Symptoms, Risk and Diagnosis
The ovaries are made up of 4 main kinds of cells, each of which can develop into a different type of malignant tumor:
Epithelial tumors start from the cells that cover the outer surface of the ovary and make up most of ovarian tumors. Most epithelial ovarian tumors are benign and don’t spread. However, of the malignant (cancerous) variety, about 85-95 percent of ovarian cancers are of this type. Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer are treated the same way.
Germ cell tumors: Less than 2 percent of ovarian cancers are germ cell tumors. Overall, they have a good outlook, with more than 9 out of 10 patients surviving at least 5 years after diagnosis.
Ovarian stromal tumors start from structural tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone. Only one percent of ovarian cancers are ovarian stromal cell tumors.
Borderline or low-malignant potential tumors: These ae ovarian masses difficult to diagnose and manage. Most patients do well with these tumors. Siteman has special pathology expertise and surgical technique to evaluate and treat these tumors.
The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Our oncologists see over a hundred cases of ovarian cancer a year. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.
Symptoms of Ovarian Cancer
Ovarian cancer often does not cause early signs or symptoms. When it does, they are vague and could be attributed to other non-cancerous conditions. Also, when symptoms do appear, the cancer is often advanced. Report any of these symptoms to your doctor, especially if they persist:
- Pain, swelling, or a feeling of pressure in the abdomen or pelvis.
- Vaginal bleeding that is heavy or irregular, especially after menopause.
- Vaginal discharge that is clear, white, or colored with blood.
- A lump in the pelvic area.
- Gastrointestinal problems, such as gas, bloating, or constipation.
Risk Factors for Epithelial Ovarian Cancer
Hereditary Risk: The only known risk factor for ovarian cancer is hereditary risk. Women who have one first-degree relative (mother, daughter, or sister) with a history of ovarian cancer have an increased risk of ovarian cancer. This risk is higher in women who have one first-degree relative and one second-degree relative (grandmother or aunt) with a history of ovarian cancer. This risk is even higher in women who have two or more first-degree relatives with a history of ovarian cancer.
Some ovarian, fallopian tube, and primary peritoneal cancers are caused by inherited gene mutations (changes). Hereditary ovarian cancer makes up about 5 to 10 percent of all cases of ovarian cancer.
Three hereditary patterns have been identified:
- Ovarian cancer alone
- Ovarian and breast cancers
- Ovarian and colon cancers
Fallopian tube cancer and peritoneal cancer may also be caused by certain inherited gene mutations.
There are tests that can detect mutated genes. These genetic tests are sometimes done for members of families with a high risk of cancer. Women who are at higher risk for ovarian cancer may decide to have their healthy ovaries removed surgically to reduce that risk.
Making a diagnosis of ovarian cancer may involve different approaches. The following tests and procedures may be used:
- Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities.
- Pelvic Exam: A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
- Transvaginal or abdominal ultrasound exam: this procedure examines the vagina, uterus, fallopian tubes, ovaries and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram.
- CA 125 assay/other blood tests: This blood test measures the level of CA 125 in the blood, a substance released by cells into the bloodstream. An increased CA 125 level is sometimes a sign of cancer or other condition. Other tumor marker tests may be used as well.
- CT scan (CAT scan): A series of detailed pictures of areas inside the body, taken from different angles may be combined with injection or oral intake of a dye to help the organs or tissues show up more clearly.
- PET scan (positron emission tomography scan): A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
- Biopsy of the ovary: During surgery to remove a suspect ovary, tissue is taken for microscopic examination. The Washington University Genomics and Pathology Service (GPS) offers genomic testing and next generation sequencing of cancer cells, which can help identify optimal treatment strategies for your specific cancer type and subtype, and may be helpful for refining prognosis.
Staging of Ovarian Cancer
Stage I: Cancer is found in one or both ovaries or fallopian tube.
Stage II: Cancer is found in one or both ovaries or fallopian tube and has spread into other areas of the pelvis or primary peritoneal cancer is found in the pelvis.
Stage III: Cancer is found in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and has spread outside the pelvis to other parts of the abdomen and/or to nearby lymph nodes.
Stage IV: Cancer has spread beyond the abdomen to other parts of the body.
Ovarian epithelial, fallopian tube and primary peritoneal cancers are grouped for treatment as early or advanced cancer. Stage I is considered early. Stages II-IV are treated as advanced.
Recurrent or persistent cancer: This cancer has come back or didn’t go away despite treatment.
The prognosis (chance of recovery) depends on the following:
- The stage and grade of the cancer.
- The size of the tumor.
- Whether all the tumor can be removed with surgery.
- The patient’s age and general health.
- Whether the cancer has just been diagnosed, has recurred or is persistent.
Clinical trials are a good option for getting the latest treatment.