The ovaries, part of the female reproductive organs, are located on either side of the lower pelvis. Some women may develop cysts on the ovary which can be felt on a pelvic exam or seen on special x-rays. A cyst is a small growth on the ovary which is filled with fluid. Pure cysts are rarely cancerous. Some will go away on their own, and others must be removed surgically. Some may be cancerous. Evaluation by a cancer specialist is imperative.

Ovarian cancer comes from cells of the ovary that grow and divide. The cells may grow to form a tumor on the ovary, and they can also break off from the main tumor and spread to other parts of the body. Ovarian cancer can spread throughout the entire body but, in most cases, it stays in the abdomen and affects organs such as the intestines, liver, and stomach.

There are many different types of ovarian cancer. Most cancers of the ovary come from the cells that make up the outer lining of the ovary and are called epithelial ovarian cancers. Epithelial ovarian cancers occur in women who do or who do not have a family history of the disease. Ovarian cancer may affect women of any age group.

Symptoms
  • Ovarian cancer is often referred to as the “silent killer” because by the time a woman has symptoms, the disease may have already spread through her abdomen and beyond.

  • Symptoms associated with ovarian cancer include: feeling bloated, vague abdominal and pelvic discomfort, gastrointestinal symptoms such as gas, back pain, and fatigue.


What Are the Key Statistics About Ovarian Cancer?
  • Ovarian cancer is the sixth most common cancer among women, excluding non-melanoma skin cancers. The American Cancer Society estimates that about 23,400 new cases of ovarian cancer will be diagnosed in the United States during 2001. Ovarian cancer accounts for 4% of all cancers in women.

  • The good news is that the ovarian cancer incidence rate has been slowly decreasing since 1991. The incidence rate is a precise way for scientists to describe how common or rare a disease is. The ovarian cancer incidence rate is defined as the number of new cases diagnosed each year per 10,000 women.

  • Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. It is estimated that there will be about 13,900 deaths from ovarian cancer in the United States during 2001.

  • The five-year survival rate is used to provide a standard way of discussing prognosis. It refers to the percentage of patients who live at least five years after their cancer is diagnosed, although many of these patients live much longer than five years after diagnosis. Five-year relative survival rates exclude from the calculations patients dying of other diseases, and are considered to be a more accurate way to describe the prognosis for patients with a particular type and stage of cancer. Of course, five-year survival rates are based on patients diagnosed and initially treated more than five years ago.

  • About 78% of all ovarian cancer patients survive one year after diagnosis and over 50% survive longer than five years after diagnosis. If diagnosed and treated before the cancer spreads to areas outside of the ovary, the five-year survival rate is between 80% and 95%..

  • However, only 30% of all ovarian cancers are found at this early stage. Older women with ovarian cancer tend to have a poorer prognosis than younger ones. For example, the five-year survival rate is 64% in women under 65 years of age and 30% in women over 65.

Types of Ovarian Tumors

There are many types of tumors that can affect the ovaries. Some are benign (noncancerous) and never spread beyond the ovary. These patients can be treated successfully by surgically removing one ovary or the part of an ovary containing a tumor. Other types of ovarian tumors are malignant (cancerous) and may spread to other parts of the body. Their treatment is more complex, and is discussed later in this document.

In general, ovarian tumors are named according to the kind of cells the tumor started from and whether the tumor is benign or cancerous. There are three main types of ovarian tumors:

  • Epithelial tumors start from the cells that cover the outer surface of the ovary.
  • Germ cell tumors start from the cells that produce the ova (eggs).
  • Stromal tumors start from the connective tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone

Major Risk Factors for Epithelial Ovarian Cancer
  • Never having children
  • Infertility or not having children until late in life
  • Family history of ovarian or breast cancer
  Factors which are associated with lower risk of ovarian cancer include a history of birth control pill use, pregnancy, tubal litigation (female sterilization), or breast feeding. Patients are diagnosed by pelvic exam, ultrasound, and/or surgical procedure called laparotomy. Once diagnosed surgery for the removal of the ovaries, fallopian tubes, and uterus (hysterectomy) is performed. If the cancer has spread beyond the ovaries an attempt is made to remove as much tumor as possible. After surgery and recuperation, chemotherapy would be recommended for most.


