Ovarian Cancer: Causes, Signs and Symptoms, Screening and Treatment
Ovarian cancer is a relatively rare form of cancer that begins in the ovaries. These small organs sit in a woman’s pelvis and house the eggs that, when fertilized, become embryos that can develop into a baby.
As occurs in virtually every other part of the body, the ovaries can sometimes give rise to cancer. The American Cancer Society estimates that about 22,530 women will receive a new diagnosis of ovarian cancer in 2019 and about 13,980 women will die of the disease. The Ovarian Cancer Research Alliance reports that ovarian cancer accounts for 2.5 percent of cancers in women, making it the 11th most common cancer among women. But it’s the fifth leading cause of cancer-related death among women, and is the deadliest of gynecologic cancers.
Causes and Risk Factors
“We don’t know exactly what causes it,” says expert. There are different hypotheses of why people get ovarian cancer, but Expert don’t know enough about how the disease begins to know for sure what causes it.
Still, having a lot of pregnancies and taking birth control pills are both associated with lower risk, which makes some people think ovulation is part of the problem. (Ovulation is the monthly process by which an egg is released from the ovary into the fallopian tube where it may or may not be fertilized by a sperm cell.) Inflammatory responses in the body are also suspected to be part of why some people develop ovarian cancer.
While the exact cause is unclear, there are several factors that are known to elevate your risk of developing this disease. Some people are born with genetic mutations that make them more prone to getting ovarian cancer, such as having a mutation on the BRCA1 or BRCA2 gene that’s also associated with a much higher risk of developing breast cancer. Being older is also considered a risk factor; as with most other types of cancer, your risk of developing ovarian cancer increases with time. Expert says the average age of an ovarian cancer patient is around 62.
Other risk factors include:
- Never having had kids, never having carried a baby to term, or becoming pregnant after age 35.
- A personal history of ovarian, breast or colorectal cancer.
- Using fertility treatments.
- Using hormone therapy after menopause.
- Having endometriosis, a disease of menstruation where endometrial tissue from inside the uterus grows outside of this organ, causing pain, heavy periods and infertility.
- Being overweight or obese.
- Smoking and alcohol use.
Some researchers have suggested that exposure to talcum powder, a common personal hygiene product that contains the mineral talc, might also increase risk. The ACS reports that the concern stems from the fact that “in its natural form, some talc contains asbestos, a substance known to cause cancers in and around the lungs when inhaled.” Breathing in talc that contains asbestos seems to have a direct connection to lung cancer, but studies into the connection between talcum powder and ovarian cancer have resulted in inconclusive or mixed results. More research needs to be done to establish whether there is an association.
Family history is also a risk factor. Knowing your family history is important, but that it’s not the only risk factor that matters. Some people think that if they don’t have family history of cancer they won’t get cancer. That’s not true. In the majority of cancers, you don’t necessarily have somebody in the family who has a cancer as well.
In addition, even though ovarian cancer only affects women, you can inherit a risk for ovarian cancer from your father as well as your mother, as the genetic code that contains potential problems is just as likely to be passed down from your father as from your mother. Be sure to ask about cases of cancer on both branches of the family tree.
Signs and Symptoms
As with other cancers that affect internal organs, it can be difficult to detect ovarian cancer early, when it’s most treatable. The ACS reports that “only about 20 percent of ovarian cancers are found at an early stage. When ovarian cancer is found early, about 94 percent of patients live longer than five years after diagnosis.”
But for most patients, this is not the case because ovarian cancer can be difficult to detect. There’s not one sign or symptom that goes along with ovarian cancer, so that makes it tricky. It’s not usually until the disease has spread beyond the ovaries that people develop any kind of symptoms. And even then, the symptoms are nonspecific – they’re the kind of thing that everybody has at some point in their lives, such as bloating or indigestion.
The ACS reports that the most common symptoms of ovarian cancer include:
- Pelvic or abdominal pain.
- Trouble eating or feeling full quickly.
- Always feeling like you need to urinate or feeling an urgency to urinate.
- Back pain.
- Upset stomach or constipation.
