Ovarian Cancer
Signs and Symptoms
Ovarian cancer originates in the cells of the ovaries, including surface epithelial cells, germ cells and the sex cord-stromal cells. Ovarian tumors include:
Germ Cell Tumors — Ovarian germ cell tumors develop from cells that produce the ova or eggs. Most germ cell tumors are benign, although some are cancerous and may be life-threatening. The most common germ cell malignancies are maturing teratomas, dysgerminomas and endodermal sinus tumors. Teenagers and women in their 20s are most often diagnosed with germ cell malignancies. Before combination chemotherapy was available as a treatment, the most aggressive of these tumors — the GNP abnormal sinus tumor — was associated with a one-year disease-free survival rate of only 10 percent to 19 percent, even though 70 percent of these tumors were diagnosed very early. Today, however, 90 percent of women with ovarian germ cell malignancies can be cured and their fertility preserved.
Stromal Tumors — Ovarian stromal tumors develop from connective tissue cells that hold the ovary together and those that produce the hormones estrogen and progesterone. The most common types are granulosa-theca tumors and Sertoli-Leydig cell tumors. These tumors are fairly rare and usually are considered low-grade cancers.
Epithelial Tumors — Epithelial ovarian cancer develops from the thin layer of cells, called the epithelium, that covers the ovary. Most epithelial ovarian tumors are benign, including including serous adenomas, mucinous adenomas and Brenner tumors. Cancerous epithelial tumors are the most common and the most serious of ovarian cancers, accounting for 85 percent to 90 percent of all ovarian cancer. Some ovarian epithelial tumors don't appear clearly cancerous under the microscope and are called borderline tumors or tumors of low malignant potential (LMP tumors).
When cancer is diagnosed early while the tumor is limited to the ovary, the cure rate is better than 90 percent. Unfortunately, about two-thirds of women with ovarian cancer initially seek medical attention when the tumor is already advanced and has spread outside of the ovary. In these instances, the five-year survival rate is significantly lower.
Ovarian cancer often does not have signs or symptoms until later in its development. Symptoms may include:
If these symptoms are persistent and a change from the norm, you should see a gynecologist.
Others symptoms of ovarian cancer can include:
These symptoms, however, may be caused by other conditions and aren't necessarily signs of ovarian cancer.
For more information, see our Patient Education.
Diagnosis
To help find the cause of your symptoms, your doctor will evaluate your medical history, perform a physical exam and recommend diagnostic tests. The exams and tests may include some of the following:
Pelvic exam includes feeling the uterus, vagina, ovaries, fallopian tubes, bladder and rectum to find any abnormality in their shape or size. A Pap test, an effective test for cancer of the cervix, is often done along with the pelvic exam, but it is not a reliable way to find or diagnose ovarian cancer.
Ultrasound refers to the use of high-frequency sound waves that are aimed at the ovaries. The pattern of the echoes they produce creates a picture called a sonogram. Healthy tissues, fluid-filled cysts and tumors look different on this picture.
CA-125 assay is a blood test used to measure the level of CA-125, a tumor marker that is often found in higher-than-normal amounts in the blood of women with ovarian cancer.
Lower GI series, or barium enema, is a series of X-rays of the colon and rectum. The pictures are taken after the patient is given an enema with a white, chalky solution containing barium, which outlines the colon and rectum on the X-ray, making tumors or other abnormal areas easier to see.
Computed tomography (CT) scan is a series of detailed pictures of areas inside the body created by a computer linked to a X-ray machine.
Biopsy is the removal of tissue for examination under a microscope. A pathologist studies the tissue to make a diagnosis. To obtain the tissue, the surgeon performs a laparotomy, an operation to open the abdomen. If cancer is suspected, the surgeon performs an oophorectomy, where the entire ovary is removed. This is important because if cancer is present, removing just a sample of tissue by cutting through the outer layer of the ovary could allow cancer cells to escape and cause the disease to spread.
For more information, see our Patient Education.
Treatment
Health care professionals specializing in pelvic cancers at UCSF Medical Center will discuss all available therapies with you and make recommendations based on the stage of your disease, age and the overall condition of your health.
Surgery — Surgery to remove the cancerous growth is the primary method for diagnosing and treating ovarian cancer.
Radiation Therapy — This treatment uses high-energy rays to damage cancer cells and stop them from growing. It is a localized treatment, which means that it works to attack cancer cells in one area. The radiation may come from a large machine, which is called external radiation, or from radioactive materials placed directly into the ovaries, called implant radiation. Some patients receive both types of radiation therapy.
Chemotherapy — Drugs to kill cancer cells are most often used when ovarian cancer has spread to other parts of the body. A patient may receive just one drug or a combination of drugs in cycles. Chemotherapy may be given by injection into a vein or orally. It is a systematic treatment, meaning that the drugs flow through the body in the bloodstream.
For more information, see our Patient Education.
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