All about ovarian cancer signs, cancer stages, and treatment

Are you looking for information on Ovarian Cancer signs, stages, and treatment? This article will take you through the basics of what you need to know about ovarian cancer. Read it carefully to learn about ovarian cancer, its signs & symptoms, and ovarian cancer treatment. This article also explains stages of ovarian cancer, ovarian cyst symptoms, ruptured ovarian cysts, and much more. So stay with this article till the end.

We strongly encourage you to talk with your doctor and health care professional about your specific medical condition and required treatments. The information contained on this website is meant to be helpful and educational. However, it is not a substitute for medical advice.

Table of Content

What is an ovary?

The ovary is a part of the female reproductive organ. Every woman has a pair of ovaries of almond size. The ovaries are two female reproductive glands. They are located in the lower abdomen. One ovary is located on the left of the uterus. Another ovary is located on the right of the uterus. They are oval in shape.

These ovary glands produce ova or eggs. Eggs develop and mature in the ovaries. These eggs are released in monthly cycles during the childbearing years. Ovaries also produce female hormones named estrogen and progesterone. The uterus is connected to the ovary through Fallopian Tubes. These tubes serve as the pathway for the egg cells to travel from the ovaries to the uterus.

The ovary releases an egg every month during ovulation.

The hormones produced by ovaries are essential for developing the female body, like breasts and body figures.  They are also involved in the menstrual cycle and pregnancy. So ovaries play an important role in the development of the female body and promote healthy fertility.

What is Ovarian Cancer?

Ovaries are female reproductive glands, as explained above. The type of cancer that begins in the ovaries is called Ovarian Cancer. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. So most of the time treatment of ovarian cancer begins late. Therefore it is more difficult to treat. Hence it becomes important to know about ovarian cancer signs.

If the cancer is detected early then it may be confined to the ovaries. Hence the treatment is easier. So early-stage detection of ovarian cancer is of vital importance. You need to be more careful if you have a family history of this type of cancer. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents.

It’s not clear what causes ovarian cancer. But there are certain factors that can increase the risk of the disease. There are certain gene mutations that may increase the chances of ovarian cancer and even breast cancer. So remember to consult your doctor if you have any unusual symptom which worries you.

Ovarian Cancer Signs

What are the symptoms of ovarian cancer? Ovarian cancer has little or no symptoms in the early stages. Ovarian cancer signs are similar to other common illnesses. So they are often overlooked. We may not link the symptoms with cancer and may take over-the-counter (OTC) medicines. However, if ovarian cancer signs repeatedly come and go you must get professional help before it is too late. You may or may not have symptoms of ovarian cancer at the early stage of ovarian cancer. As cancer gets advanced, it is challenging to cure.

Ovarian cancer signs that you may notice at an early stage are:

• Pain in pelvis area – Pain from ovarian cancer is in the lower abdomen, below your belly button.
• Pressure, pain, or bloating in the abdominal region.
• Difficulty in eating and abnormal fullness after meals.
• Swelling in the lower abdomen
• Changes in the menstrual cycle and constipation
• Unusual vaginal bleeding
• Weight loss or weight gain
• Severe back pain
• Nausea, vomiting, and loss of appetite
• Heartburn and upset stomach
• Quickly getting a sensation of stomach fullness while eating
• Change in bowel pattern and constipation
• Frequent urination
• Fatigue

Those women who have these symptoms almost daily for more than a few weeks must consult their doctor. A prompt medical evaluation will lead to detection at the earliest possible stage of the disease. Early-stage diagnosis is associated with an improved prognosis.

If you observe any of these ovarian cancer signs for over two weeks, get yourself tested by the doctor. It is possible that these symptoms may occur because of any other condition in the body. However, if you have one or more of these symptoms for a significant period, it is advisable to consult a cancer specialist.

In the initial stages, these symptoms might not be severe. But you should not ignore them.  As the tumor grows and cancer spreads outside of the ovaries, the pain can become severe. But it may be too late by that time. Like any other cancer, ovarian cancer, if detected in later stages is hard to treat.

