Ovarian cancer: Causes, symptoms, and treatments

Ovarian cancer refers to any cancerous growth that begins in the ovary.

It is the fifth most common cause of cancer deaths in women and the tenth most common cancer among women in the United States.

Among the gynecologic cancers—those affecting the uterus, cervix, and ovaries—ovarian cancer has the highest rate of deaths.

In 2017, around 22,440 women in the U.S. are expected to receive a diagnosis of ovarian cancer, and around 14,080 are expected to die from this disease.

Fast facts about ovarian cancer

Around 22,000 Americans receive a diagnosis of ovarian cancer yearly.

Risk factors for developing ovarian cancer include family history, older age, reproductive history, and obesity.

Treatment options include surgery, radiotherapy, and chemotherapy.

If it is diagnosed in the early stages, there is a 94 percent chance of surviving for at least 5 more years.

Symptoms

woman with pelvic pain holding stomach while laying on side.
Pelvic pain can be a sign of ovarian cancer.

Most ovarian cancers start in the epithelium, or outer lining, of the ovary.

In the early stages, there may be few or no symptoms.

Symptoms may resemble those of other conditions, such as premenstrual syndrome (PMS), irritable bowel syndrome (IBS), or a temporary bladder problem.

The main difference between ovarian cancer and other possible disorders is the persistence and gradual worsening of symptoms.

Early symptoms of ovarian cancer may include:

pain in the pelvis, the lower abdomen, or the lower part of the body

back pain

indigestion or heartburn

feeling full rapidly when eating

more frequent and urgent urination

pain during sexual intercourse

changes in bowel habits, such as constipation

As the cancer progresses, there may also be:

nausea

weight loss

breathlessness

tiredness

loss of appetite

If an individual experiences bloating, pressure, or pain in the abdomen or pelvis that lasts for more than a few weeks they should see a doctor immediately

Causes

Ovarian cancer happens when cells divide and multiply in an unregulated way. However, exactly why this happens is not clear.

The following risk factors are linked to a higher chance of developing the disease:

Family history

Women with close relatives who have had ovarian or breast cancer have a higher risk of developing ovarian cancer, compared with other women.

Genetic screening can determine whether somebody carries certain genes that are associated with an increased risk.

Age

Most cases of ovarian cancer occur after menopause, and especially in women aged over 63 years. It is rare before the age of 40 years.

Reproductive history

Women who have had one or more full-term pregnancies, especially before the age of 26 years, have a lower risk. The more pregnancies they have, the lower the risk.

Breastfeeding may also decrease the risk.

Birth control

Using the contraceptive pill for at least 3 to 6 months appears to reduce the risk. The longer the pill is used, the lower the risk appears to be.

Using an injectible contraceptive hormone, depot medroxyprogesterone acetate (DMPA or Depo-Provera CI), especially for 3 years or more, reduces the risk further.

Infertility or fertility treatment

Fertility drugs have been linked to a higher risk of ovarian cancer, especially in women who used them for more than one year without becoming pregnant. Those who are infertile may also have a higher risk than those who are not, possible due to not carrying a pregnancy.

Breast cancer

Women who have received a diagnosis of breast cancer have a higher chance of being diagnosed with ovarian cancer.

For this reason, women who are diagnosed with breast cancer and who test positive for the BRCA1 or BRCA2 gene may opt to have an oophorectomy as preventive therapy.

Hormone therapy

HRT slightly increases a women’s risk of developing ovarian cancer. The risk appears to increase the longer the HRT continues, and returns to normal as soon as treatment stops.

Androgen therapy, such as the use of the drug, Danazol, may also increase the risk.

Obesity and overweight

Obesity and overweight appear to increase the risk of developing many cancers. Ovarian cancer is more common in women with a body mass index (BMI) of over 30.

Gynecologic surgery

Having surgery on the reproductive organs appear to reduce the risk of ovarian cancer. In women who undergo tubal ligation, this may be reduced by up to two thirds. A hysterectomy may reduce the risk by one third.

Endometriosis

Women who develop endometriosis have an around 30 percent higher risk of developing ovarian cancer, compared with other women.

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Stages

If ovarian cancer is diagnosed, the next step is to identify its stage and grade.

The stage of a cancer refers to the cancer’s spread.

There are different ways of staging cancer. The American Cancer Society uses a four-stage system.

Stage 1: Cancer cells affect only the ovary or ovaries and have not spread to another area.

Stage 2: The cancer has affected one or both ovaries and also other organs within the pelvis, such as the uterus, fallopian tubes, bladder, or rectum.

Stage 3: The cancer affects one or both ovaries and either the lining of the abdomen or lymph nodes in the back of the abdomen.

Stage 4: The cancer has spread to other parts of the body, outside the peritoneal cavity. This cavity includes the abdomen and the pelvis. Areas that may now be affected include the liver, spleen, and the fluid around the lungs.

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