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Anatomy of the Ovaries and Uterus:

Illustration of the female reproductive systemThe ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth. Illustration courtesy of the National Cancer Institute/Alan Hoffring (artist)

Ovarian cancer causes more deaths than any other cancer of the female reproductive system, yet ovarian cancer accounts for only 3% of all cancers in women.

Ovarian cancer is particularly dangerous because its presence is difficult to detect until it has spread beyond the ovaries. If diagnosed and treated while the cancer has not spread outside the ovary, the 5-year survival rate is 93%.(1, 2)

About one fifth of ovarian cancers are found at an early stage, but unfortunately more than 50% of women with ovarian cancer are diagnosed in the late stages of the disease.

 

Symptoms of Ovarian Cancer

Early cancers of the ovaries may result in either no symptoms, or vague symptoms that are more commonly caused by other things. One or more of the following symptoms can be related to ovarian cancer:

      • Vague digestive disturbances such as abdominal bloating, feeling of fullness, mild indigestion, , loss of appetite, or gas.
      • Pelvic pressure, abdominal pain, pain in the lower back
      • swelling in the abdomen, abdominal mass, hard abdomen,
      • Difficulty eating or feeling full quickly
      • Urinary symptoms (urgency or frequency)
      • Diarrhea or constipation
      • Vaginal bleeding between menstrual periods or after menopause
      • Shortness of breath

Symptoms associated with advanced ovarian cancer include

        • severe nausea, vomiting,
        • pain, and
        • weight loss.

Risk Factors of Ovarian Cancer

  • Age over 50 increases risk: Most ovarian cancer occurs in women aged 50 years or older, but it can occur in younger women. Two-thirds of ovarian cancer occurs in women over 55.
  • Ethnic Group: Mortality and incidence rates are higher for white women than for any other racial or ethnic group.
  • Genetic factors increase risk: A woman's chance of having ovarian cancer increases if one or more of her close relatives (i.e., mother, daughter, or sister) has had the disease. About 1 in 10 cases of ovarian cancers are linked to gene changes that can be found with certain tests. Women with a family history of ovarian cancer might want to talk to their doctor about genetic counseling and perhaps genetic testing.
  • Personal history of cancer increases risk: Women with a history of breast, endometrial, or colon cancer also have a greater chance of developing ovarian cancer than do women who have not had these cancers.
  • Oral contraceptive use greater than 5 years decreases the risk for women at average risk of developing ovarian cancer, however for women at high risk because of gene changes, the results are mixed.
  • Excess body fat increases risk: Body fat, as measured by body mass index, increases the risk of ovarian cancer. A study from the American Cancer Society found a higher rate of death from ovarian cancer in women who were overweight. The risk went up by 50% in the heaviest women. A number of studies have shown a lower rate of this cancer in women who ate a diet high in vegetables. The American Cancer Society recommends eating at least 5 servings of fruits and vegetables every day and limiting the amount of red meats, especially those that are high in fat.
  • Breast feeding for a year or longer is thought to decrease the risk of ovarian cancer.
  • Tubal ligation or hysterectomy: "Tying" the tubes as a method of birth control, when done after childbearing, may reduce the chance of ovarian cancer. Removing the uterus may also reduce the risk. But, according to the American Cancer Society, these surgeries should only be done for a valid medical reason and not just for their effect on ovarian cancer risk.
  • Menstrual periods: Studies have found a link between the number of menstrual cycles in a woman’s lifetime and her risk of getting ovarian cancer. Women who started having periods early, before the age of 12, or who went through menopause after the age of 50 have a small increased risk of ovarian cancer. Also there is a slight increased risk for women who have not had children, or had their first child after they were 30 years old.
  • Fertility drugs: Some studies have found that long-time use of one fertility drug (clomiphene citrate), especially if no pregnancy took place, may increase the risk. Infertility alone, also increases the risk, even without the use of fertility drugs.
  • Talcum powder: Some research has found a slight increase in risk of ovarian cancer among women who used talcum powder on the genital area. Asbestos in the powder has been thought to be the cause, however these products have been free of asbestos for more than 20 years. Follow-up studies will need to be done on newer products.

    Read more about risk factors from the National Cancer Institute

Preventive Surgery

Surgery to remove one or both ovaries is called oophorectomy. Recent research has shown that surgery to remove the ovaries in women with mutation in the BRCA1 and BRCA2 genes can dramatically reduce their risk of developing ovarian cancer. Whether or not a woman should have this surgery is a complex question because it causes menopause to take place early. While this operation lowers ovarian cancer risk a great deal, cancer can still form in the cells lining the pelvis where the ovaries were located.

Screening for Ovarian Cancer

There is no good screening test for ovarian cancer, but having regular pelvic examinations is important in the detection of ovarian cancer. Routine Pap smears and pelvic examinations are recommended for all women over 20 years old.

CA-125 is a tumor marker but is highly inaccurate. It is often found in higher-than-normal amounts in the blood of women with ovarian cancer, but it is not always elevated in patients with early-stage disease and may be elevated in certain benign conditions. It’s okay to get the blood test, but just realize that this test is not highly accurate or reliable. In other words, it can be negative in the face of cancer, and it can be positive, when there’s no cancer.  There simply is no good test right now for ovarian cancer.  There are frequent emails circulating that the doctors are trying to hide a good test from the public. This is not true. According to the American Cancer Society, "CA-125 protein levels in the blood can be measured as a marker for ovarian cancer, but should not be used simply to screen for the disease because of its poor accuracy. Testing with CA125 is recommended for women at very high risk, such as those with a family history of the disease. Also, the blood test is routinely used for women diagnosed with ovarian cancer to measure their response to treatments, as well as to watch for recurrence."

Transvaginal sonography is an ultrasound test that places a small instrument in the vagina. It can help find a mass in the ovary, but it can't actually tell which masses are cancers and which are not.

Call for an appointment with your health care provider if you have not had your regular pelvic exam or you feel you have symptoms of ovarian cancer.

Educational Video Tutorials

Ovarian Cancer from the National Library of Medicine and the National Institute of Health (Medline Plus)

Support Groups in Pinellas County, Florida

  • American Cancer Society - Cancer Support Group for any person with cancer or those who provide emotional support to cancer patients. Registration is recommended. (No fees) The following groups are offered:
    • Largo Medical Center, 201 14th St., SW, Largo, FL . Call (727)-588-5702
    • St. Petersburg General Hospital, 6500 38th Ave.,m N., St. Petersburg, FL 33710; Call (727)-384-1414
    • Powell Cancer Pavillion, 303 Pinellas St., Clearwater, FL Call (727)-462-2139
    • Sun Coast Hospital, 2025 Indian Rocks Rd, Largo, FL 33774
  • American Cancer Society - Caregivers Support Group
    • Powell Cancer Pavillion, 303 Pinellas St., Clearwater, FL; Call (727) 462-2139 (No fees)
  • Moffitt:  Support Group H Lee Moffitt Center, Tampa  Call 1-888-MOFFITT 
  • Cancer Hope Network: Cancer Support Counseling (Free one-on-one support for newly diagnosed cancer patients and their families) Call 1-877-HOPENET

Locate a Physician who Specializes in Cancer (Oncologist)

References

1) Basic information about ovarian cancer, CDC, 2007
2) Ovarian cancer from the American Cancer Society
3) Ovarian cancer prevention and early detection study from the National Cancer Institute

Related links:
--Written by N Thompson, RN, MSN, ARNP Last updated September 2010

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