Ovarian Cancer Overview

September is Ovarian Cancer Awareness Month

The American Cancer Society's most recent estimates for ovarian cancer in the United States are for 2014:

  • 21,980 new cases of ovarian cancer
  • 14,270 deaths from ovarian cancer

This cancer mainly develops in older women. About half of the women who are diagnosed with ovarian cancer are 63 years or older. It is more common in white women that African-American women.

The rate at which women are diagnosed with ovarian cancer has been slowly falling over the past 20 years.

In the past, ovarian cancer was known as the "silent killer" because it was thought to reveal no symptoms in its earliest, most curable stages. Recently, however, researchers reported a cluster of symptoms that can indicate ovarian cancer. And advocates - both survivors and families - are beginning to make noise and encourage awareness for this disease.

Here's what you need to know about ovarian cancer:

1. Symptoms do exist.
Bloating, pelvic or abdominal pain, difficulty eating, feeling full quickly, and frequent or urgent urinating are shown to be more common in women with ovarian cancer. These are vague symptoms and often mistaken for gastrointestinal problems. But if they persist for several days, get checked out by your gynecologist. "You can explain away these symptoms to yourself. But the only way to be sure it's nothing is to go get a pelvic exam," says J. Rebecca Liu, M.D., assistant professor of obstetrics and gynecology at the U-M Medical School and a gynecologic oncologist at the U-M Comprehensive Cancer Center.

2. There is no screening test for ovarian cancer, like a Pap smear or mammogram.
The CA125 blood test measures the amount of a certain protein that's often elevated with ovarian cancer. But the test is not foolproof. "There are a lot of benign conditions that can cause higher levels of CA125," Liu says. Early detection is a key area of research. U-M researchers are looking for markers in the blood that indicate ovarian cancer, an approach that could in time lead to a blood test to screen for ovarian cancer.

3. All women need yearly pelvic exams.
Maybe your doctor says you don't need a Pap smear every year, but Pap tests just check for cervical abnormalities. A pelvic exam is not the same thing. In particular, older women should not discontinue their yearly gynecology visit as ovarian cancer is more likely to occur in women older than 60. "A pelvic exam is key because it's the best screening we have right now," Liu says.

4. Survival rates are significantly better when ovarian cancer is diagnosed in an early stage.
With stage I ovarian cancer, the earliest stage, 95 percent of women are alive five years after diagnosis. Only 30 percent of women with stage III or IV ovarian cancer survive five years. Some 70 percent of women have advanced disease when they are diagnosed.

5. Ovarian cancer is difficult to treat because it's often resistant to current treatments.
It may respond to chemotherapy drugs initially, but when it recurs - which it usually does - the cells will no longer be killed by that drug. Researchers are focusing on new molecularly targeted therapies that hone in on and destroy the cancer cells, and they hope this will overcome the resistance.

6. It’s most common in older white women.
Most patients are older than 60 and post-menopausal. Women who have not had children are at higher risk. Women who have taken birth control for a number of years lower their risk.

7. A small number of ovarian cancers are hereditary.
It's linked to the same genes that are linked to breast cancer, BRCA1 and BRCA2. If ovarian cancer runs in your family, particularly on your mother's side, and if family members were diagnosed at a young age, you might consider genetic testing.

8. The best person to treat ovarian cancer is a gynecologic oncologist.
These specialists are skilled in the comprehensive management of female reproductive cancers, including surgery and chemotherapy. Studies have shown gynecologic oncologists are two to three times more likely to provide surgical care consistent with national guidelines. Women with ovarian cancer treated by gynecologic oncologists have 10 percent to 25 percent better survival rates than women treated by general oncologists or gynecologists. While your regular gynecologist can perform diagnostic tests, if you are diagnosed with ovarian cancer, you should see a gynecologic oncologist.

What is ovarian cancer?

Ovarian cancer is cancer that begins in the ovaries. Ovaries are reproductive glands found only in females (women).

There are three types of ovarian cancer:

1. Epithelial ovarian cancer is the most common. About 85% to 90% of ovarian cancers are epithelial ovarian carcinomas. It forms on the surface of the ovary in the epithelial cells.

2. Germ cell cancer is an uncommon form of ovarian cancer. Germ cells are the cells that usually form the ova or eggs. Most germ cell tumors are benign, but some are cancerous and may be life threatening. Less than 2% of ovarian cancers are germ cell tumors.

3. Stromal cell cancer is a rare form of ovarian cancer. About 1% of ovarian cancers are ovarian stromal cell tumors. It starts in the cells that produce female hormones and hold the ovarian tissues together.

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