Source: Cancer Resource Room

What is Ovarian Cancer?
The ovaries are a pair of small organs in a woman located on the right and left sides of the uterus, just behind the bladder. Each ovary is about the size of an almond. The ovaries have two functions: (1) production and release of eggs and (2) making the hormones, estrogen and progesterone. All of the eggs in the ovaries are formed during the development of a female infant before birth. An egg matures and is released each month. This is called ovulation. Ovulation begins at puberty and continues about once a month until menopause. The hormones made by the ovary are released in different amounts throughout life, though at higher or lower levels depending on a woman's age.

Cancers are the result of abnormal cells growing and multiplying in one organ of the body and sometimes spreading to other places in the body where the groups of cells continue to grow. Several types of cancer cells can develop in the ovaries.

The most common type of ovarian cancer is called Epithelial Ovarian Carcinoma (EOC). The word "epithelial" describes cells that cover or line the organs of the body; so in this case, the cancer starts in the cells covering the surface of the ovaries. Other less common types of ovarian cancer are Germ Cell Carcinoma (from the cells that form the eggs) and Stromal Carcinoma (from the tissue that holds the inside of the ovary together and makes hormones).

Types of Ovarian Cancer

• Epithelial Ovarian
• Serous
• Endometroid
• Mucinous
• Clear Cell
• Germ Cell
• Teratomas
• Dysgerminomas
• Endometrial Sinus
• Stromal
• Granulosa
• Sertoli-Leydig Cell

What are the symptoms of ovarian cancer?
The symptoms are not specific and can be the same as those of common ailments like urinary tract infections or bowel problems. However if they last a long while or are unusual for someone, then the person should be examined medically. They include:

• Pelvic pain or pain during intercourse
• Abdominal bloating or discomfort
• Nausea, indigestion, constipation, diarrhea
• Urinary frequency without an infection
• Abnormal menstrual/vaginal bleeding
• Fatigue, shortness of breath
• Unintentional weight changes, especially weight gain

People now realize that as a group of physical changes, these symptoms can be early warning signs of ovarian cancer.

How is ovarian cancer diagnosed?
All diagnosis starts with a complete medical history and physical exam. The medical history is important as an opportunity for the patient to report possible symptoms and the length of time they have been present. Family history provides information about diseases that might increase a woman's risk of having ovarian cancer, especially close relatives who have had breast and/or ovarian cancer, or nonpolyp cancer of the rectum or colon. A history of all pregnancies, births, fertility-related treatments, and oral contraceptive use are important in evaluating a woman's disease risk.

The general physical examination evaluates the chest and abdomen for abnormal fluid that can accumulate when an ovarian cancer is present. Occasionally a mass (lump) can be felt in the abdomen. But the important test is the pelvic exam. Most women have had "pelvics" before and know how the process examines the uterus, ovaries, cervix, bladder and rectum. If this procedure is not familiar to you, ask your doctor to explain each step as she or he goes through the examination.

Blood tests are done to assess a woman's general health. Some blood tests can be routine like a blood count for anemia. There are two blood tests done for ovarian cancer: CA-125 and LPA (lysophosphatidic acid). Both are proteins in the blood which can be elevated in women with ovarian cancer. These tests are not specific (accurate) in diagnosing ovarian cancer but may provide an important clue that cancer is present. Some women with early ovarian cancer will have an increase of the protein, CA-125, and some will not. LPA can be elevated in many women with ovarian cancer, but it is also high in other diseases so it, too, is not specific.

The imaging tools that are the most useful and commonly done in diagnosing ovarian cancer are the transvaginal ultrasound and the CT scan of the abdomen and pelvis.

The transvaginal ultrasound is a device (or probe) that transmits sound waves through the vagina. These sound waves bounce off the internal organs to create images of the uterus and ovaries on a monitor. The ultrasound probe is placed in the vagina like a tampon would be. It is not painful and requires no anesthestic. The test takes about 5 minutes.

A CT scan of the abdomen and pelvis shows all the organs in those areas as a series of cross-sections These cross-sections can show even small masses or cysts (hollow spaces within an organ) in the ovaries. It can also show pockets of fluid in the abdomen, as well as any masses or abnormal tissues in and around the uterus and bladder.

What is a biopsy and how is it useful?
If the information from the woman's medical history, physical exam, blood tests, ultrasound, and CT scan are suspicious for an ovarian cancer, then a biopsy is done. A biopsy is the most important test in diagnosing ovarian cancer because it takes tissue from the ovary for a pathologist to look at under a microscope. This is the only way to see if the cells of the tissue are normal or cancerous. The two most common ways to do a biopsy of the ovaries are laparoscopically or by exploratory laparotomy. Both are done in an operating room under general anesthesia.

Laparoscopy is done through a small incision near the belly button. A narrow tube with a fiber-optic camera in it is placed in the lower abdomen and the picture is projected on a TV screen. Using the camera to look at the organs of the pelvis, a surgeon can locate any abnormal appearing tissue and take samples for the pathologist. This is similar to the procedure used to do tubal ligations. The laparoscopy is done as a same-day surgery so it does not involve an overnight stay in the hospital.

Exploratory laparotomy is a more extensive surgical procedure than laparoscopy, and is useful because it allows the surgeon to have direct visual inspection of all the organs in the lower abdomen. This procedure is done by making an incision in the abdomen from the belly button down to the pubis (just above where the pubic hair begins). The surgery is more extensive than laparoscopy and requires some post-operative time in the hospital.

When the tissue has been given to the pathologist, a diagnosis is made based upon the appearance of the cells as seen in the microscope, and by special tests done with dyes or stains. It can take as long as 7 - 10 days to make a definite diagnosis. After the diagnosis is made, the plans for treatment can be made based on the type of ovarian cancer and the stage of the person's disease.

What does the stage of a disease mean?
Stage means where the disease is located, that is, just in the organ where it started to grow, outside the organ, spread to the lymph nodes or spread to other places in the body. This is different than the grade of a tumor which describes how abnormal in appearance the cancer cells compared to the normal cells of the same tissue. Even though the grade of the tumor cells does not affect the stage category, it is usually the case that more abnormal cells are found in higher stage disease.

• Stage I: tumor is located inside one or both ovaries, without breaking through the surface, and there are no tumor cells in the fluid in the abdomen.
• Stage II: tumor in one or both ovaries, has broken through the surface, may have tumor cells in the fluid in the abdomen, and has extended to other nearby organs including the fallopian tube, uterus, bladder, and rectum.
• Stage III: tumor in one or both ovaries with spread to the lining of the abdomen and the lymph nodes.
• Stage IV: tumor is in the ovaries and has metastasized to other organs such as the liver and lungs.

Support & Education Programs

We know that being diagnosed with cancer can be stressful for you and your family. We offer a variety of cancer support services to help patients and families gain the support and information they will need to meet the challenges ahead.

To find information on the Gynecological Support Group, education and support workshops plus wellness services, please view the HOPES calendar.

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