It is important to distinguish between early-stage ovarian cancer and advanced disease because the treatment depends upon your stage grade and performance score.

Types of Ovarian Cancer

Ovarian cancer is the seventh most common cancer among women. There are three types of ovarian cancer.

• Epithelial ovarian cancer – This is the most common type. It accounts for 85 % to 89 % of ovarian cancers. It forms on the surface of the ovary in the epithelial cells.
• Germ Cell Ovarian Cancer – This is an uncommon form of ovarian cancer. It accounts for only about 5 % of ovarian cancers in women. This type of cancer starts in the cells that form the eggs in the ovaries. This cancer is usually found in adolescent girls and young women. Normally it affects only one ovary.
• Stromal Cell Ovarian Cancer – This type of cancer starts in the cells that produce female hormones and hold the ovarian tissues together. It forms 10% of all ovarian cancers. Research confirms that there is a link between breast and ovarian cancer Any woman who has had one of these cancers is at a higher risk for developing the other.

Stages of Ovary Cancer

Knowing the stage of ovarian cancer (progression of the disease) is important to plan correct treatment. So your doctor will carry out diagnostic tests before deciding upon the course of treatment. Gynecologic oncologists use a variety of tools designed for diagnosing ovarian cancer and determine the type and stage of the disease. During surgery also certain additional steps will be performed by the doctor to determine the extent of the disease. This process is called staging.

If you are diagnosed with ovarian cancer doctor will identify the stage of cancer-based on the spread of the cancer cells in your body. In simple words, ovarian cancer is grouped into four stages.

Most ovarian cancers are staged using the FIGO system. In this system, surgical results are used to determine the extent of the Primary Tumor (T). It also determines whether cancer is present in the Lymph Nodes (N) and whether cancer has metastasized (M) to other parts of the body, such as the liver, bones, or brain. Based on this information stages of the cancer are determined.

Stage I – In this stage cancer is found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.

Stage II: In this stage, cancer spreads from one or both ovaries to other tissues in the pelvis, such as the fallopian tubes or uterus. Cancer cells may be found in fluid collected from the abdomen.

Stage III – In Stage III cancer has spread outside the pelvis or nearby lymph nodes. Most commonly cancer spreads to the omentum (an apron of fatty tissue that hangs down from the colon and stomach, diaphragm, intestine, and the outside (surface) of the liver.

Stage IV – In this stage, cancer spreads to tissues outside the abdomen and pelvis. Most commonly it spreads to the space around the lungs. If cancer spreads inside the liver or spleen, it is considered to be Stage IV.

A simple classification of stages of ovarian cancer is as follows:

• Localized ovarian cancer: In this stage, the cancer is only in the ovaries. There are no signs of the spread of cancer outside the ovaries.
• Regional ovarian cancer: The cancer cells are now spread outside the ovaries and have infected nearby tissues and lymph nodes.
• Distant ovarian cancer: This is the advanced stage of ovarian cancer. Ovarian cancer spreads to other organs of your body, like the liver and lungs.

Classification of subtypes of ovarian cancer based on letters and numbers:

Letters T, N, and M indicate cancer location, and the number indicates how advanced is the stage of cancer.

T indicates the Size, Invasiveness, and Depth of the tumor

N indicates Involvement, Number of Nodes, and Location

M indicates metastasis (if the disease has spread to other organs)

Know more about Stages of Ovarian Cancer

*AJCC= American Joint Committee on Cancer

FIGO= International Federation of Gynecology and Obstetrics

How is ovarian cancer diagnosed?

If you experience any of the symptoms mentioned above you must consult your doctor. Your doctor will do the following tests and procedures for ovarian cancer screening.

