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About Ovarian Cancer

In this section, you or a loved one can find out more about medical treatments and practical information about ovarian cancer. Read on to find answers to some of your questions as well as links to other information. Being informed is an important first step toward becoming an active decision-maker in your care plan. 

What Is Ovarian Cancer?

Ovarian cancer makes up a small persentage of cancer in women but it causes more deaths than breast cancer. Ovarian cancer is the growth of abnormal, malignant cells that start in a woman's ovaries. Ovaries are the part of the reproductive system that produces eggs and are mainly made up of three types of cells, each of which can develop into a different type of tumor. 

Epithelial tumors grow in the layer of tissue that covers the surface of the ovary. While most are benign (noncancerous), cancerous epithelial tumors account for the largest percentage of ovarian cancers. Additionally, some ovarian epithelial tumors are described as having low malignant potential, and they tend to affect younger women. They grow slowly and are less life-threatening.

Germ cell tumors, which can be benign or cancerous, grow in the cells that form eggs. Germ cell tumors include teratomas, which can contain substances including hair, teeth and bone; dysgerminomas (the most common ovarian germ cell cancer); and endodermal sinus tumors and choriocarcinomas.

Stromal tumors develop in the tissues that hold the ovary together and produce the hormones estrogen and progesterone. 

Additionally, a very small number of ovarian cancers are small cell carcinomas, mainly affecting young women, with a median age at diagnosis of 24 years old.

What Causes Ovarian Cancer?

Though the cause of ovarian cancer is unknown, some theorize that increased hormone levels before and during ovulation may cause abnormal cells to grow. There are several risk factors: 

  • Age is a risk factor with about half the women diagnosed with ovarian cancer being 63 years of age or older. 
  • The age at which a woman starts or finishes menstruation is also a factor, with a higher risk for women who started menstruating before age 12 or who underwent menopause after age 52. 
  • Additionally, a woman who had a full-term pregnancy before age 26 has a lower risk of ovarian cancer and the risk decreases with each full-term pregnancy. 
  • Women with a first full-term pregnancy after age 35 or those who never carried a pregnancy to term have higher risks of ovarian cancer. Obese women (those with a body mass index of at least 30) may have a higher risk of ovarian cancer. 
  • Other risk factors include long-term or large-dose estrogen hormone replacement therapy, having never been pregnant, having undergone fertility treatment, smoking, use of an intrauterine device, and polycystic ovary syndrome. 
  • Additionally, some women with certain gene mutations may have a higher risk of ovarian cancer. These gene mutations include breast cancer gene 1 (BRCA1), breast cancer gene 2 (BRCA2) and the gene that causes Lynch syndrome, which is most commonly associated with colon cancer.
What Are the Effects of Ovarian Cancer?

In addition to affecting the reproductive system, ovarian cancer cells can invade nearby tissues and travel to other parts of the body through the blood or lymph system, where they may grow and replace normal tissue in a process called metastasis. 

Which Body Parts Are Affected?

Ovarian cancer first affects the ovaries; but as it spreads, it can affect the entire reproductive system, nearby organs such as the colon and liver, and more distant organs and tissues through the process of metastasis. 

Unfortunately, early ovarian cancer is difficult to detect. The symptoms of ovarian cancer are shared by other diseases but occur more frequently and are more severe in the case of ovarian cancer. Common symptoms include: 

  • Bloating 
  • Pelvic or abdominal pain 
  • Trouble eating or feeling full quickly 
  • A need to urinate urgently or often 
  • Back pain 
  • Constipation 
  • Fatigue 
  • Menstrual changes 
  • Pain during sex 
  • Upset stomach 
  • Abdominal swelling 
  • Weight loss 
What Are the Complications of Ovarian Cancer?

The course of ovarian cancer can vary widely, depending on the type and stage of tumor, as well as age at diagnosis, general health and other factors. 

Reproductive System Complications

Most women have surgery to remove their ovaries and uterus as part of their treatment for ovarian cancer and are therefore no longer able to become pregnant. The removal of a woman's ovaries also causes a woman to enter menopause if she has not already done so. Sexual side effects can be common, including decreased libido, vaginal dryness, a shortened vagina, diminished response and self-consciousness. 

Digestive System Complications

During surgery, it may be necessary to remove a piece of colon to help decrease the size of a tumor. In some cases, the colon can be sewn back together. Sometimes, though, the ends can't be joined right away, and the top of the colon is attached to a stoma, or opening, in the abdomen to allow the exit of waste. This is a colostomy, and it can usually be reversed. 

Urinary Tract Complications

Ovarian cancer surgery may sometimes require the removal of a part of the bladder. As the bladder heals, a catheter may be necessary. When the bladder heals, the catheter can be removed.

Other Complications

Surgery may also require removing all or parts of the spleen, gallbladder, stomach, liver or pancreas.

Medical Treatment

While treatment plans should be tailored to each individual's unique circumstances, most women with ovarian cancer undergo surgery. Surgery is usually followed up by chemotherapy or another therapy, although sometimes chemotherapy may be given before surgery. 

Surgery 

Surgery, ideally performed by a qualified gynecological oncologist, is generally used to both diagnose and treat ovarian cancer. Women who have some types of early-stage ovarian cancer may be able to retain one ovary and remain fertile but usually both ovaries, the fallopian tubes, the uterus, nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum are removed. If the cervix is removed as well, it is referred to as a total hysterectomy. The surgeon may also go beyond the uterus in the process called debulking. The goal is to leave no tumors larger than a centimeter behind, and this may mean examining and removing parts of organs near the ovaries and uterus including the colon, stomach, liver, bladder, spleen and pancreas. 

Chemotherapy 

Usually used following surgery, chemotherapy for ovarian cancer involves the infusion of chemicals into the bloodstream or abdomen to destroy cancer cells or to stop them from growing in and beyond the ovaries. Chemotherapy can have side effects such as nausea, loss of hair, poor appetite, fatigue, infection and increased bleeding; but most effects are temporary. 

Radiation

Less often used for ovarian cancer, radiation therapy involves high-energy X-rays that target cancer cells and shrink tumors.

Targeted therapy

Treatment may include targeted therapy, which is designed to attack specific cancer cells without harming normal cells. Targeted therapy includes monoclonal antibody therapy and treatment with PARP inhibitors.

Complementary Therapy Options

Some patients may seek to relieve some of their cancer symptoms and side effects with complementary care. Complementary therapies should not be confused with alternative therapies, which by definition, replace conventional therapy. Acupuncture, massage, aromatherapy, vitamin supplementation, special diets and meditation are among the more common complementary therapies.

Patients should discuss these treatments with their doctor to avoid compromising their traditional medical care. 

Lifestyle Options

For most people, regardless of having cancer or not, exercise, healthy eating and good sleep habits are recommended. A healthy lifestyle can lead to enhanced quality of life for most people. Talk to your doctor before making any lifestyle changes. 

Diet

For women with ovarian cancer, it's important to maintain a nutritious diet and to drink lots of fluids to maintain energy, stay as healthy as possible and to help avoid constipation and diarrhea, both of which are common during cancer treatment.

Exercise

If appropriate, regular exercise can help regulate mood and provide cardiovascular benefits.

Prevent infection

Wash hands often, avoid crowds and sick people, trim nails carefully and take measures to avoid cuts, scrapes and situations that may introduce an increased risk of infection during cancer treatment.

Managing depression, anxiety and stress

Enlisting the support of those closest to you is crucial. Women may also want to consider psychotherapy, relaxation exercises and similar measures to help deal with stress, fear and anxiety.

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