Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Ovarian Cancer
What is it?
About 90% of ovarian cancers are epithelial ovarian carcinomas. In this type of cancer, a malignant tumor originates in the surface epithelium tissue, which is the lining on the outside of the ovary. The risk of epithelial ovarian cancer increases with age, especially after the age of 50.
Germ cell tumors account for approximately 5% of all ovarian cancers and originate in the egg-producing cells found within the ovary. This type of ovarian cancer can occur in women of any age, but approximately 80% are diagnosed in women under the age of 30.
About 25% of ovarian cancers are found at an early stage. Early detection improves the chances that ovarian cancer can be treated successfully. When ovarian cancer is found early at a localized stage, about 90% of patients live longer than 5 years after diagnosis.
Symptoms
Early cancers of the ovaries tend to cause symptoms that are relatively vague. These symptoms include abdominal swelling, unusual vaginal bleeding, pelvic pressure, back pain, leg pain, and digestive problems such as gas, bloating, indigestion, or long-term stomach pain. Most of these symptoms can also be caused by other less serious conditions. Nonetheless, prompt attention to symptoms can improve the odds of early diagnosis and successful treatment. If you have any of these symptoms, report them to your primary care provider right away.
Risk Factors
- Age: Most ovarian cancers develop after menopause. Two-thirds of women who develop ovarian cancer are over 55 years old.
- Obesity: A study from the ACS found a higher rate of death from ovarian cancer in obese women. The risk was increased by 50% in the heaviest women.
- Reproductive history: Women who started menstruating at an early age (before age 12), had no children or had their first child after age 30, and/or experienced menopause after age 50 may have an increased risk for ovarian cancer.
- Family history: Your ovarian cancer risk is increased if your mother, sister, or daughter have (or have had) ovarian cancer. If there is a family history of cancer caused by an inherited mutation (change) of the breast cancer gene BRCA1 or BRCA2, you have a very high risk of ovarian cancer. Also, a mutation leading to inherited colorectal cancer can increase the risk of ovarian cancer. Many cases of familial epithelial ovarian cancer are caused by inherited gene mutations that can be identified by genetic testing.
- Personal history of breast cancer: If you have had breast cancer, you also have an increased risk of developing ovarian cancer.
- Talcum powder: It has been suggested that talcum powder applied directly to the genital area or on sanitary napkins may be carcinogenic. Most, but not all, studies suggest a slight increase in risk of ovarian cancer in women who used talc on the genital area.
- Estrogen replacement therapy and hormone replacement therapy: Some studies suggest women using estrogens after menopause have an increased risk of developing ovarian cancer, but other studies have not found any effect on ovarian cancer risk.
A recent study suggested that using estrogen replacement therapy (ERT) increases the risk of developing ovarian cancer, and that the risk increases with continued use. The risk among women who used ERT for longer than 10 years was almost double that of women who had never used it, and the risk among those who used it for 20 years or more was tripled. (Remember, however, that the average lifetime risk for ovarian cancer is only about 2%.) Most of these findings have been for women taking estrogen alone, not for those taking combined progesterone and estrogen. The increased risk is less certain for women taking both drugs.
Treatment
The choice of treatment depends largely on the type of cancer and the stage of the disease.
Factors that could play a part in choosing the best treatment plan might include your general state of health, whether you plan to have children, and other personal considerations. Age alone is not a determining factor since several studies have shown that older women tolerate ovarian cancer treatments well. Be sure you understand all the risks and side effects of the various therapies before making a decision about treatment.
The main treatments for ovarian cancer are:
- Surgery
- Chemotherapy
- Radiation therapy
In some cases, more than one treatment will be recommended.
