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Ovarian Cancer is the 5th leading cause of cancer death in the United States. A woman has roughly a 1.3% lifetime chance of developing it. It occurs more commonly in a woman who is 63 years old or older. The symptoms of this type of cancer can be very vague and it is often not until the cancer is more advanced that it is noticed and detected. Signs and symptoms may include abdominal bloating and swelling, weight loss or gain, urinary urgency, and a sensation of being full even if a large meal isn’t consumed. Other vague symptoms can include constipation, upset stomach, or back pain.

There is no routine test for ovarian cancer. A routine pelvic exam would not be useful in detecting an ovarian tumor because it may be very small and is not found. Transvaginal ultrasound may be able to better see a tumor but certainly cannot determine malignancy. There is the CA125 blood test that is often displaying elevated levels in instances of ovarian cancer. However, not all ovarian cancer patients have elevated levels and other women have elevated levels and no cancer is present. Ovarian cysts are a very common occurrence in women particularly during ovulation. If cysts are detected in menopausal women, this is a much greater cause of concern.

There are several gene mutations that are shown to place woman at a significantly higher risk for the development of both ovarian and breast cancers. These genes are the BRCA1, BRCA2, and PALB2 genes. Routine testing for these genes is not done in all women. Those with a strong family history of breast/ovarian cancers at younger ages certainly should consider testing. Considering that a woman’s lifetime risk of developing ovarian cancer is 1.3%, and those with the BRCA1 mutation have a 39% chance of developing ovarian cancer, as well as an 11-17% chance if they have the BRCA2 mutation, it is a strong indicator of who is at increased risk. The BRCA testing evaluates a person’s DNA either through blood or saliva and is generally covered by most insurance carriers if there is a strong family history of the disease.

There are several factors that may decrease a woman’s risk of developing ovarian cancer. The number of ovulation cycles is linked to ovarian cancer risks. Things that decrease ovulation such as pregnancy, late puberty, and early menopause may decrease the cancer risk. Individuals who have no children and a late menopause may be at increased risk for this cancer. Other factors such as obesity and endometriosis may include the risk. Birth control pills which prohibit ovulation show a 50% reduction in the risk of developing this cancer. Talc powder has shown a potential link to development of ovarian cancer so it may be best to avoid using it in the genital region.

When ovarian cancer is detected, generally surgery is the first treatment approach. The tumor will be removed and sometimes surrounding tissues are removed as well. If cancer has spread beyond the ovaries, as much of the malignancy is removed as possible; and is known as

debulking. Neoadjuvant chemotherapy is sometimes usually prior to tumor removal to shrink the tumor first. Chemotherapy in multiple rounds, often 6, is used. Certain targeted therapies are added to the chemotherapy to enhance survival rates.

There are three types of ovarian tumors: epithelial, stromal, and germ cell tumors. Epithelial tumors occur in the outside tissue of the ovaries and represents 90% of ovarian tumors. Stromal tumors occur in the hormone producing cells and are about 7% of the tumors. Finally germ cell tumors are those which arise in the egg producing cells and are very rare.

Ovarian cancer is often not detected until the later stages of the disease due to the vague symptoms that generally don’t cause a woman to seek medical care until the disease unfortunately has progressed. Staging the cancer is of critical importance and 5 year survival rates are very different among the different stages. There are 4 basic stages and further classifications within each stage.

Stage I-cancer is only present in the ovaries

IA-cancer in one ovary

IB-cancer in both ovaries

1C-cancer is also outside of the ovary. It may be present in abdominal fluid or tissue around ovary

Survival rate is approximately 90%. Unfortunately only about 15% of ovarian cancer cases are detected at this early stage

Stage II-cancer is in ovaries and has spread to other organs in the pelvic region

IIA-cancer in ovaries & spread to uterus or fallopian tubes

IIB-cancer in ovaries & spread to bladder or rectum

Survival rate is about 70%

Stage III-cancer is in ovaries or fallopian tubes and has spread beyond pelvis

IIIA-cancer in ovaries may have spread in organs in the pelvis; it is found in lymph nodes in the abdomen

IIIA2-cancer in ovaries may have spread to pelvic organs and cancer is present in upper abdominal lining. It may be present in abdominal lymph nodes

IIIB-spread beyond pelvis and cells are found outside the spleen or liver. It may be present in abdominal lymph nodes

IIIC-spread beyond pelvis and larger cancer cell deposits are found in abdomen or outside spleen/liver. Cancer cells may be present in abdominal lymph nodes

Survival rate is about 39%

Stage IV-cancer has spread from the ovaries/fallopian tubes to inside of liver, lungs, spleen, or other organs located outside of peritoneal cavity

IVA-cancer is outside the pelvis/lymph nodes/abdomen to the liver/lungs. Cancer cells are present in the fluid surrounding the lungs

IVB-cancer cells have spread inside the spleen, liver, skin, and/or brain

Stage 4 ovarian cancer has only a dismal 17% survival rate