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    Ovarian cancer

    Cancer - ovaries

    Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs.

    Causes

    Ovarian cancer is the fifth most common cancer among women. It causes more deaths than any other type of female reproductive cancer.

    The cause is unknown.

    Riskof developing ovarian cancer may be due to:

    • Thefewer children a woman has and thelater in life she gives birth, thehigher her riskof ovarian cancer.
    • Certain geneproblems (defects in the BRCA1or BRCA2 genes) are responsible for a small number of ovarian cancer cases.
    • Women who have had breast cancer or have a family history of breast or ovarian cancer have an increased riskof ovarian cancer.
    • Women who take estrogen replacement only (not with progesterone) for 5 years or moremay have a high risk of ovarian cancer. Birth control pills, however, decrease the risk of ovarian cancer.
    • Fertility drugs probably do not increase the riskof ovarian cancer.
    • Older women are at highest riskof developing ovarian cancer. Most deaths from ovarian cancer occur in women age 55 and older.

    Symptoms

    Ovarian cancer symptoms are often vague. Women and their doctors often blame the symptoms on other, more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries.

    See your doctor if you have the following symptoms on a daily basis for more than a few weeks:

    • Bloating or swollen belly area
    • Difficulty eating or feeling full quickly
    • Pelvic or lower abdominal pain; the area may feel "heavy" to you (pelvic heaviness)

    Other symptoms are also possiblewith ovarian cancer. But these symptoms are also common in women who do not have cancer:

    • Abnormal menstrual cycles
    • Digestive symptoms:
      • Constipation
      • Increased gas
      • Indigestion
      • Lack of appetite
      • Nausea and vomiting
    • Back pain for unknown reasonsthat worsens over time
    • Vaginal bleeding that occurs between periods
    • Weight gain or loss

    Other symptoms that can occur with this disease:

    • Excessive hair growth that is coarse and dark
    • Sudden urge to urinate
    • Needing to urinate more often than usual (increased urinary frequency or urgency )

    Exams and Tests

    A physical exam is often normal. With have advanced ovarian cancer,the doctormayfind a swollen abdomen often due tocollection (called ascites).

    A pelvic examination may reveal an ovarian or abdominal mass.

    A CA-125 blood test is not considered a good screening test for ovarian cancer. However, it may be done if a woman:

    • Has symptoms of ovarian cancer
    • Has already been diagnosed with ovarian cancer to determine how well treatment is working

    Other tests that may be done include:

    • Complete blood count and blood chemistry
    • Pregnancy test (serum HCG)
    • CT or MRI of the pelvis or abdomen
    • Ultrasound of the pelvis

    Surgery such as a pelvic laparoscopy or exploratory laparotomy is often done tofind the cause ofsymptoms. A biopsy will be done to help make the diagnosis.

    No lab or imaging test has ever been shown to be able to screen for or diagnose ovarian cancer in its early stages.

    Treatment

    Surgery is used to treat all stages of ovarian cancer. For early stagessurgery may be the only treatment. Surgery involves:

    • Removal of the uterus (total hysterectomy)
    • Removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy)
    • Partial or complete removal of the omentum, the fatty layer that covers and pads organs in the abdomen
    • Examination, biopsy, or removal of the lymph nodes and other tissues in the pelvis and abdomen

    Surgerydone by a specialist in femaleorgan cancers has been shown to result in a higher success rate.

    Chemotherapy is used after surgery to treat any cancer that remains. Chemotherapy can also be used if the cancer comes back. Chemotherapyis most oftengiven into the veins. Sometimes it is given directly into the abdominal cavity (intraperitoneal).

    Radiation therapy is rarely usedto treatovarian cancer in the United States.

    After surgery and chemotherapy, patients should be followed up closely:

    • A physical exam (including pelvic exam) every 2 - 4 months for the first 2 years. This isfollowed by every 6 months for 3 years, and theneach year.
    • A CA-125 blood test at each visit if the level started outhigh.
    • The doctor may also order periodic computed tomography (CT) scans of your chest, abdomen, and pelvic area.

    Support Groups

    You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

    Outlook (Prognosis)

    Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made

    • About 3 of 4 women with ovarian cancer survive 1 year after diagnosis.
    • Nearly half of women live longer than 5 years after diagnosis.
    • If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the 5-year survival rate is very high

    Possible Complications

    • Spread of the cancer to other organs
    • Fluid in the abdomen (ascites)
    • Blockage of the intestines

    When to Contact a Medical Professional

    Contactyour health care provider if you are a woman over 40 years old who has not recently had a pelvic exam. Routine pelvic exams are recommended for all women over 20 years old.

    Call for an appointment with your provider if you have symptoms of ovarian cancer.

    Prevention

    There are no standard recommendations for screening for ovarian cancer. Pelvic ultrasound or blood tests, such as the CA-125 has not been found to be effective and is not recommended.

    BRCA gene testing may be done in women at high risk for ovarian cancer.

    Removing the ovaries and tubes in women who have aproblem in the BRCA1 orBRCA2 gene may reduce the risk of developing ovarian cancer.But ovarian cancer may still develop in other areas of the pelvis.

    References

    Armstrong D. Ovaries and fallopian tubes. In: Abeloff MD, Armitage JO, Niederhuber JE, et al. eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2008:chap 93.

    Berek JS, Chalas E, Edelson M, Moore DH, Burke WM, Cliby WA, et al. Prophylactic and risk-reducing bilateral salpingo-oophorectomy: recommendations based on risk of ovarian cancer. Obstet Gynecol. 2010 Sep;116(3):733-43.

    Coleman RL, Ramirez PT, Gershenson DM. Neoplastic diseases of the ovary: screening, benign and malignant epithelial and germ cell neoplasms, sex-cord stromal tumors. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds.Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 33.

    National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Ovarian cancer: including fallopian tube cancer and primary peritoneal cancer. Version 1.2013. Available at:http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf.Accessed November 16, 2012.  

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    • Ovarian cancer dangers

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    • Uterus

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    • Ovarian cancer

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      • Female reproductive anat...

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      • Ascites with ovarian can...

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      • Ovarian cancer dangers

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      • Uterus

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      • Ovarian cancer

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      A Closer Look

      Talking to your MD

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          Tests for Ovarian cancer

            Review Date: 11/17/2012

            Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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