More than 21,000 women in the U.S. will be diagnosed in 2015 with ovarian cancer, according to the American Cancer Society. More than half of those women will be age 63 or older. It is extremely rare in women younger than 40 years. Obesity, some fertility drugs, having a child after age 35, long-term use of estrogen (especially without progesterone) or family history of the disease may increase the risk of developing ovarian cancer. Birth control, breastfeeding, and tubal ligation may reduce the risk of ovarian cancer.
One of the reasons ovarian cancer is such a deadly disease is that it often grows undetected in its early stage, because the ovaries are deep inside the abdominal cavity, and because symptoms are vague or mimic other conditions. Symptoms may include bloating, pelvic or abdominal pain, urinary urgency or frequency, pain during sex, menstrual changes, fatigue, heartburn, or constipation.
A pelvic exam, transvaginal ultrasound, computed tomography (CT) scan, x-rays, or CA-125 protein cancer marker blood test may suggest the possibility of ovarian cancer. A biopsy must be performed to confirm the diagnosis.
If cancer is found, a CT or magnetic resonance imaging (MRI) may help determine if and where cancer has spread.
Surgery performed by a gynecologic oncologist is the primary treatment for most ovarian cancers. Tumors in their earliest stages found in women of childbearing age may be treated with approaches that preserve the uterus, and in some cases of ovarian germ cell tumors, the unaffected ovary may remain. When ovarian cancer has spread, surgeons typically remove the uterus (hysterectomy), both ovaries and fallopian tubes (bilateral salpingo-oophorectomy), and the layer of fatty tissue that covers the abdominal interior (omentectomy). Tissue and fluid samples may be taken during surgery to help determine the stage of ovarian cancer and plan optimal treatment. Surgeons may also “debulk” tumors that have spread throughout the abdomen. Reducing such tumors may involve reducing tissue in the colon, bladder, spleen, stomach, or other internal organs.
Chemotherapy is often used in addition to surgery to destroy any remaining cancer cells, either orally, intravenously, or intraperitoneally -- inserted into the abdominal cavity to concentrate the dose in the affected area. Targeted therapy identifies specific genes, proteins, or tissue environments that promote cancer growth and survival, and blocks those targets to inhibit the growth and spread of cancer cells. The breast cancer gene BRCA has been associated with ovarian cancer, and BRCA targeted therapies may help shrink tumors in ovarian cancer patients with BRCA mutations.
Hormone therapy “switches off” the production of estrogen, which can stimulate cancer cell growth. Different types are used in premenopausal and postmenopausal women, and are taken orally or injected on a regular schedule. Side effects may include menopausal symptoms, such as hot flashes or bone thinning.
Radiation therapy is not often used to shrink ovarian tumors because of the potential damage to healthy tissues in the abdomen, leading to digestive problems and intestinal scarring.
Researchers are constantly seeking ways to detect ovarian cancer earlier, and to find less toxic treatments for women with advanced disease. Patients who do not respond to traditional treatments may be appropriate candidates for new approaches in targeted therapy and immunotherapy, where drugs are created to delay or stop the spread of cancer cells.