What is it?
Cancer of the ovaries is the sixth most common cancer in women. The life-time risk of developing ovarian cancer is 1/70 or about 25,000 new cases each year.  Of these, more than 14,000 women die each year, thus making it a more common cause of death than the more prevalent (but more easily detected) cancers of the uterus and cervix.  The main reason this type of cancer goes undetected is the symptoms of ovarian cancer are fairly non-specific. They include:
abdominal discomfort, pressure, bloating, or swelling

• urinary urgency and/or change in bowel habits
• pelvic pain/discomfort and
• loss of appetite, indigestion, gas or nausea.

The ovaries, located on either side of the uterus in the lower abdomen, have two main functions: to produce estrogen and progesterone, hormones that are responsible for the development of secondary sexual characteristics and regulating the reproductive cycle; and to develop and release an egg into the fallopian tube once a month during childbearing years.

Ovarian tumors can be either benign or malignant; it is not usually possible to tell them apart until a tumor has been biopsied or removed or has spread to other parts of the body. Three types of tumors are seen:

• epithelial tumors – most (about 85%) ovarian tumors begin in the epithelial cells covering the outside of the ovaries
• germ cell tumors – occur in the egg-producing cells and more often seen in younger women
• stromal tumors – derive from connective tissues of the ovary that produce estrogen and progesterone

While benign tumors do not metastasize, cancerous ovarian tumors will spread if left undiagnosed and untreated– first throughout the ovary, then to the uterus, bladder, rectum, and the lining of the abdomen. Eventually, cancerous cells will reach the lymph nodes and distant site metastasis throughout the body will occur.

The main risk factor for ovarian cancer is a positive family history.  In many of these families, mutations in the BRCA1 and BRCA2 genes are associated with a 50-60% lifetime risk of developing ovarian cancer.  The prevalence of ovarian cancer is low in young women but increases with age, with the highest rate occurring in the eighth decade of life.  The risk of developing ovarian cancer is somewhat increased in women who have not had children, are taking fertility drugs, are obese during early adulthood, and perhaps also in those who take hormone replacement therapy.  Slightly decreased risks may be associated with having a tubal ligation (tubes tied), taking oral contraceptives, having children, and breast feeding.  Demographic factors may also play a factor.  The incidence of ovarian cancer per 100,000 Swedish women was 14.9 cases, whereas 2.7 cases were seen per 100,000 Japanese women.  Of interest, Japanese women who migrated to the U.S. had similar incident rates to those of American women (13.3 cases per 100,000), thus suggesting an environmental or dietary relationship.

It is difficult to detect ovarian cancer early – only about 25% of the cancers are found in the easily treatable stage, before they have spread beyond the ovary. Because the symptoms of ovarian cancer are subtle and non-specific and since there are many non-cancerous conditions that can also cause similar symptoms, it is important to have regular checkups and to consult with your physician if you are experiencing any of the noted symptoms.