Risk Factors

Several factors influence the risk of developing ovarian cancer:

• Age: Women of any age are at risk, but most ovarian cancers develop after menopause. About half of all ovarian cancers occur in women over age 63.
• Family history of ovarian or breast cancer: As with many diseases, family history may play a role in risk, but how much of a role isn't yet known. If breast or ovarian cancer runs in your family, tell your health care provider. It may increase your risk. Learn more about hereditary cancer risk from our Family Cancer Assessment Clinic.
• Hormone exposure: Women who started menstruating early, or have never been pregnant, or who entered menopause after age 50 may have an increased risk of ovarian cancer.
• Obesity: Although most estrogen is produced by a woman's ovaries, fat tissue can change other hormones into estrogen. This increase in estrogen levels raises ovarian cancer risk.

Symptoms

Early signs of ovarian cancer are often nonspecific, but these are the most common:

• Abnormal vaginal bleeding
• Back discomfort
• Changes in bowel or bladder habits
• Difficulty eating and feeling full quickly
• Increased abdominal size
• Indigestion, bloating, or gas
• Nausea
• Pelvic and abdominal pain or cramping
• Unexplained weight loss or gain
• Unusual fatigue

Many of these symptoms could be related to other health problems. A woman with any of these symptoms should see her health care provider so the problem can be diagnosed and treated as early as possible.

Screening and Diagnosis

Screening tests

A pelvic exam is the only routine screening test for ovarian cancer. In this exam, the doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. It is usually performed in the same visit as a Pap test (a screening test for cervical cancer).

A woman with persistent symptoms should see her gynecologist. If a woman has symptoms that suggest ovarian cancer, the doctor will find out whether it is due to cancer or to some other cause. The doctor may order one or more of the following tests:

• Physical exam: The doctor checks general signs of health and may press on the abdomen to check for tumors or an abnormal buildup of fluid. A sample of fluid can be taken to look for ovarian cancer cells.
• Blood tests: The doctor may order blood tests. The lab may check the levels of several substances, including CA-125. CA-125 is a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration to monitor a woman's response to ovarian cancer treatment and for detecting recurrence after treatment.
• Ultrasound: This procedure uses high-energy sound waves bounced off internal tissues or organs to make echoes. The echoes form a picture of body tissues called a sonogram. The picture may show an ovarian tumor. For a better view of the ovaries, the ultrasound device may be inserted into the vagina (called a transvaginal ultrasound).
• Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, the doctor may suggest surgery to remove tissue and fluid from the pelvis and abdomen.

Staging

If ovarian cancer is diagnosed, the doctor needs to know the stage (extent) of the disease to plan the best treatment. Staging is the process of finding out whether the cancer has spread, and if so, to what parts of the body.

Usually, surgery is needed before staging can be completed. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer.

The doctor may order the following tests to find out whether the cancer has spread:

• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show a tumor, abnormal fluid, swollen lymph nodes, or if the cancer has spread to other parts of the body.
• Chest x-ray: This is an x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Barium enema x-ray: Doctors may order a series of x-rays of the lower intestine. The patient is given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
• Colonoscopy: The doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.

Stages of Ovarian Cancer

Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.

Stage II: Cancer cells have spread from one or both ovaries to the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen.

Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.

Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs.

Recurrent ovarian cancer: Cancer that comes back after it has been treated. Persistent cancer is cancer that does not go away with treatment.

Treatment

At Huntsman Cancer Institute, ovarian cancer is treated by a team of specialists, including gynecologic oncologists (doctors who specialize in cancers of the female reproductive system), surgeons, radiation oncologists, social workers, dietitians, and other professionals.

Treatment options depend on the cancer's stage, the patient's general health, plans for bearing children, and other personal considerations. Here are common treatment options for ovarian cancer:

• Surgery
• Chemotherapy
• Radiation therapy
• Clinical trials

Surgery

This treatment removes cancer from the body. Surgery options include the following:

• Both ovaries and fallopian tubes (called a salpingo-oophorectomy)
• The uterus (called a hysterectomy)
• The omentum (the thin, fatty pad of tissue that covers the intestines
• Nearby lymph nodes (called a sentinel lymph node biopsy)
• Samples of tissue from the pelvis and abdomen

If the cancer has spread, the surgeon removes as much cancer as possible. This is called "debulking" surgery.

If a woman has early stage I ovarian cancer, the extent of surgery may depend on whether she wants to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.

Chemotherapy

This treatment uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery.

Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways:

• By vein (IV): The drugs can be given through a thin tube inserted into a vein.
• By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen (belly area).
• By mouth: Some drugs for ovarian cancer can be given by mouth.

Watch our introduction to chemotherapy video to learn more about this type of treatment.

Radiation therapy

Although rarely used in the initial treatment of ovarian cancer, radiation therapy may be used to relieve pain and other problems caused by the disease.

Clinical trials

These are studies that discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctor about participating in a clinical trial or to ask any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.