Receiving a diagnosis of ovarian cancer is difficult and life changing. Fortunately, medical advances have made treatments more effective. Women diagnosed in the earliest stages have a five-year survival rate of nearly 93 percent, according to the American Cancer Society (ACS). Until recently, ovarian cancer was known as a "silent killer" because it usually wasn't found until it had spread to other areas of your body. But new evidence shows that most women may have symptoms even in the early stages, and awareness of symptoms may hopefully lead to earlier detection. Early detection is important; still, only about 20 percent of ovarian cancers are found before tumor growth has spread beyond the ovaries. Your chance of surviving ovarian cancer is better if the cancer is found early.

Causes of Ovarian Cancer

Women have two ovaries, one on either side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the female sex hormones estrogen and progesterone. An ovarian tumor is a growth of abnormal cells that may be either noncancerous (benign) or cancerous (malignant). Although benign tumors are made up of abnormal cells, these cells don't spread to other body tissues (metastasize). Ovarian cancer cells metastasize in one of two ways. Generally, they spread directly to adjacent tissue or organs in the pelvis and abdomen. They can also spread through your bloodstream or lymph channels to other parts of your body.

Three basic types of ovarian tumors exist, designated by where they form in the ovary. They include:

• Epithelial tumors. About 85 to 90 percent of ovarian cancers develop in the epithelium, the thin layer of tissue that covers the ovaries, according to the American Cancer Society.
• Germ cell tumors. These tumors occur in the egg-producing cells of the ovary and generally occur in younger women.
• Stromal tumors. These tumors develop in the estrogen- and progesterone-producing tissue that holds the ovary together.

The exact cause of ovarian cancer remains unknown. Some researchers believe it has to do with the tissue-repair process that follows the monthly release of an egg through a tiny tear in an ovarian follicle (ovulation) during a woman's reproductive years. The formation and division of new cells at the rupture site may set up a situation in which genetic errors occur. Others propose that the increased hormone levels before and during ovulation may stimulate the growth of abnormal cells.

Signs & Symptoms of Ovarian Cancer

Symptoms of ovarian cancer are nonspecific and mimic those of many other more common conditions, including digestive and bladder disorders. A woman with ovarian cancer may be diagnosed with another condition before finally learning she has cancer. Common misdiagnoses include irritable bowel syndrome, stress and depression. The key seems to be persistent or worsening signs and symptoms. With most digestive disorders, symptoms tend to come and go, or they occur in certain situations or after eating certain foods. With ovarian cancer, there's typically little fluctuation — symptoms are constant and gradually worsen. Recent studies have shown that women with ovarian cancer are more likely than are other women to consistently experience the following symptoms:

• Abdominal pressure, fullness, swelling or bloating
• Urinary urgency
• Pelvic discomfort or pain

Additional signs and symptoms that women with ovarian cancer may experience include:

• Persistent indigestion, gas or nausea
• Unexplained changes in bowel habits, such as constipation
• Changes in bladder habits, including a frequent need to urinate
• Loss of appetite or quickly feeling full
• Increased abdominal girth or clothes fitting tighter around your waist
• Pain during intercourse (dyspareunia)
• A persistent lack of energy
• Low back pain
• Changes in menstruation

Diagnosis of Ovarian Cancer

A healthcare provider may perform the following tests to determine if a woman has an ovarian cyst or to help characterize the type of cyst that is present:

• Endovaginal ultrasound: This type of imaging test is a special form of ultrasound developed to examine the pelvic organs and is the best test for diagnosing an ovarian cyst. A cyst can be diagnosed based on its appearance on the ultrasound.
  • An endovaginal ultrasound is a painless procedure that resembles a pelvic exam. A thin, covered wand or probe is placed into the vagina, and the examiner directs the probe toward the uterus and ovaries.
  • This type of ultrasound produces a better image than a scan through the abdominal wall can because the probe can be positioned closer to the ovaries.
  • Using an endovaginal ultrasound, the internal cystic structure may be categorized as simple (just fluid filled), complex (with areas of fluid mixed with solid material), or completely solid (with no obvious fluid).
• Other imaging: CT scanning aids in assessing the extent of the condition. MRI scanning may also be used to clarify results of an ultrasound.
• Laparoscopic surgery: The surgeon fills a woman's abdomen with a gas and makes small incisions through which a thin scope (laparoscope) can pass into the abdomen. The surgeon identifies the cyst through the scope and may remove the cyst or take a biopsy from it.
• Serum CA-125 assay: This blood test checks for a substance called CA-125, which is associated with ovarian cancer (the CA stands for cancer antigen). This test is used in the assessment of epithelial ovarian cancer and may help determine if an ovarian mass is harmless or cancerous. However, sometimes benign conditions may result in the elevated levels of CA-125 in the blood, so the test does not positively establish the diagnosis of ovarian cancer.
• Hormone levels: A blood test to check LH, FSH, estradiol, and testosterone levels may indicate potential problems concerning these hormone levels.
• Pregnancy testing: The treatment of ovarian cysts is different for a pregnant woman than it is for a nonpregnant woman. An ectopic pregnancy (pregnancy outside the uterus) must be ruled out because some of the symptoms of ectopic pregnancy may be similar to those of ovarian cysts.
• Culdocentesis: This test involves taking a fluid sample from the pelvis with a needle inserted through the vaginal wall behind the uterine cervix.

