Ovarian Cancer

Types of Ovarian Cancer

There are many types of ovarian cancer, including some that are extremely rare and require specialized treatment. The main types of ovarian cancer are named for the cells where the disease first forms.

• Epithelial ovarian cancer: About 90% of ovarian cancers start in the epithelium tissue, which is the lining on the outside of the ovary. This type of ovarian cancer is divided into serous, mucinous, endometrioid, clear cell, transitional and undifferentiated types. The risk of epithelial ovarian cancer increases with age, especially after the age of 50.
• Germ cell ovarian cancer: Germ cell tumors account for about 5% of ovarian cancers. They begin in the egg-producing cells. This type of ovarian cancer can occur in women of any age, but about 80% are found in women under the age of 30. The main subtypes are teratoma, dysgerminoma, endodermal sinus tumor and choriocarcinoma.
• Stromal ovarian cancer: These tumors, about 5% of ovarian cancers, grow in the connective tissue that holds the ovary together and makes estrogen and progesterone. Most are found in older women, but sometimes they occur in girls. Stromal tumors usually do not spread as fast as other ovarian tumors. Sub-types include granulosa, granulosa-theca and Sertoli-Leydig cell tumors.
• Primary peritoneal ovarian cancer is a rare cancer. It has cells like those on the outside of the ovaries, but it starts in the lining of the pelvis and abdomen. Women can get this type of cancer even after their ovaries have been removed. Symptoms and treatment are similar to epithelial ovarian cancer. Fallopian tube cancer is also a rare cancer. It starts in the fallopian tube and acts like epithelial ovarian cancer. Symptoms and treatment are similar to ovarian cancer.

Ovarian Cancer Risk Factors

Anything that increases your chance of getting ovarian cancer is a risk factor. These include:

• Age: The risk of ovarian cancer increases with age. About half of ovarian cancers are in women over 60.
• Family history of ovarian cancer
• Genetic factors: Approximately 10% to 15% of ovarian cancers are due to genes that make you more likely to develop cancer.
• Never having children. The more children you have, the less likely you are to develop ovarian cancer.

Women who are at high risk for ovarian cancer should be screened regularly. You are considered high risk if you have:

• BRCA1 or BRCA2 gene
• Hereditary breast ovarian cancer syndrome
• Hereditary non-polyposis colorectal cancer (HNPCC), also called Lynch syndrome
• BRIP1, RAP51C, or RAD51D gene

Not everyone with risk factors gets ovarian cancer. However, if you have risk factors, it’s a good idea to discuss them with your health care provider.

Ovarian Cancer Signs and Symptoms

Most women with ovarian cancer have vague symptoms. These signs often are like less serious conditions including indigestion, weight gain or aging.

Symptoms and signs of ovarian cancer vary from woman to woman, but they may include:

• General abdominal discomfort or pain (gas, indigestion, pressure, swelling, bloating, cramps)
• Bloating and/or a feeling of fullness, even after a light meal
• Nausea, diarrhea, constipation or frequent urination
• Unexplained weight loss or gain
• Loss of appetite
• Abnormal vaginal bleeding
• Unusual fatigue
• Back pain
• Pain during sex
• Menstrual changes

These symptoms do not always mean you have ovarian cancer, but it's a good idea to discuss them with your health care provider if they:

• Are new symptoms
• Last more than a few weeks
• Occur more than 12 times a month

Ovarian Cancer Diagnosis

Our experts use the most advanced and accurate equipment available for ovarian cancer diagnosis and determine with pinpoint accuracy if and where it has spread. They have extensive experience with all types of ovarian cancer, including rare ovarian cancers. The chances for successful ovarian cancer treatment are much higher if the cancer is caught early and diagnosed accurately. If ovarian cancer is diagnosed in the early stages, the chances for successful treatment are high.

Testing for Ovarian Cancer

If you have symptoms that may signal ovarian cancer, your doctor will examine you and ask you questions about your health and family medical history. One or more of the following tests for ovarian cancer may be used to find out if you have the disease and if it has spread. These tests also may be used to find out if treatment is working.

Pelvic Exam

A pelvic exam helps find out if there is a mass on either side of the uterus. This may be a sign of ovarian cancer.

Blood Test

A blood test may be performed to measure the level in your body of CA-125, a protein that is made by ovarian cancer cells. CA-125 is known as a tumor marker because its levels usually are higher in women with ovarian cancer. However, the CA-125 test alone cannot find ovarian cancer. A high level of CA-125 does not always mean you have ovarian cancer, and low levels of CA-125 do not mean you are cancer-free. Some types of ovarian cancer produce only low levels of CA-125 or none at all.

