- Risk Factors
- Signs & Symptoms
Ovarian epithelial cancer is a disease in which malignant (cancer) cells form in the tissue covering the ovary.
The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones (chemicals that control the way certain cells or organs function).
Ovarian epithelial cancer is one type of cancer that affects the ovary. (See the PDQ treatment summaries on Ovarian Germ Cell Tumors and Ovarian Low Malignant Potential Tumors for information about other types of ovarian cancer.)
Women who have a family history of ovarian cancer are at an increased risk of developing ovarian cancer.
Anything that increases your risk of getting a disease is called a risk factor. Women who have one first-degree relative (mother, daughter, or sister) with ovarian cancer are at an increased risk of developing ovarian cancer. This risk is higher in women who have one first-degree relative and one second-degree relative (grandmother or aunt) with ovarian cancer. This risk is even higher in women who have two or more first-degree relatives with ovarian cancer.
Some ovarian cancers are caused by inherited gene mutations (changes).
The genes in cells carry the hereditary information that is received from a person's parents. Hereditary ovarian cancer makes up approximately 5% to 10% of all cases of ovarian cancer. Three hereditary patterns have been identified: ovarian cancer alone, ovarian and breast cancers, and ovarian and colon cancers.
Tests that can detect mutated genes have been developed. These genetic tests are sometimes done for members of families with a high risk of cancer. (See the PDQ summaries on Ovarian Cancer Screening, Ovarian Cancer Prevention, and Genetics of Breast and Ovarian Cancer for more information.)
Women with an increased risk of ovarian cancer may consider surgery to prevent it.
Some women who have an increased risk of ovarian cancer may choose to have a prophylactic oophorectomy (the removal of healthy ovaries so that cancer cannot grow in them). In high-risk women, this procedure has been shown to greatly decrease the risk of developing ovarian cancer. (See the PDQ summary on Ovarian Cancer Prevention for more information.)
Possible signs of ovarian cancer include pain or swelling in the abdomen.
Early ovarian cancer may not cause any symptoms. When symptoms do appear, ovarian cancer is often advanced. Symptoms of ovarian cancer may include the following:
- Pain or swelling in the abdomen.
- Pain in the pelvis.
- Gastrointestinal problems, such as gas, bloating, or constipation.
These symptoms may be caused by other conditions and not by ovarian cancer. If the symptoms get worse or do not go away on their own, a doctor should be consulted so that any problem can be diagnosed and treated as early as possible. When found in its early stages, ovarian epithelial cancer can often be cured.
Women with any stage of ovarian cancer should think about taking part in a clinical trial. Information about ongoing clinical trials is available from the NCI Web site.
Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect (find) and diagnose ovarian cancer.
The following tests and procedures may be used:
- Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
- CA 125 assay: A test that measures the level of CA 125 in the blood. CA 125 is a substance released by cells into the bloodstream. An increased CA 125 level is sometimes a sign of cancer or other condition.
- Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The tissue is removed in a procedure called a laparotomy (a surgical incision made in the wall of the abdomen).
Certain factors affect treatment options and prognosis (chance of recovery).
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer.
- The type and size of the tumor.
- The patient's age and general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
After ovarian epithelial cancer has been diagnosed, tests are done to find out if cancer cells have spread within the ovaries or to other parts of the body.
The process used to find out if cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
An operation called a laparotomy is usually done to find out the stage of the disease. A doctor must cut into the abdomen and carefully look at all the organs to see if they contain cancer. The doctor will also perform a biopsy (cut out small pieces of tissue so they can be looked at under a microscope to see whether they contain cancer). Usually the doctor will remove the cancer and organs that contain cancer during the laparotomy. (See the Treatment Options by Stage section.)
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for ovarian epithelial cancer:
In stage I, cancer is found in one or both of the ovaries. Stage I is divided into stage IA, stage IB, and stage IC.
- Stage IA: Cancer is found in a single ovary.
- Stage IB: Cancer is found in both ovaries.
Stage IC: Cancer is found in one or both ovaries and one of
the following is true:
- cancer is found on the outside surface of one or both ovaries; or
- the capsule (outer covering) of the tumor has ruptured (broken open); or
- cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).
In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.
- Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).
- Stage IIB: Cancer has spread to other tissue within the pelvis.
- Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).
In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.
- Stage IIIA: The tumor is found in the pelvis only, but cancer cells have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).
- Stage IIIB: Cancer has spread to the peritoneum but is 2 centimeters or smaller in diameter.
- Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen.
Cancer that has spread to the surface of the liver is also considered stage III disease.
In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body.
Cancer that has spread to tissues in the liver is also considered stage IV disease.
Recurrent or Persistent Ovarian Epithelial Cancer
Recurrent ovarian epithelial cancer is cancer that has recurred (come back) after it has been treated. Persistent cancer is cancer that does not go away with treatment.