Cancer of the Ovary - Fact Sheet

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	What is Cancer of the Ovary?
	Causes
	Symptoms
	Diagnosis
	Treatment

The Ovaries

The ovaries are a pair of female reproductive organs that are located in the pelvis. They sit either side of the uterus (womb) at the ends of the fallopian tubes, and are usually about the size of an almond. The ovaries perform two functions: to produce eggs and to make female hormones.

What Is Cancer of the Ovary?

Cancer of the ovary is a disease in which some of the cells of the ovary undergo changes and develop into cancer. There are three different types of ovarian cancer. These types differ depending on the cells from which the cancer originates. The three types of ovarian cancer are:

	Epithelial Ovarian Cancer - cancer which originates from a surface cell of the ovary. It is the most common form of ovarian cancer, and most cases occur in post-menopausal women, usually in their 60s or 70s. Unfortunately, the vast majority (65%) of women with ovarian epithelial cancer are diagnosed with advanced stage (stage III) disease. In almost all cases, early ovarian cancer is picked up as incidental findings in someone who is having treatment for an unrelated problem.
	Germ Cell Ovarian Cancer - these cancers are very uncommon, accounting for no more than 5% of ovarian cancers. They arise from the germ cells, or egg making cells, of the ovary, and usually occur in women under the age of 40. They are most common in teenagers or women in their twenties.
	Sex Chord Stromal Tumours - in parts of the ovaries, the egg sits in the centre of layers of cells called granulosa cells and theca cells. If tumours arise from these cells, they are called granulosa cell tumour or granulosa theca cell tumours. These tumours are uncommon. If they undergo a peculiar differentiation to start looking like similar sorts of cells that exist in the testes, then you can end up with tumours that fall under the heading of sex cord stromal tumours, which are rare.

What Causes Cancer of the Ovary?

There are a number of factors which are believed to affect your chances of developing cancer of the ovary. Research has shown that cancerous growth of the cells covering the surface of the ovaries (epithelial ovarian cancer) appears to result from an accumulation of damage to different types of genes in those surface cells. It is also believed that the factors that increase the risk of developing ovarian cancer probably act (directly or indirectly) by increasing the chance that genetic damage occurs in the cells covering the ovary. Some of these factors are age; family history, number of children, body weight and hormone replacement therapy.

Symptoms

Very often there are no symptoms n the early stages of ovarian cancers and many are only found by chance during a routine gynaecological check-up. However, if symptoms are present, these are the most common:

	Increasing swelling of your lower abdomen without weight gain elsewhere;
	Increasing swelling of your lower abdomen which does not improve with diet or exercise;
	A lump or mass in your abdomen, especially your lower abdomen;
	Lower abdominal / pelvic pain that does not settle quickly and simply;
	Feelings of pressure on your bowel or bladder and a feeling that the bowel or bladder cannot be completely emptied; or
	Abnormal bleeding from the vagina, especially after the menopause.

If you are experiencing any of the above symptoms, you must have them checked by your doctor, but remember, they are common to many other conditions and most women with these symptoms will not have cancer.

Diagnosis

Ovarian cancer is not easy to diagnose. However, if your doctor suspects the presence of a tumour, there are several tests that may be performed. Your doctor will probably begin by taking your medical history and conducting an internal pelvic examination. Blood tests may be ordered, as well as an ultrasound of the pelvis. In some cases a CT scan may be performed.

If a tumour is found or strongly suspected, patients should be referred to a specially trained gynaecological oncologist. At this stage a laparotomy is usually performed. This operation will allow your doctor to assess the spread of your cancer and remove much of it.

The outcomes for treatment of cancer of the ovary depend on the stage of the cancer at the time of diagnosis and treatment. As such, it is imperative that you contact your doctor should you have any of the previously mentioned symptoms.

Treatment

All cases of ovarian cancer can be treated. Treatments will depend on your age, your desire to have further children, the type of tumour you have and the stage of the tumour. There are three types of treatment used for ovarian cancer: surgery, radiation therapy and chemotherapy.

For Epithelial Ovarian Cancer, if the disease is limited to one ovary, and occurs in a young woman who wishes to retain her ability to bear children, then treatment will generally be by removal of the fallopian tube and ovary on that side, as well as removal of the omentum (a fatty apron that hangs off the bottom of the stomach and part of the bowel) and lymph nodes in the pelvis and para-aortic region on the same side as the tumour. A decision as to whether or not you also received chemotherapy would have to await the pathology report on this operation.

If the tumour was limited to the inside of the cyst on that ovary, and there was no evidence of anything on the surface of the tumour itself, you would not usually receive chemotherapy unless it was a clear cell tumour.

If the disease has spread beyond one ovary then generally the treatment will be to leave you with no visible evidence of a tumour. This will usually require a hysterectomy, removal of both fallopian tubes and ovaries, removal of the omentum and multiple biopsies. If it is an advanced disease then bowel resections followed by chemotherapy may be required.

Because most Germ Cell Ovarian Cancers arise in relatively young women or teenagers, maintenance of the ability to bear children is a major issue. Fortunately, these tumours tend to be very sensitive to chemotherapy. This means that radical cancer operations which involve the removal of both ovaries and the uterus are often not needed, even if there is advanced stage disease. However, in women who have finished child bearing, removal of both ovaries and the uterus is generally recommended.

Sometimes, information on the spread of the cancer only becomes available during your operation, and therefore it is important to discuss all the possible options with your doctor beforehand. If you have any questions about your own treatment, don't be afraid to ask your doctor. It often helps to make a list of questions for your doctor and to take a close friend or relative with you.

Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be please to refer you to another specialist for a second opinion, if you feel this would be helpful.