• Pelvic examination – Your doctor will check the pelvic area by inserting gloved fingers through your vagina and simultaneously pressing the abdomen. The doctor will try to find out any unusual changes like excess growth. Early-stage cancer cannot be diagnosed by pelvic examination. The doctor may also advise you to go for a PAP smear test to check for cervical cancer.
• Blood test for Cancer Antigen 125 – CA-125 is a protein produced by ovarian cancer cells. If your blood shows a high CA-125 level, then you need to consult a gynecologic oncologist.  Sometimes, a younger woman may also have high levels of CA-125 due to endometriosis or uterine fibroids.
• Ultrasound imaging through the vagina – The doctor will insert a probe of the ultrasound machine through the vagina to check the vagina and ovaries. The size, shape, and structure of your ovaries will be analyzed.
• Computed tomography (CT scan) – The doctor takes several X-ray images of your body. These images are combined to make a 3-D picture that shows any abnormalities or tumors.
• Positron emission tomography (PET scan) is often combined with a CT scan and is referred to as PET-CT scan. In this procedure, the doctor will inject a radioactive substance into your blood and scan your body. Cancer cells eat more radioactive substances so that PET scanning will show the high intensity of radioactive substances in the areas with cancerous cells.
• Magnetic resonance imaging (MRI scan) – In this procedure doctor injects a special dye (contrast medium) into your blood. MRI gives a clear picture of your internal body organs. MRI scan measures the size of the tumor.
• Biopsy – The doctor removes a small piece of your tissue (organ suspected of having cancer). The pathologist observes the tissue sample under a microscope and looks for abnormal cancer cells. Sometimes fluid from the abdomen (peritoneal fluid) is also removed (Paracentesis) and checked under a microscope for cancer cells.

Frequently asked questions

Question 1 – How ovarian cancer is diagnosed?

Answer – Please read the above paragraphs for full information. A number of screening tests are done. Some of these are Pelvic Examination, Trans Vaginal Ultrasound (TVUS), CA-125 Blood Test, and Biopsy. C-125 is produced by some cancer ovarian cells. So blood test is one way of detecting ovarian cancer.

Question 2 – Can ovarian cancer be detected by ultrasound?

Answer – The answer is “Yes”. It is usually the first test done. Ultrasound can detect an ovarian tumor, solid mass, and a fluid-filled cyst.

Question 3 – What are the ovarian cancer signs which I can detect early?

Answer 3 – Some of the early signs are Bloating, Pelvic or abdominal pain, Difficulty in eating and feeling full soon, Urinary symptoms like urgency or higher frequency of passing urine, Loss of weight, Swelling in the lower abdomen, Unusual vaginal bleeding, etc.

Question 4 – Am I at high risk of ovarian cancer?

Answer – People in a higher age group at higher risk. If you are under 40 years, the risk is very less. Most ovarian cancer develops after menopause. However, even if you are young, do not ignore the symptoms.

Question 5 – Can you live with ovarian cancer without knowing?

Answer – This type of cancer can remain asymptomatic for many years. This makes it dangerous.

Question 6 – Is ovarian cancer painful?

Answer – One of the symptoms of this cancer is pelvic or abdominal pain and back pain. So it can be painful.

Question 7 – Can ovarian cancer be fully cured?

Answer – Chances are higher if it is detected in the early stages. So all women should be familiar with ovarian cancer signs. Initial treatment consists of surgery and chemotherapy. It can be effectively cured. Approximately 20% of women with advanced-stage ovarian cancer survive beyond 12 years after treatment.

What is ovarian cancer treatment?

The treatment depends upon your stage grade and performance score. So your doctor will perform tests. It is important to distinguish between early-stage ovarian cancer and advanced disease. Surgery, chemotherapy, and radiation therapy are used either alone or in combination for ovarian cancer treatment.

Surgery

• It is usually the first step in treating ovarian cancer.
• Usually, this type of surgery is performed using a procedure called a Laparotomy. The surgeon makes a long cut in the wall of the abdomen. If ovarian cancer is found, the following procedures are performed.
• Primary Cytoreductive Surgery or Interval Debulking may be done. It involves removing the bulk of the tumor, removal of the uterus, both tube and ovaries, omentum, pelvic and para-aortic nodes.
• Sometimes chemotherapy might be needed before the surgery, this is called Neo-Adjuvant Chemotherapy.
• Sometimes the surgery is extensive. It may include the removal of portions of the small or large intestine and the removal of tumors from the liver, diaphragm, and pelvis.
• If you have early-stage I cancer, and still want to get pregnant, it may be possible to only remove one ovary and fallopian tube.
• If cancer is present in one ovary, the surgeon will remove that ovary only. With one ovary, you can become pregnant again.
• Both ovaries and fallopian tubes will be removed if both ovaries have cancer. In such a case, you can become pregnant using a frozen embryo only.
• If the disease is spread to the uterus, the doctor will remove your ovaries, fallopian tubes, uterus, and abdomen fold.
• If your ovarian cancer is at an advanced stage, the doctor will give chemotherapy after surgery.

