Ovarian cancer starts in the ovaries. Women have two ovaries, one on each side of the pelvis. The ovaries produce eggs. They are also the main source of the female hormones estrogen and progesterone.
The ovaries contain three kinds of tissue:
Germ cells: These cells make eggs. The eggs are formed on the inside of the ovary.
Stromal cells: These cells make most of the female hormones (estrogen and progesterone).
Epithelial cells: These cells cover the ovary. Most ovarian cancers start in this covering.
There are three main types of tumors, named for where the tumor originated:
Germ cell tumors start from the cells that produce the eggs (ova).
Stromal tumors start from connective tissue cells that hold the ovary together and make the female hormones.
Epithelial tumors start from the cells that cover the outer surface of the ovary.
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Ovarian cancer ranks fifth in cancer deaths among women, according to the American Cancer Society, which estimates that about 21,290 new cases of ovarian cancer will be diagnosed in the United States during 2015. A woman's risk of getting ovarian cancer during her lifetime is about 1 in 75.
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Early cancers of the ovaries tend to cause symptoms that are somewhat vague. Symptoms might include:
- Swelling of the stomach (abdomen) from a buildup of fluid
- Unusual vaginal bleeding
- Pelvic pressure
- Back or leg pain
- Problems such as gas, bloating, long-term stomach pain or indigestion
Any of these symptoms may be caused by cancer or by other, less serious health problems.
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If there is any reason to suspect ovarian cancer, the doctor will use one or more methods to find out if the disease is really present. Following are some of the tests that could be done:
These tests can show whether there is a mass in the pelvis, but they cannot tell if it is cancer.
Ultrasound uses sound waves to create an image on a video screen. Because tumors and normal tissue reflect sound waves differently, this test may be useful in finding tumors and in telling whether a mass is solid or a fluid-filled cyst.
CT scans (computed tomography) use an X-ray beam to take a series of pictures of the body from many angles. A computer combines the pictures to form a detailed image. CT scans are useful in showing how large the tumor is, whether lymph nodes are enlarged and whether the tumor has spread to other organs. CT scans can also be used to guide a biopsy needle into a tumor in order to remove a sample of tissue.
CT scans take longer than regular X-rays. You will need to lie still on a table while they are being done. Also, some contrast dye will be injected, or you may be asked to drink a contrast fluid.
MRI (magnetic resonance imaging), like a CT scan, displays a cross-sectional picture of the body. But the MRI uses radio waves and strong magnets instead of X-rays. MRI scans are helpful in looking at the brain and spinal cord.
Chest X-rays may be taken to see if the cancer has spread to the lungs.
Laparoscopy (lap-uh-ROS-ku-pe) is another method that lets the doctor see the ovaries and other pelvic organs. A thin, lighted tube is placed through a small cut (incision) into the lower abdomen.
Biopsy is the only way to tell for certain if a growth in the pelvis is cancer. A sample of tissue or fluid is removed and looked at under a microscope to see if cancer cells are present. A biopsy is usually done at the time of surgery. The goal of surgery is to obtain tissue samples and to remove all deposits of cancer larger than about ½ inch.
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The main treatments for ovarian cancer are surgery, chemotherapy and radiation therapy. In some cases, two or even all three of these treatments will be used.
How much and what type of surgery a woman has depends on how far the cancer has spread, her general health, and whether she still hopes to have children. Your surgeon should be experienced in ovarian cancer surgery. Many gynecologists are not prepared to do this kind of cancer operation. Many doctors refer their patients to doctors with special training called gynecologic oncologists.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated. The Medical Oncology/Hematology Division at Sinai directs the chemotherapy program at LifeBridge.
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. The Department of Radiation Oncology at Sinai Hospital provides the most advanced radiotherapy for many cancers.
Clinical trials are research studies conducted with people who volunteer to take part. The study examines questions and tries to find better ways to prevent, screen for, diagnose or treat a disease. People who take part in cancer clinical trials receive up-to-date care from experts.
For trials that are currently available to ovarian cancer patients, click here.
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