- Abdominal swelling accompanied by weight loss.
- Menstrual changes, such as heavier-than-normal or irregular bleeding.
While most women will experience at least a few of these symptoms at some point, the key with ovarian cancer is that these symptoms become persistent or change from a normal baseline. If you notice that you’re having these sorts of symptoms more often or they become more severe, see your doctor for evaluation. Many of these symptoms may be associated with other conditions unrelated to ovarian cancer.
People know their bodies very well and if something’s not right, it’s important for women to speak up and demand a little more attention, anecdotally, women tell stories about how they had a symptom for a while and it was ignored and it turned out to be ovarian cancer. If it’s not right, it definitely merits speaking up and being a little bit of a nag. There’s a lot at stake, so it’s worth it to be a nag to get the answer.
Unlike mammograms for breast cancer or Pap smears to check for cervical cancer, ovarian cancer doesn’t have a good routine screening test. Still, the National Ovarian Cancer Coalition reports that women should see their doctor regularly for a few tests that may reveal ovarian cancer including:
- A pelvic exam. “Women age 18 and older should have a mandatory annual vaginal exam,” and women age 35 and older should have an annual rectovaginal exam, the NOCC reports. This exam involves the doctor inserting fingers in the rectum and vagina simultaneously to feel for swelling and pain.
- A transvaginal ultrasound. Using a wand-based ultrasound device inserted into the vagina, your doctor generates an image of your reproductive organs. This is recommended for women at high-risk for ovarian cancer and those who’ve had an abnormal pelvic exam.
- A CA-125 blood test. This test examines blood levels of a protein called CA-125 that’s produced by ovarian cells. This is also recommended for women at high risk of developing ovarian cancer and those who’ve had an abnormal pelvic exam.
The problem with any and all of these tests is that they’re not as accurate as would be considered ideal. There’s no test that’s really been proven to be helpful for ovarian cancer screening, Expert says. Both ultrasounds and the CA-125 test can point to certain signs that ovarian cancer may be present, but neither has really been validated, and part of the reason for that is because ovarian cancer is relatively rare. All of these tests have unacceptably high false positive rates, which can lead to something as significant as unnecessary surgery. Still, for women who are known to carry certain genetic mutations that increase their risk, the potential downsides of screening may be worth it. But expert still don’t have something that’s perfect there.
And it’s important not to confuse different types of cancer and screening tests. A lot of people think that if they have a normal Pap smear, they don’t have ovarian cancer, but the Pap has nothing to do with ovarian cancer. Rather, Pap smears are screening tests for cervical cancer. They tell your doctor nothing about the state of your ovaries.
Because ovarian cancer occurs deep within the body and is not amenable to routine screening tests, it’s often diagnosed at later stages, once it has spread to other sites that may trigger more noticeable symptoms. If ovarian cancer is suspected, you’ll likely undergo a physical exam and imaging tests, such as an ultrasound or CT scan to look for tumors in the pelvic area. MRI scans, PET scans and colonoscopies may also be part of the work-up you’ll receive if your doctor suspects ovarian cancer.
If a tumor is found, you’ll likely have a biopsy, which is a surgical procedure in which a small amount of tissue is removed and tested in the lab to look for cancerous cells. In some cases where fluid has built up in the abdomen, a sample of that fluid may be extracted and tested for the presence of cancer cells in a procedure called paracentesis. Your doctor will also likely check your CA-125 levels and other blood markers.
If you’re diagnosed with ovarian cancer, it’s very important to undergo genetic testing. All women with ovarian cancer should have a genetic evaluation. We used to think it was only certain people with ovarian cancer, but now we know that every woman with ovarian cancer should be tested to see if she has a genetic predisposition to cancer. Information may change the treatment approach and can be a lifesaving piece of information for other family members.
As with other forms of cancer, ovarian cancer is classified into stages that indicate how far along the cancer has progressed. When you’re initially diagnosed, a pathologist will examine your samples and assign a stage to your cancer. This determination is based on the size of the tumor, whether it has spread into tissues around the ovaries, and whether it has spread to other, distant organs. This information helps guide your gynecologic oncologist in selecting the right treatment approach for your particular case.
