Ovarian Cancer

While the exact cause of ovarian cancer is unknown, this cancer is linked to several risk factors, including:

• Age – most common in women ages 50 to 60
• Inherited gene mutations – breast cancer gene 1 (BRCA1), breast cancer gene 2 (BRCA2) and gene mutations that cause Lynch syndrome, which is also associated with colon cancer, increase a person's risk
• Estrogen hormone replacement therapy
• Starting menstruation early (before age 12) or beginning menopause late (after age 52)
• Never being pregnant
• Receiving fertility treatment
• Smoking
• Using intrauterine devices
• Polycystic ovarian disease (POCD)

Ovarian cancer occurs when cells within, near or on the ovaries grow out of control. There are three main types, which are distinguished by where exactly the cancer begins.

Ovarian cancer types include:

• Epithelial tumors – accounting for most ovarian cancers, these begin in the tissue covering the outside of the ovaries
• Stromal tumors – begin in the ovarian tissue that contains hormone-producing cells
• Germ cell tumors – begin in the egg-producing cells

Ovarian cancer symptoms include:

• Abdominal bloating or swelling
• Quickly feeling full when eating
• Weight loss
• Pelvic discomfort
• Bowel habit changes, such as constipation
• Frequent need to urinate
• Nausea, indigestion, gas, constipation or diarrhea
• Persistent fatigue
• Pain during sex
• Menstrual changes

Keep in mind that these symptoms can also indicate conditions other than ovarian cancer. If you are experiencing any of these symptoms, contact your doctor as soon as possible so the cause can be diagnosed and treated promptly.

About 20% of ovarian cancers are found at an early stage. When ovarian cancer is detected early at a localized stage, about 94% of patients live longer than five years after diagnosis.

If you are experiencing symptoms of ovarian cancer, your doctor will first ask you some questions and perform a pelvic exam to look for signs, such as an enlarged ovary or fluid in the abdomen, which is called ascites.

If your doctor suspects ovarian cancer, he or she may recommend the following diagnostic tests:

• Blood tests – performed to check the level of several substances in your blood, including a cancer antigen called CA-125.
• Ultrasound – uses sound waves to visualize organs inside the pelvis. For a better view of the ovaries, a small, lubricated probe (a transducer) may be inserted into the vagina for a test called a transvaginal ultrasound.
• Computed tomography (CT) scan – uses X-rays to create cross-sectional pictures inside the body. CT scans may not show smaller ovarian tumors, but they can detect whether a larger tumor is growing into nearby structures or whether lymph nodes are enlarged.
• Biopsy – tissue and fluid are removed from the pelvis and abdomen so that a pathologist can more closely examine it for the presence of cancer.

At Houston Methodist, we are dedicated to providing leading-edge diagnosis and treatment options for ovarian cancer. Depending on the type and stage of the cancer, your care team may use one or more of the following ovarian cancer treatment options:

Surgery for Ovarian Cancer

Surgery is the primary treatment for most ovarian cancers.

The goal of ovarian cancer surgery is to remove as much of the tumor as possible, a process called debulking. This procedure may involve removing one or more of the following organs:

• One or both ovaries
• The uterus and both fallopian tubes
• Fatty tissue in the lower abdominal area that connects, covers and protects organs, called omentum
• Pelvic and para-aortic lymph nodes
• Any other tumor-bearing area, including a portion of the small or large intestine, appendix or spleen

For early-stage ovarian cancer, minimally invasive surgical techniques can sometimes be used, as well as fertility-sparing procedures in some cases.

Chemotherapy for Ovarian Cancer

Chemotherapy kills cancer cells using drugs that are given intravenously by IV or orally. With ovarian cancer, chemotherapy is most commonly used to destroy any cancer cells that may remain after surgery. In some cases, chemotherapy may be given before surgery to help shrink the tumor and make it easier to remove.

Hyperthermic (Heated) Intraoperative Peritoneal Chemotherapy (HIPEC) for Ovarian Cancer

HIPEC delivers heated chemotherapy directly into the abdomen during surgery. It's used to treat advanced ovarian cancer that has spread to the abdominal cavity lining, such as to the appendix, colon and stomach.

Radiation Therapy for Ovarian Cancer

Radiation therapy uses high-energy rays to kill cancer cells in a targeted, specific area. It is seldom used in the initial treatment of ovarian cancer, but may be used to relieve pain and other problems caused by advanced disease.