Ovarian Cancer

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The ovaries are the two female reproductive organs located on either side of the lower abdomen. The role of the ovaries is to produce eggs and female sex hormones every month during a woman's reproductive cycle. In ovarian cancer, the cells of the ovary grow and divide uncontrollably. While ovarian cancer can spread beyond the ovary, ovarian cancers differ in their degree of aggressiveness and cure rate.

This type of cancer is most common in women who have completed menopause. Early detection and prompt diagnosis and treatment can improve the patient's outlook. But because ovarian cancer most often has no symptoms in the early stages, in many patients the disease may be quite advanced when it is first diagnosed.

The risk factors for developing ovarian cancer have not been identified with any certainty. However, a family history of the disease exists in about 10 percent of ovarian-cancer cases. If a woman has two or more close relatives with this condition, her risk is considerably higher than for a woman without a family link to the disease. Women who do have a family history may obtain a blood test for the BRCA1 gene, which can identify those who are at risk.

Because the rate of ovarian cancer is highest in the world's most prosperous countries, the risk of ovarian cancer has been connected to a rich, high-fat diet and to the use of fertility drugs, neither of which is common in poorer countries. There are some indications that the use of talcum powder, which at one time contained asbestos, on sanitary napkins or on the vaginal area, may be involved. Infertility has also been identified as a possible cause. Research is in progress, although to date there is little definitive information on who is at risk; aside from the genetic link, most theories remain highly speculative.

The symptoms of even fairly advanced ovarian cancer are often vague and may be confused with other medical symptoms. Women may complain that they feel bloated, that their clothes feel tight; they may have vague abdominal and pelvic discomfort and gastrointestinal symptoms that include gas, back pain and fatigue. If these symptoms persist for a period of weeks, they could be warning signs of ovarian cancer.

Many women develop small growths, or cysts, on an ovary during their childbearing years. These cysts can be felt in a pelvic exam or identified through X rays and other diagnostic tests. Such a cyst, if it does not cause the woman a problem, is usually harmless. A cyst that occurs after menopause, however, is more likely to be cancerous. A cyst or an enlarged ovary in a postmenopausal woman should be evaluated by a physician promptly.

Surgery is the treatment for ovarian cancer in all of its stages. There may be no need for further treatment if the surgeon can document through evaluation of surrounding areas of the abdominal cavity that the cancer has not spread beyond the ovary. If the cancer has spread, chemotherapy, usually given through a vein, may be indicated for a period of six-to-twelve months. Other options include radiation therapy, which can either be administered from a machine outside the body (external-beam radiation therapy) or put directly into the abdomen in the form of a radioactive liquid (intraperitoneal radiation therapy). After this therapy, many surgeons perform an exploratory surgical procedure called a second-look laparotomy to determine if any cancer cells remain and if treatment should be ended or revised. Biopsies are conducted with this procedure, also to determine whether any cancer remains.

If initial chemotherapy fails, new medications can be effective. Doctors are evaluating new methods of treatment.

Women who have a close relative who has had ovarian cancer should be examined by their doctor every six months. Their visit should include:

1. A pelvic examination

2. A vaginal ultrasound to identify any tumors

3. A blood test called a CA125 test that can detect the disease early

Women who have two or more close family members with the disease should consider removal of the ovaries when their families are complete, and they no longer wish to become pregnant. This can be done as a simple outpatient surgery with minimal discomfort and a short recovery period.