About Ovarian Cancer
Ovarian cancer is the second most common cancer of the reproductive organs among women in the United States. It most commonly occurs in women between the ages of 50 and 65. A woman’s lifetime risk of developing ovarian cancer is approximately 1.4 percent.
There are several different types of cancer that can start in the ovary; the most common is called “epithelial” ovarian cancer. This topic review will discuss the treatment of epithelial ovarian cancer, with a focus on chemotherapy after initial surgery. The diagnosis and staging of ovarian cancer is discussed separately.
Certain factors increase a person’s risk of developing ovarian cancer, including:
- Never having been pregnant.
- Early age of menarche (when menstrual periods begin) or late age of menopause.
- A family history of ovarian, breast, or endometrial (uterine) cancer, particularly if the person inherits a specific type of genetic abnormality called a BRCA1 or BRCA2 mutation.
- A family history of a genetic condition called Lynch syndrome (hereditary nonpolyposis colorectal cancer [HNPCC]).
Ovarian Cancer signs and symptoms
During the early stages of ovarian cancer, symptoms may be present but are often vague and ill-defined. Symptoms may include pelvic or abdominal discomfort, increased abdominal size or bloating, decreased appetite, feeling full after eating a small amount of food, or urinary symptoms (urgency and frequency).
In some women, ovarian cancer is initially suspected when a mass or lump is felt during a routine pelvic examination. However, a mass is not always detectable in the early stages of ovarian cancer. Even when a mass is detected, it does not necessarily mean that the woman has ovarian cancer. There are many common noncancerous conditions (such as ovarian cysts) that can cause masses.
Ovarian Cancer Diagnosis
If ovarian cancer is suspected based on symptoms and/or an abnormal physical examination, imaging tests of the abdomen and pelvis are usually recommended as an initial step in the evaluation. Imaging tests may include ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). These tests do not provide enough information by themselves to definitively diagnose ovarian cancer, although they may provide important information about the location and/or extent of a possible cancer.
The only way to diagnose ovarian cancer with certainty is through surgery. In some cases (for example, if surgery is not possible or if the woman is a candidate for chemotherapy prior to surgery), a nonsurgical procedure may be done instead. This involves removing tissue or fluid from the abdomen or chest with a needle (called a biopsy, paracentesis, or thoracentesis) for testing.
Ovarian cancer is diagnosed (and the stage determined) through exploratory surgery. The surgeon will also remove all visible cancer. In most cases, this involves removing the uterus, fallopian tubes, and ovaries. This is done to ensure that as much of the cancer as possible is removed, and to help prevent the cancer from spreading further. Sometimes, no further treatment is needed; however, most of the time, additional (or “adjuvant”) treatment with chemotherapy is recommended.
Most women with ovarian cancer do get treatment with chemotherapy (in addition to surgery). After the cancer is removed with surgery to the extent possible, there is still a risk that cancer cells remain and may return or spread to other parts of the body. Chemotherapy is given after surgery to destroy these cells; it improves the chance that the cancer will not recur and decreases the risk of dying of ovarian cancer.