Ovarian Cancer: Symptoms, Causes, Treatment

Ovarian cancer is cancer that starts in one or both ovaries, or in the fallopian tubes, or even in the abdominal lining called the peritoneum.

Women normally have two ovaries: one on either side of the uterus, in the lower abdominal area. During the years when a woman could get pregnant, the ovaries make eggs that travel through the fallopian tubes to the uterus. If sperm fertilizes an egg, it could settle in the lining of the uterus and develop in pregnancy.

Half of those who get ovarian cancer are 63 or older. It’s more often found in white women, who get it more often than in Black women. A woman’s chance of getting ovarian cancer at some point in her life is 1 in 78.

It’s often hard to find before it’s advanced, which can make treatment harder.

Symptoms

Ovarian cancer might not cause any symptoms, especially in the early stages. That’s in part because the ovaries are quite small -- each about the size and shape of an almond -- and located deep inside your abdomen.

But in some cases, especially in later stages, ovarian cancer might cause symptoms. These include:

• Unusual discharge of blood or other substance from your vagina
• Feeling bloated
• Lack of appetite
• Easier and faster to get full at meals
• Pain or pressure in the belly or back
• Need to pee more often or more urgently
• Constipation

Symptoms like these that last longer than 2 weeks mean it’s a good time to talk with your doctor. They could be symptoms of any number of illnesses, many of them less serious than ovarian cancer. But it’s best to talk to your doctor to be sure.

Causes and Risk Factors

Doctors don’t know what causes ovarian cancer, but certain things make you more likely to get the disease. These include:

• Having an Eastern European or Ashkenazi Jewish background
• A close relative, like a mother, sister, aunt, or grandmother, who had ovarian cancer
• Genetic variations like BRCA1, BRCA2, or Lynch syndrome
• A history of colon, uterine, or breast cancer
• Being middle-aged or older
• A history of endometriosis (where tissue from the uterus grows elsewhere)
• Never having given birth
• Trouble getting pregnant
• Taking estrogen without progesterone for 10 years or more

Still, none of these things mean that you will get this disease for certain. Talk to your doctor about your risk factors.

Diagnosis

Your doctor will ask about your medical history to learn about possible risk factors, including family members who’ve had cancer. They will ask about any symptoms and will likely do a pelvic exam by hand to check for signs of fluid buildup (ascites) or an enlarged ovary. To do this, they will insert a finger into your vagina and rectum.

If your medical team suspects ovarian cancer after this, they will ask for more tests. These include:

• Imaging tests. Medical personnel take pictures of the inside of your body by ultrasound, X-ray, CT scan, MRI, or other methods.
• Laparoscopy. Your doctor pushes a thin lighted tube with a camera through a cut in your torso to look at the ovaries and other tissues and organs in the area.
• Biopsy. Your doctor removes some or all of suspected cancerous tissue to look at under the microscope. They usually do this during surgery to remove the tumor, but they may do it during the laparoscopy or with a needle guided by imaging like a CT scan.
• CA-125 blood test. It checks your level of the protein CA-125, which ovarian cancer cells make. Though it’s a helpful indicator, your levels may not be high enough to test positive, even if you do have ovarian cancer. Plus, other illnesses also can raise CA-125 levels.

Ovarian Cancer Types and Stages

The three main types of ovarian cancer are:

• Epithelial cell tumors. These start in the lining on the outside of the ovaries. Most ovarian cancers are this type.
• Germ cell tumors. These start inside the ovaries in cells that make eggs.
• Stromal tumors. These start in other ovarian tissue.

The stages of ovarian cancer are:

• Stage 1. The cancer hasn’t spread beyond the ovaries (stages 1A and 1B) or into fluid around them (stage 1C)
• Stage 2. The cancer has spread into nearby organs in the pelvis, such as the uterus or fallopian tubes.
• Stage 3. The cancer has spread to the abdomen, but not to farther parts of the body.
• Stage 4. The cancer has spread farther in the body.

Treatment

Your health care team will likely treat your ovarian cancer with a combination of surgery and chemotherapy or radiation (if cancer has spread).

• Surgery. You may get an operation to remove tumors.
• Chemotherapy. A medical team delivers special drugs by needle into your veins or by pills that you swallow to shrink cancerous growths.
• Radiation therapy. When ovarian cancer spreads to other parts of the body, high-­energy X-rays kill cancer cells and shrink tumors. Radiation is only rarely used when ovarian cancer has not spread.
• Palliative care. This is medical care that focuses not just on your illness but on your quality of life, pain management, and stress. It includes your mental, emotional, and spiritual issues, as well as your physical ones. Palliative care is for anyone with a serious illness, including cancer, regardless of stage.

Your medical team may have several different members, such as:

• Gynecologic oncologists treat cancers of a woman’s reproductive system. They do some surgery and give chemotherapy.
• Surgeons perform surgery like tumor removal and biopsies.
• Medical oncologists treat cancer with medicine like chemotherapy, targeted therapy, or immunotherapy.
• Palliative care doctors specialize in this field of medicine. They may be someone you want to talk with about any aspect of your treatment, decision-making, or anything else related to your cancer and quality of life.

You may also want to talk with a counselor or support group as you work through your diagnosis and treatment.

Outlook

Before you check the statistics, keep in mind that they’re based on big groups of people and don’t predict what will happen to any particular person.

Five-year survival rates are over 90% for cancers that start in the ovaries and stay there. That means more than 90% of people diagnosed with ovarian cancer are still alive 5 years later.

The rates range from 57% to 94% for cancer that spreads to nearby areas like the lymph nodes. The exact rate depends on the specific type of ovarian cancer. Once the cancer has traveled (or "metastasized") to distant parts of the body, the rate falls to 30% to 74% depending on the type.

Remember that each case is different. Talk to your doctor about the specifics of your particular diagnosis and what it could mean for your health.

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