Chemotherapy

Chemotherapy is a systematic treatment. The drug enters the bloodstream and reaches all parts of the body. The drug kills a small number of cancer cells that may still be there after surgery. This is why chemotherapy can be effective in treating ovarian cancer that has spread beyond the ovaries. However, the same drugs that kill cancer cells may also damage healthy cells, leading to side effects.

The doctor will give you an injection into a vein (IV) or given by mouth. There is a combination of two types of drugs for chemotherapy. Combination therapy includes platinum compounds (cisplatin or carboplatin) and a taxane (paclitaxel or docetaxel).

Sometimes chemotherapy may also be injected directly into the abdominal cavity, through a thin tube called a catheter. This is called Intra-Peritoneal (IP) chemotherapy. This way a large dose of medicine is delivered directly to the tumor location.

Chemotherapy is usually given in cycles. Periods of chemotherapy treatment are alternated with rest periods when no chemotherapy is given. In most cases, women with ovarian cancer receive chemotherapy for about 6 months following their surgery.

Following are the side effects of chemotherapy. It is not essential that all of the side effects will occur:-

• Nausea
• Mouth sores
• Vomiting
• Bleeding
• Bruising easily
• Increased chance of infection
• Hair loss
• Fatigue

Radiation therapy

High energy X- rays are used only if ovarian cancer has spread to other organs of the body. The high-energy particles or X-rays kill cancer cells. Radiation Therapy is employed along with chemotherapy or when patient does not respond to other treatment options. Side effects of radiation therapy:-

• Diarrhea
• Fatigue
• Dry or red skin in the treated area
• Anemia
• Discomfort in passing urine

What is the ovarian cancer survival rate?

Survival rate gives you an idea about what percentage of women with the same disease status is still alive in a particular specified time. This will also help you understand the benefits of treatment.

The ovarian cancer survival rate depends on the type and stage of cancer. The five-year relative survival rate is shown in the table below. Please note that this is just an estimate based on previous outcomes.

Is the prevention of ovarian cancer possible?

Several factors cause ovarian cancer. It would be best if you avoid those risk factors for ovarian cancer prevention. You cannot change some ovarian cancer risk factors like age and having a family history of ovarian cancer. You can reduce cancer risk by maintaining a healthy weight and avoiding hormone replacement therapy after menopause. Research has shown that many factors can help in the prevention of ovarian cancer, as mentioned below:-

Taking oral contraceptives for birth control- If you take oral contraceptives for three or more years, then the chances of getting ovarian cancer are reduced by 30% to 50%.  Using oral birth control pills reduces the risk of ovarian cancer in high-risk women with BRCA1 and BRCA2 mutations. However, birth control pills can increase breast cancer risk in women with or without these mutations. The use of Intrauterine devices also reduces the risk of ovarian cancer.

Breastfeeding- The longer you breastfeed your baby, the lower is your risk of developing ovarian/fallopian tube cancer.

Pregnancy- If you had a full-term pregnancy, then the risk of ovarian/fallopian tube cancer development is low.

Surgeries- If you have undergone a hysterectomy (removal of the uterus) or fallopian tube ligation, you are at a reduced risk of getting ovarian/fallopian tube cancer. Sometimes, doctors remove both your ovaries and fallopian tubes to minimize cancer risk.

References

PCOS

Endometriosis

Cysts in ovary

Stages of the cancer

Diagnostic Tests

How is it treated?

Women’s Cancer Network.

Survival rate