The Stages of Ovarian Cancer

Staging of ovarian cancer is described using the FIGO system. FIGO stands for International Federation of Gynecologists and Obstetricians.

  • Stage I - The cancer is still contained within the ovary.

  • Stage IA - Cancer has developed in one ovary and the tumor is confined to the inside of the ovary. There is no cancer on the outer surface of the ovary. Laboratory examination of washings from the abdomen and pelvis did not find any cancer cells.

    Stage IB - Cancer has developed within both ovaries without any tumor on their outer surfaces. Laboratory examination of washings from the abdomen and pelvis did not find any cancer cells.

    Stage IC - The tumor is present in one or both ovaries and one or more of the following are present: (1) cancer on the outer surface of at least on the ovaries, (2) in the case of cystic tumors (fluid-filled tumors), the capsule (outer wall of the tumor) has ruptured (burst), (3) laboratory examination found cancer cells in fluid or washings from the abdomen.

  • Stage II - The cancer involves one or both ovaries and has involved other organs (such as the uterus, fallopian tubes, bladder, the sigmoid colon, or the rectum) within the pelvis.
  • Stage IIA - The cancer has extended to, or has actually invaded the uterus or the fallopian tubes, or both. Laboratory examination of washings from the abdomen did not find any cancer cells.

    Stage IIB - The cancer has extended to other nearby pelvic organs such as the bladder, the sigmoid colon, or the rectum. Laboratory examination of fluid from the abdomen did not find any cancer cells.

    Stage IIC - The cancer involves pelvic organs as in stages 2A or 2B and one or more of the following are present: (1) cancer on the outer surface of at least one of the ovaries, (2) in the case of cystic tumors (fluid-filled tumors), the capsule (outer wall of the tumor) has ruptured (burst), (3) laboratory examination found cancer cells in fluid or washings from the abdomen.

  • Stage III - The cancer involves one or both ovaries, and one or both of the following are present: (1) cancer has spread beyond the pelvis to the lining of the abdomen, (2) cancer has spread to lymph nodes (glands that fight infection and produce some types of blood cells.)
  • Stage IIIA - During the staging operation, the surgeon can see cancer involving the ovary or ovaries, but no cancer is visible to the naked eye in the abdomen and the cancer has not spread to lymph nodes. However, when biopsies are checked under a microscope, tiny deposits of cancer are found in the lining of the upper abdomen.

    Stage IIIB - There is cancer in one or both ovaries, and deposits of cancer are present in the abdomen which are large enough for the surgeon to see but smaller than 2cm (about 3/4 inch) across. Cancer has not spread to the lymph nodes.

    Stage IIIC - The tumor is in one or both ovaries, and one or both of the following is present: (1) cancer has spread to lymph nodes, (2) deposits of cancer larger than 2cm (about 3/4 inch) across are seen in the abdomen.

  • Stage IV - This is the most advanced stage of ovarian cancer. The tumor is on one or both ovaries. Distant metastasis (spread of the cancer to the inside of the liver, the lungs, or to other organs located outside of the peritoneal cavity) has occurred. Finding ovarian cancer cells in pleural fluid (from the cavity that surrounds the lungs) is also evidence of stage 4 disease.
  • Recurrent ovarian cancer - This means that the disease has recurred (come back) after completion of treatment.

Chemotherapy

  There many different types of chemotherapies and clinical trials. To learn more about clinical trials log on to http://cancertrials.nci.nih.gov.
 

Use these resources to find more information:
cancercenter.bidmc.harvard.edu/treat/gyn/index.htm
www.cancer.org
www.womenshealth.about.com/womansheal/
library/weekly/aa070798.htm

www.cancerlinksusa.com/ovary/wynk
www.vic.com/~smokeyweb/hall&martin/ovarycancer.htm
www.ovarian-news.org
www.ovarian.org
www.cancerlinksusa.com/ovarian.htm
www.ovariancancer.org
www.sgo.org
oncolink.upenn.edu/pdg
oncolink.upenn.edu
www.cancernet.nci.nih.gov
www.cancersupportivecare.com
www.cancerlinks.org
www.medscape.com
www.cancercare.org
www.wellnesscommunity.org

Some of the above information has been made available through the American Cancer Society's Web site.


   



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