Ovarian Cancer Biopsy

The only way to find out for certain if a growth is ovarian cancer is for the doctor to remove cells from it and look at them under a microscope (biopsy). Tissue can be removed by:

• Surgery
• Laparoscopy
• Fine needle aspiration (FNA)

Ovarian Cancer Imaging

• CT or CAT (computed axial tomography) scans
• MRI (magnetic resonance imaging) scans
• PET (positron emission tomography) scans
• Chest X-rays
• Transvaginal ultrasound: A wand-shaped scanner is put into the vagina. It has a small ultrasound device on the end.

Genetic Testing for Ovarian Cancer

If you are at high risk for ovarian cancer because of personal or family history, your doctor may ask you to have more tests, including some that give information about your genes. These tests may help you make important decisions about cancer prevention for yourself and your children. There are benefits and risks with genetic testing, which you should discuss with your doctor. Blood tests can find out if you have a BRCA1 or BRCA2 gene, which can cause ovarian cancer as well as breast cancer. Others test for genes that play a part in Lynch syndrome, an inherited colon cancer syndrome.

Ovarian Cancer Treatment

When you receive ovarian cancer treatment at MD Anderson at cooper, a team of some of the region's foremost experts customizes your care. This team of specialists communicates and collaborates at every step. They customize your ovarian cancer treatment to be sure you receive the highest chance for successful treatment with the least impact on your body.

Our physicians have extensive experience in treating every type of ovarian cancer, including rare ovarian cancers. We offer the latest, most-advanced therapies, including surgery, chemotherapy, hormonal therapies and targeted therapies.

Surgery usually is the first step in treating ovarian cancer. It is crucial that your surgeon be experienced in this delicate procedure. Studies have shown that patients with ovarian cancer have better outcomes and better chances for survival when the largest amount possible of the tumor is removed.

The gynecologic oncology surgeons at MD Anderson Cancer Center at Cooper are some of the most experienced in the nation. This gives them a level of expertise that is available at few other cancer centers.

If you are diagnosed with ovarian cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:

• The stage of the cancer
• The size of the tumor after surgery 
• Your desire to have children
• Your age and overall health

One or more of the following therapies may be recommended to treat ovarian cancer or help relieve symptoms.

• Ovarian Cancer Surgery:Surgery is the main treatment for ovarian cancer. Often times, ovarian cancer surgery is done to remove or biopsy a mass to find out if it is cancer. Once cancer is confirmed, the surgeon stages the cancer based on how far it has spread from the ovaries. If the disease seems to be limited to one or both ovaries, the surgeon will biopsy the pelvis and abdomen to find out if the cancer has spread.
• Debulking Ovarian Cancer: If it is obvious during the surgery that ovarian cancer has spread, the surgeon will remove as much of the tumor as possible. This may help other treatments work better. The ovaries, uterus, cervix, Fallopian tubes and omentum (fatty tissue around these organs), and any other visible tumors in the pelvic and abdominal areas may be removed during debulking. The spleen, lymph nodes, liver or intestines also may be removed partially or completely. Sometimes debulking is not possible because the patient is not healthy enough or the tumor may be attached to other organs. In these cases, any tumor left will be treated with chemotherapy.
• Chemotherapy for Ovarian Cancer: You may need chemotherapy after surgery to destroy ovarian cancer cells that are still in the body. Intraperitoneal chemotherapy (IP therapy) for ovarian cancer is a way to give chemotherapy drugs. It may be used if a small amount of tumor is left after debulking. Sometimes IP chemotherapy works better than regular chemotherapy. In IP treatment, concentrated chemotherapy is put into the abdominal cavity through a catheter (tiny tube) or implanted port. This allows it to come into contact with the cancer and the area of the body where the cancer is likely to spread. The drugs also get into the blood and travel through the body.
• Radiation for Ovarian Cancer: Although radiation therapy rarely is used to treat ovarian cancer, it may help destroy any cancer cells that are left in the pelvic area. It also may be used if the cancer has come back after other treatments. In most cases, the main goal of radiation therapy is to control symptoms such as pain, not to treat the cancer.
• Ovarian Cancer Targeted Therapy: MD Anderson at Cooper is among just a few cancer centers in the nation that are able to offer targeted therapy for some types of ovarian cancer. These new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.

Make an Appointment With an Ovarian Cancer Expert at MD Anderson at Cooper

To learn more about the ovarian cancer services available at MD Anderson at Cooper or to schedule an appointment, please call 855.MDA.COOPER (855.632.2667).