Ovarian cancer is a disease in which malignant cells are found in an ovary. This type of cancer may start in the fallopian tubes or in the peritoneal cavity (the space within the abdomen that contains the intestines, the stomach, and the liver) and we sometimes refer to these cancers interchangeably.
There are three types of ovarian tumors, named for the tissue in which they are found:
- Epithelial cell refers to cells that cover the surface of the ovary. Most of these tumors are benign (noncancerous). However, epithelial ovarian cancer accounts for 85 to 90 percent of ovarian cancer cases.
- Germ cell refers to cells that form in the eggs in the ovary.
- Stromal cell refers to cells that form in the ovary and produce female hormones.
Although we still do not know what causes cancer, there are new and powerful options available today to successfully detect and fight ovarian cancer. The most powerful impact is to identify high risk women and prevent cancers. The second most important factor is trying to catch cancer early, when it is most treatable.
As an NCI-designated cancer center, UVA brings you comprehensive cancer prevention, detection and treatment options, as well as personal support for you and your family.
Risk Factors of Ovarian Cancer
These risk factors may increase your chances of getting ovarian cancer:
- Family history of ovarian cancer — up to 20 percent of ovarian cancer may be due to inherited risk
- Family history of pancreatic cancer, breast cancer or colon cancer
- Age (risk increases with age)
- No pregnancies
- Higher socioeconomic status
- Early onset of menstrual periods (before age 12)
- Late menopause
What You Should Know About BRCA1 and BRCA2
The mutations that most often cause both breast and ovarian cancer are changes in the BRCA1 and BRCA2 genes ("Breast cancer 1 gene" and "Breast cancer 2 gene"). While the BRCA mutations account for the majority of hereditary ovarian cancer, many other mutations can cause ovarian cancer.
Women with inherited mutations in the BRCA1 or BRCA2 genes are three to seven times more likely to develop breast and ovarian cancer than those who do not have the mutations, and at an earlier age.
According to the National Cancer Institute (NCI), the women who are mostly likely to have BRCA1 or BRCA2 mutations are those of Eastern European (Ashkenazi) Jewish heritage and/or those with family members who have had:
- Multiple cases of breast cancer
- Cases of both breast and ovarian cancer, or
- One or more family members with two primary cancers (original tumors at different sites).
However, the NCI also notes that not every woman in such families carries an alteration in BRCA1 or BRCA2, and not every cancer in such families is linked to alterations in these genes.
UVA High-Risk Breast and Ovarian Cancer Clinic can perform an in-depth evaluation to provide valuable insight into inherited risk. For women who are at higher inherited risk for breast and ovarian cancers, the high-risk program offers many options for potential genetic testing, cancer screening and risk-reduction options.
Hereditary versus Sporadic Cancer
We all have 20,000 to 25,000 genes in the cells of our body. These genes determine all of our characteristics — hair color, height, body type and so on. Cancer is caused by uncontrolled growth of cells as the result of mutations in genes.
Because the mutated genes that cause hereditary cancer are inherited from a person's parents, every cell in the body of a person with such a mutation contains the mutation.
It usually takes more than one mutation to cause cancer, but people who inherit a cancer-causing mutation are that much more likely to get cancer in their lifetimes.
About 90 percent of all cases of cancer are sporadic cancers; for ovarian cancer, 80 percent are sporadic. Unlike hereditary cancer, in which mutations are passed on from parents, in cases of sporadic cancer, the mutation occurs spontaneously — often from unknown origins and reasons.
Doctors believe that these mutations are caused through exposure to risk factors for cancer during a person's lifetime.
Ovarian cancer often does not cause many early signs until the cancer grows. The following are the most common symptoms of ovarian cancer. In women with cancer, they are more likely to occur more than 12 times in a month.
