Ovarian Cancer: The Facts

What is it?

Ovarian Cancer originates in the inner tissue or outer lining of the ovaries. The ovaries are part of the female reproductive system. They are solid and almond shaped and located in the lower abdomen/pelvic area. Females naturally have two ovaries, one on each side of the uterus, with each connected to a fallopian tube leading to the uterus. The ovaries produce female hormones, especially estrogen and progesterone, which are responsible for the development of breasts and body shape and produce egg cells. Every 28-30 days in the menstrual cycle, one ovary releases a mature egg cell. Throughout the lifetime of a woman, and especially at different points in her menstrual cycle, the ovaries routinely change shape, position, and cell makeup. After menopause around age 45-50, the ovaries stop functioning, shrink and fibrose (deteriorate). There are three types of Ovarian Cancer:

• Epithelial Carcinoma is the most common form of Ovarian Cancer. These tumors begin in the epithelial cells that form the lining of the ovaries.
  
  
• Germ Cell Cancer is the formation of tumors in the cells that become the egg cells released by the ovary every month. Germ Cell Cancer is typically found in younger women and makes up only about 5% of diagnosed cases of Ovarian Cancer.
  
  
• Stromal Cell Cancer begins in the cells that form the tissues holding the ovary together. Like Germ Cell Cancer, Stromal Cell Cancer makes up only about 5% of cases.
  

Ovarian Cancer is also identified by a series of stages. The stage describes the extent of the disease at the time of diagnosis, including tumor size and whether the cancer has spread (metastasized) to other areas of the body. The stages are commonly described as follows:

• Stage I - may be in one or both ovaries, but has not spread to any other organs.
  
  
• Stage II - has spread to the other reproductive organs such as the fallopian tubes and the uterus and/or has extended through the pelvis.
  
  
• Stage III - has spread to the abdomen above the pelvis and the lymph nodes, liver surface, and/or small bowel regions.
  
  
• Stage IV - is the most advanced stage, in which the disease has spread to organs outside the abdomen and beyond the liver, such as the lungs.
  

Who gets it?

In the United States in the year 2000, an estimated 23,100 women will be diagnosed with Ovarian Cancer, and 14,000 women will die as a result of Ovarian Cancer. Ovarian Cancer is much less common than other types of cancer affecting the female reproductive system. Ovarian Cancer is the 5th most common cancer in women, but makes up only 4% of cancer cases. The rate of diagnosis of Ovarian Cancer in Rhode Island is approximately equal to the national average.

The average risk of Ovarian Cancer for women who have no family history of the disease is approximately 1.5%. This means that, on average, 1 in 70 women will get Ovarian Cancer during their lifetime. There are some known risk factors that may affect your chances of getting Ovarian Cancer:

• Family History - This is the most important risk factor for developing Ovarian Cancer. There is a known inheritable genetic mutation that puts women at a higher risk for developing Ovarian Cancer. If a woman has one or more primary relatives (mother or sister) who have had Ovarian Cancer, she is three times more likely to be diagnosed with the disease herself. Genetic testing can be done on women in this "high risk" group to determine if they carry one of the gene mutations. Being a carrier of this gene does not necessarily mean that a woman has or will develop Ovarian Cancer. It simply means that a woman is at a higher risk of developing Ovarian Cancer and should be followed very closely for evidence of the disease.
  
  
• Age - Ovarian Cancer occurs primarily in women between the ages of 40 and 70.
  
  
• Menstrual Cycles - A woman who begins her first period before age 12 and/or begins menopause after age 50 has an increased risk for Ovarian Cancer.
  
  
• Ethnic Background - In the U.S., the highest incidence of Ovarian Cancer is among Caucasians and Hawaiians, and lowest among Native Americans.
  
  
• High-Fat Diet - Ovarian Cancer has been linked to an increased amount of estrogen activity in the body. Excess fat can cause the body to retain estrogen and may convert other hormones into a form of estrogen, increasing the risks of Ovarian Cancer.
  
  
• Pregnancy - The more times a woman has been pregnant, the lower her risk of Ovarian Cancer.
  
  
• Birth Control - Birth control pills make the body think that it is pregnant. Consequently, a woman who has not been pregnant, but has used birth control for at least 5 years, lowers her risk of Ovarian Cancer.
  

How is it detected?

There is no uniformly accepted test for Ovarian Cancer at this time. The ovaries are difficult to examine since they are set deep in the abdomen. The following methods are all used, usually in combination, to help doctors diagnose Ovarian Cancer:

• Biopsy - The only sure way to determine if a woman has Ovarian Cancer is to take a sample of ovary and abdominal tissue. The tissue sample is then examined under a microscope to determine if cancer cells are present.
  
  
• Pelvic Exam - An exam in which the physician presses the abdomen, vagina, and rectum to find abnormal masses.
  
  
• Transvaginal Ultrasound - A probe is inserted into the vagina that bounces high frequency sound waves off the ovaries and surrounding areas to produce a picture which can be used by the doctor to detect problems.
  
  
• CT/CAT scan - A CT scan is a computer generated X-ray image that allows doctors to look at "slices" of the abdomen for lumps, shadows, and other abnormal changes.
  
  
• Culdocentesis - A needle is used to obtain a sample of fluid from the vaginal wall and the area surrounding the ovaries, which can then be analyzed for the presence of cancer cells.
  
  
• Color-flow Doppler - This test is a type of ultrasound that checks the blood flow to the ovaries. An increase in blood flow to a certain area can be an indication of cancer in that region.
  
  
• CA-125 Blood Test - A blood sample is analyzed for a circulating protein hormone, CA-125. Often, the amount of CA-125 in the blood directly relates to the amount of cancer cells in the body. However, a higher CA-125 level does not necessarily indicate Ovarian Cancer, and a normal level does not automatically rule it out. This test is still under study.
  

Symptoms:

The difficulty with Ovarian Cancer is that the early stages usually act as a "silent disease," with few or no symptoms. For this reason, 75% of cases are first diagnosed in the Stages III and IV. Even in these stages, there may be no symptoms. Women have reported all of the following symptoms before a diagnosis of Ovarian Cancer, but none of them necessarily mean that you have Ovarian Cancer:

• Abdominal bloating and discomfort
  
• Loss of appetite/sudden weight loss
  
• Indigestion and nausea
  
• Feelings of fullness even after light meals
  
• Diarrhea
  
• Frequent urination
  
• Constipation
  
• Fluid around lungs/shortness of breath
  
• Vaginal bleeding not during menstruation
  

It is important to report any symptoms to your physician immediately so that the actual cause may be determined.

Is it curable?

Ovarian Cancer is the most deadly of all gynecological cancers, primarily because most cases are already in their late stages when first diagnosed. As rare as it may be, Ovarian Cancer is still the 4th highest killer of female cancer patients in Rhode Island. If the cancer is caught before it has spread beyond the ovaries (Stage I), there is a 95% survival rate. Seventy-eight percent of all Ovarian Cancer patients survive for 1 year after diagnosis. Over 50% of patients with lower stages of Ovarian Cancer survive for 5 years.

It's easier to prevent cancer than to treat it....

Certain lifestyle habits can help to reduce your risk of developing Ovarian Cancer (as well as other cancers):

• Yearly gynecological exam and pelvic exam
  
• Exercise
  
• Low-fat diet
  
• Not smoking
  

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