- Stage 1: The cancer is confined to the ovaries.
- Stage 2: Cancerous cells have been found in one or both ovaries and have been found in other tissues in the pelvis, such as the fallopian tubes, uterus, bladder, colon or rectum.
- Stage 3: Cancerous cells have been found in one or both ovaries and the lining of the abdomen or lymph nodes in the abdomen. It may have also spread to other nearby organs, such as the liver and other parts of the reproductive system.
- Stage 4: This is the most advanced and fatal stage of ovarian cancer, in which cancer has spread to distant organs, such as the brain or lungs.
If someone has a suspicion of ovarian cancer, they should be treated by a gynecologic oncologist, which is a doctor specifically trained in caring for women with ovarian cancer. Seeking out the right specialist has been shown to offer women improved outcomes.
Once you’ve found the right doctor, several decisions will ensue, with the first being whether or not surgery will be part of the treatment protocol, and if so, whether it should be done before or after chemotherapy. Experts generally do approach (treatment) surgically, but in certain situations the surgery may not be the right first step.
Depending on the situation, surgery may be conducted as an open procedure, meaning that the surgeon will cut into the body, or you might have the option for a minimally invasive approach that requires less trauma and less recovery time. The ovaries will be removed, but your doctor may take other tissue as well. It depends on a woman’s age. If a woman does not have a specific desire to keep her other organs, Your doctor generally remove the uterus, cervix, fallopian tubes and ovaries.
The key is for the surgeon to assess carefully where the disease may have spread and remove as much of it as possible. This is why some patients undergo chemotherapy first – to shrink the tumor and make it easier to remove entirely. For patients who are undergoing chemotherapy first, your doctor may reassess your condition after a few rounds to determine whether surgery has become a more viable option.
Radiation is not usually a front-line treatment, but may be used as a palliative therapy if ovarian cancer recurs or comes back. Ovarian cancer does tend to recur, but one thing that’s important to note is that the vast majority of patients will have a good response to front-line therapy. But unfortunately, with time, a majority of people do experience a recurrence.
As with other forms of cancer, generally speaking, the earlier a case of ovarian cancer is detected, the better your chances of survival. The ACS reports on the relative five-year survival rates of ovarian cancer based on its stage, which means this percentage of people with this stage of ovarian cancer will survive at least five years from diagnosis:
- Stage 1: 78 percent
- Stage 2: 61 percent
- Stage 3: 28 percent
- Stage 4: 19 percent
Within each stage, there is much variation of survival rates based on the specific characteristics of the cancer. Survival rates can’t tell the whole story and your own journey will be individual. Survival rates are simply a guide that may help you understand what to expect from a specific case of cancer.
Because we don’t know exactly what causes ovarian cancer, it’s difficult to say that doing or not doing a specific thing will prevent you from getting this disease. But there are ways to lower your risk.
You can’t cut your genetic risk factors, such as if you’ve inherited a mutation on the BRCA1 or BRCA2 gene, but it’s believed that taking oral contraceptives could help some women lower their risk of developing ovarian cancer in spite of these genetic factors. The ACS reports that “women who used oral contraceptives for five or more years have about 50 percent lower risk of developing ovarian cancer compared with women who never used oral contraceptives.”
It is not well-known among women in the general population and also physicians that the oral contraceptive decreases ovarian cancer risk by 50 percent. It really cuts your risk in half. So it’s really one of the most effective prevention strategies that we have.
Some surgical procedures, such as preemptive removal of the ovaries, removal of the fallopian tubes, tubal ligation (a surgical sterilization procedure that blocks or cuts the fallopian tubes) or hysterectomy (removal of the uterus) might also be recommended in certain cases.
Other actions you can take to reduce your risk include:
- Maintaining a healthy weight.
- Eating right.
- Avoiding post-menopausal hormone therapies.
- Not smoking.
- Avoiding excessive alcohol use.
- Paying attention to your body and talking to your doctor if something seems amiss.
If you don’t feel right, get it checked out. Early detection is really the key.