- Pelvic or abdominal pain
- Increasing abdominal size
- Difficulty eating
- Feeling full quickly when eating
- Constipation and pelvic pressure
There are several ways to detect ovarian cancer and all begin with a physical exam, including a pelvic exam to feel the vagina, rectum and lower abdomen for masses or growths. Your doctor may also order other tests, including:
- Transvaginal ultrasound – an imaging technique that uses an ultrasound probe inserted into the vagina to produce an image of the ovaries created by sound waves.
- Computed tomography (CT or CAT scan) – a noninvasive procedure that takes cross-sectional images of the brain or other internal organs to detect any abnormalities that may not show up on an ordinary x-ray.
- Blood test – to measure a substance in the blood called CA-125 (a tumor marker that is found to be elevated in the blood of women with ovarian cancer). This test is more often used to monitor the progress of treatment than as a screening test since non-cancer problems can cause it to be elevated.
Treatment for High-Risk Women
If your family or personal history indicates a significant level of risk, our team will work with you to design a treatment plan that’s right for you. We can offer several strategies to help keep you healthy while aggressively monitoring you for the development of any cancer.
- Personal risk assessment and close observation with cancer screening
- Chemoprevention which offers FDA approved medications, including birth control pills, to help prevent ovarian cancer from developing
- Surgical risk reduction options for those women who carry a genetic mutation and have the most increased risk of developing ovarian cancer
Genetic mutations and other inherited risk factors are a factor in less than 10 percent of all breast and 20 percent of ovarian cancers. If you do carry an inherited mutation that increases the risk of ovarian cancer, our genetic counselors can help you understand what it means to you. Because genetic risk is complex, our genetic counselors are an integral part of the high-risk program’s interdisciplinary team, whose primary purpose is helping you manage your risk of developing cancer.
To reduce your risk of ovarian cancer, and to keep yourself healthy overall, you should eat a balanced diet, get regular exercise and try to keep yourself relaxed and stress- free. You should also avoid risk factors that are under your control and known to cause cancer.
What is Chemoprevention?
Chemoprevention is the use of natural or synthetic substances to reduce the risk of getting cancer or of having cancer recur. Chemoprevention works in several different ways. First, it can prevent the mutations that can cause cancer. It can also help stop the process that makes the mutated, damaged cells grow out of control.
Chemoprevention is not the same as chemotherapy. Chemotherapy is used to kill cells that have already mutated and become cancerous. Chemoprevention is done to try to stop cells from becoming cancerous.
Birth controls pill as cancer prevention
Birth control pills decrease ovarian cancer by up to 50 percent if used for five years (they also decrease the risk of endometrial cancer). Your doctor will work with you to help determine if birth control pills might be right for you to help lower your risk of cancer.
What is Surgical Risk Reduction?
Doctors in our High-Risk Breast and Ovarian Cancer Clinic may offer women at the highest risk of ovarian cancer surgical options to reduce their risk. This is primarily for women who carry a genetic mutation. Removing the fallopian tubes and ovaries (performing a salpingo-oophorectomy) can almost eliminate any risk of ovarian cancer.
Treatment for Ovarian Cancer
If you need treatment for a diagnosed ovarian cancer, UVA also provides comprehensive treatment with surgery, chemotherapy and clinical trials in our Gynecologic Oncology Division as part of our NCI designated Cancer Center.
Surgical options for ovarian cancer prevention and treatment may include:
- Salpingo-oophorectomy: surgery to remove the fallopian tubes and ovaries
- Hysterectomy: surgical removal of the uterus
- Lymph node dissection: removal of some lymph nodes from the pelvis and abdomen
- Debulking surgery: removing any tumor found in the abdomen/pelvis during surgery
Women with ovarian cancer are almost always treated with a combination of both surgery and chemotherapy. Our gynecologic oncology team is specialized in women’s cancers and can offer the most innovative treatments nationwide.
- Standard chemotherapy
- Intraperitoneal chemotherapy
- Clinical trials for both initial treatment and recurrent cancers