Treatments of Ovarian Cancer

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Surgery

In most cases, you'll want to have a gynecologic oncologist perform ovarian cancer surgery because they often have more training and experience with this type of operation. Generally, women with ovarian cancer require an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads. During this procedure, your surgeon also removes as much cancer as possible from your abdomen (surgical debulking). Ideally, less than a total of 1 cubic centimeter of tumor matter remains in your abdominal cavity after surgery (optimal debulking). This may involve removing part of your intestines. In addition, your surgeon will take samples of tissue and fluid from your abdomen to examine for cancer cells. This evaluation is critical in identifying the stage of your disease and determining if you need additional therapy. If you want to preserve the option to have children and if your tumor is discovered early, your surgeon may be able to remove only the involved ovary and its fallopian tube. But, subsequent chemotherapy may cause infertility. However, in some cases, it is possible to successfully bear children after treatment. Be sure to discuss your desire to have children with your doctor.

Chemotherapy

After surgery, you'll most likely be treated with chemotherapy - drugs designed to kill any remaining cancer cells. The initial regimen for ovarian cancer includes the combination of carboplatin (Paraplatin) and paclitaxel (Taxol) injected into the bloodstream (intravenous administration). Clinical trials have found that this combination is effective, though researchers are continually looking for ways to improve on it. A more intensive regimen has recently been shown to improve survival in women with advanced ovarian cancer by combining standard intravenous chemotherapy with chemotherapy injected directly into the abdominal cavity through a catheter placed at the time of the initial operation. This intra-abdominal infusion exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously. Side effects — including abdominal pain, nausea and vomiting — may leave many women unable to complete a full course of treatment or others to forego treatment entirely. But even an incomplete course of this treatment may help women live longer. Other treatments being explored include new chemotherapy drugs, vaccines, gene therapy and immunotherapy, which boosts the immune system to help combat cancer. The newest option, if standard chemotherapy fails, is a drug called bevacizumab (Avastin). It works by disrupting the blood supply to the tumor, possibly causing it to shrink. The most serious side effect associated with bevacizumab is bowel perforation, which occurs in about 7 percent of people taking it.

Radiation

While a mainstay in the treatment of some other cancers, radiation generally isn't considered effective for ovarian cancer. Sometimes, your doctor may recommend external beam radiation therapy (EBCT) to treat the symptoms of advanced cancer.

Prevention of Ovarian Cancer

Several factors appear to reduce the risk of ovarian cancer, including:

• Oral contraception (birth control pills). Compared with women who've never used them, women who use oral contraceptives for five years or more reduce their risk of ovarian cancer by about 50 percent, according to the ACS.
• Pregnancy and breast-feeding. Having at least one child lowers your risk of developing ovarian cancer. Breast-feeding a child also may reduce your risk of ovarian cancer.
• Tubal ligation or hysterectomy. Having your tubes tied or having a hysterectomy may reduce your risk of ovarian cancer.

When to seek Medical Advice

See your doctor if you have swelling, bloating, pressure or pain in your abdomen or pelvis that lasts for more than a few weeks. If you've already seen a doctor and received a diagnosis other than ovarian cancer, but you're not getting relief from the treatment, schedule a follow-up visit with your doctor or get a second opinion. Make sure that a pelvic exam is a part of your evaluation. If you have a history of ovarian cancer or a strong history of breast cancer in your family, strongly consider seeing a doctor trained to detect and care for ovarian cancer patients so that you can talk about screening, genetic testing and treatment options while you are disease-free.