2, and 3 describe how abnormal the cancer cells look. Grade 1 cancer cells are not as likely as to grow and spread as grade 3 cells. Staging
To plan the best treatment, the doctor needs to know the grade of the tumor and the extent (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.
Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer.
Your doctor may order tests to find out whether the cancer has spread:
CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
Chest x-ray: X-rays of the chest can show tumors or fluid.
Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.
These are the stages of ovarian cancer:
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 on 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.
Treatment methods
Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used.
Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body:
Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
Intraperitoneal chemotherapy: Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis.
Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.
Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.
Surgery
The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:
both ovaries and fallopian tubes (salpingo-oophorectomy)
the uterus (hysterectomy)
the omentum (the thin, fatty pad of tissue that covers the intestines)
nearby lymph nodes
samples of tissue from the pelvis and abdomen
If the cancer has spread, the surgeon removes as much cancer as possible. This is called "debulking" surgery.
If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.
You may be uncomfortable for the first few days after surgery. Medicine can help control your pain.
The time it takes to heal after surgery is different for each woman. You will spend several days in the hospital. It may be several weeks before you return to normal activities.
If you haven't gone through menopause yet, surgery may cause hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Your doctor would give you a treatment plan including drugs and lifestyle changes that can help, and most symptoms go away or lessen with time. Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery.
Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways:
By vein (IV): The drugs can be given through a thin tube inserted into a vein.
By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen.
By mouth: Some drugs for ovarian cancer can be given by mouth.
Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.
You may have your treatment in a clinic, at the doctor's office, or at home. Some women may need to stay in the hospital during treatment.
The temporary side effects of chemotherapy hair loss (Your hair will grow back) , nausea and vomiting, diarrhea, or mouth and lip sores. Most of these side effects usually go away after treatment ends. Radiation therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. A large machine directs radiation at the body.
Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment is given at a hospital or clinic. Each treatment takes only a few minutes.
Side effects depend mainly on the amount of radiation given and the part of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea, or bloody stools. Also, your skin in the treated area may become red, dry, and tender. Although the side effects can be distressing, your doctor can usually treat or control them. Also, they gradually go away after treatment ends.
Nutrition and physical activity
It's important for women with ovarian cancer to take care of themselves. Taking care of yourself includes eating well and staying as active as you can.
You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian can suggest ways to deal with these problems
Many women find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy.
Follow-up care
You will need regular checkups after treatment for ovarian cancer. Even when there are no longer any signs of cancer, the disease sometimes returns because undetected cancer cells remained somewhere in your body after treatment.
If you have any health problems between checkups, you should contact your doctor.