| Signs
and Symptoms
Ovarian cancer originates in the cells of the ovaries,
including surface epithelial cells, germ cells and the
sex cord-stromal cells. Ovarian tumors include:
•
Germ Cell Tumors — Ovarian germ
cell tumors develop from cells that produce the ova or
eggs. Most germ cell tumors are benign, although some
are cancerous and may be life-threatening. The most common
germ cell malignancies are maturing teratomas, dysgerminomas
and endodermal sinus tumors. Teenagers and women in their
20s are most often diagnosed with germ cell malignancies.
Before combination chemotherapy was available as a treatment,
the most aggressive of these tumors — the GNP abnormal
sinus tumor — was associated with a one-year disease-free
survival rate of only 10 percent to 19 percent, even though
70 percent of these tumors were diagnosed very early.
Today, however, 90 percent of women with ovarian germ
cell malignancies can be cured and their fertility preserved.
•
Stromal Tumors — Ovarian stromal
tumors develop from connective tissue cells that hold
the ovary together and those that produce the hormones
estrogen and progesterone. The most common types are granulosa-theca
tumors and Sertoli-Leydig cell tumors. These tumors are
fairly rare and usually are considered low-grade cancers.
•
Epithelial Tumors — Epithelial
ovarian cancer develops from the thin layer of cells,
called the epithelium, that covers the ovary. Most epithelial
ovarian tumors are benign, including including serous
adenomas, mucinous adenomas and Brenner tumors. Cancerous
epithelial tumors are the most common and the most serious
of ovarian cancers, accounting for 85 percent to 90 percent
of all ovarian cancer. Some ovarian epithelial tumors
don't appear clearly cancerous under the microscope and
are called borderline tumors or tumors of low malignant
potential (LMP tumors).
When cancer is diagnosed early while the tumor is limited
to the ovary, the cure rate is better than 90 percent.
Unfortunately, about two-thirds of women with ovarian
cancer initially seek medical attention when the tumor
is already advanced and has spread outside of the ovary.
In these instances, the five-year survival rate is significantly
lower.
Ovarian cancer often does not have signs or symptoms until
later in its development. Symptoms may include:
•
Abdominal bloating or swelling
•
Abdominal or pelvic pain
•
Difficulty eating or feeling full quickly
•
Frequent urination or feeling a need to urinate
If these symptoms are persistent and a change from the
norm, you should see a gynecologist.
Others symptoms of ovarian cancer can include:
•
Back pain
•
Constipation
•
Fatigue
•
Menstrual changes
•
Pain during sex
•
Upset stomach
These symptoms, however, may be caused by other conditions
and aren't necessarily signs of ovarian cancer.
Diagnosis
To help find the cause of your symptoms, your doctor will
evaluate your medical history, perform a physical exam
and recommend diagnostic tests. The exams and tests may
include some of the following:
•
Pelvic exam includes feeling the uterus, vagina, ovaries,
fallopian tubes, bladder and rectum to find any abnormality
in their shape or size. A Pap test, an effective test
for cancer of the cervix, is often done along with the
pelvic exam, but it is not a reliable way to find or diagnose
ovarian cancer.
•
Ultrasound refers to the use of high-frequency sound waves
that are aimed at the ovaries. The pattern of the echoes
they produce creates a picture called a sonogram. Healthy
tissues, fluid-filled cysts and tumors look different
on this picture.
•
CA-125 assay is a blood test used to measure the level
of CA-125, a tumor marker that is often found in higher-than-normal
amounts in the blood of women with ovarian cancer.
•
Lower GI series, or barium enema, is a series of X-rays
of the colon and rectum. The pictures are taken after
the patient is given an enema with a white, chalky solution
containing barium, which outlines the colon and rectum
on the X-ray, making tumors or other abnormal areas easier
to see.
•
Computed tomography (CT) scan is a series of detailed
pictures of areas inside the body created by a computer
linked to a X-ray machine.
•
Biopsy is the removal of tissue for examination under
a microscope. A pathologist studies the tissue to make
a diagnosis. To obtain the tissue, the surgeon performs
a laparotomy, an operation to open the abdomen. If cancer
is suspected, the surgeon performs an oophorectomy, where
the entire ovary is removed. This is important because
if cancer is present, removing just a sample of tissue
by cutting through the outer layer of the ovary could
allow cancer cells to escape and cause the disease to
spread.
Treatment
Health care professionals specializing in pelvic cancers
at UCSF Medical Center will discuss all available therapies
with you and make recommendations based on the stage of
your disease, age and the overall condition of your health.
•
Surgery — Surgery to remove the
cancerous growth is the primary method for diagnosing
and treating ovarian cancer.
•
Radiation Therapy — This treatment
uses high-energy rays to damage cancer cells and stop
them from growing. It is a localized treatment, which
means that it works to attack cancer cells in one area.
The radiation may come from a large machine, which is
called external radiation, or from radioactive materials
placed directly into the ovaries, called implant radiation.
Some patients receive both types of radiation therapy.
•
Chemotherapy — Drugs to kill cancer
cells are most often used when ovarian cancer has spread
to other parts of the body. A patient may receive just
one drug or a combination of drugs in cycles. Chemotherapy
may be given by injection into a vein or orally. It is
a systematic treatment, meaning that the drugs flow through
the body in the bloodstream.
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