Ovarian cancer is a cancerous growth arising from the ovary.

Symptoms are frequently very subtle early on and may include: bloating, pelvic pain, difficulty eating, and frequent urination, and are easily confused with other illnesses.

Most (more than 90%) ovarian cancers are classified as “epithelial” and are believed to arise from the surface (epithelium) of the ovary. However, some evidence suggests that the fallopian tube could also be the source of some ovarian cancers.

Since the ovaries and tubes are closely related to each other, it is thought that these fallopian cancer cells can mimic ovarian cancer. Other types may arise from the egg cells (germ cell tumor) or supporting cells.

Ovarian cancers are included in the category of gynecologic cancer.

Signs and symptoms of ovarian cancer are frequently absent early on and when they exist they may be subtle. In most cases, the symptoms persist for several months before being recognized and diagnosed.

Most typical symptoms include: bloating, abdominal or pelvic pain, difficulty eating, and possibly urinary symptoms. If these symptoms recently started and occur more than 12 times per month the diagnosis should be considered.

Other findings include an abdominal mass, back pain, constipation, tiredness and a range of other non-specific symptoms, as well as more specific symptoms such as abnormal vaginal bleeding or involuntary weight loss. There can be a build-up of fluid (ascites) in the abdominal cavity.

Ovarian cancer is associated with age, family history of ovarian cancer.

Cause

In most cases, the exact cause of ovarian cancer remains unknown. The risk of developing ovarian cancer appears to be affected by several factors:

Older women who have never given birth, and those who have a first or second degree relative with the disease, have an increased risk.

Hereditary forms of ovarian cancer can be caused by mutations in specific genes (most notably BRCA1 and BRCA2, but also in genes for hereditary nonpolyposis colorectal cancer).

Infertile women and those with a condition called endometriosis, and those who use postmenopausal estrogen replacement therapy are at increased risk.

Risk factors

Women who have had children are less likely to develop ovarian cancer than women who have not, and breastfeeding may also reduce the risk of certain types of ovarian cancer.

Tubal ligation and hysterectomy reduce the risk and removal of both tubes and ovaries (bilateral salpingo-oophorectomy) dramatically reduces the risk of not only ovarian cancer but breast cancer also.

A hysterectomy that does not include the removal of the ovaries has a one-third reduced risk of developing ovarian cancer, it also has no higher risk of developing other types of cancer, heart disease or hip fractures.

Diagnostic Instruments and techniques

Diagnosis of ovarian cancer starts with a physical examination (including a pelvic examination), a blood test (for CA-125 and sometimes other markers), and transvaginal ultrasound.

The diagnosis must be confirmed with surgery to inspect the abdominal cavity, take biopsies (tissue samples for microscopic analysis) and look for cancer cells in the abdominal fluid.

Ovarian cancer at its early stages (I/II) is difficult to diagnose until it spreads and advances to later stages (III/IV).

This is because most symptoms are non-specific and thus of little use in diagnosis. The serum BHCG level should be measured in any female in whom pregnancy is a possibility.

In addition, serum alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) should be measured in young girls and adolescents with suspected ovarian tumors because the younger the patient, the greater the likelihood of a malignant germ cell tumor.

To definitively diagnose ovarian cancer, a surgical procedure to take a look into the abdomen is required. This can be an open procedure (laparotomy, an incision through the abdominal wall) or keyhole surgery (laparoscopy).

During this procedure, suspicious areas will be removed and sent for microscopic analysis. Fluid from the abdominal cavity can also be analyzed for cancerous cells. If there is cancer, this procedure can also determine if it has spread, which is a form of tumor staging).



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