Ovarian Cancer

What is ovarian cancer?

From: MedlinePlus, National Library of Medicine

Cancer is a disease in which abnormal cells in the body grow out of control and form a tumor. Ovarian cancer is a cancerous tumor that forms in the tissues of an ovary. The ovaries are a pair of female reproductive glands that make eggs and female hormones.

What are the types of ovarian cancer?

From: MedlinePlus, National Library of Medicine

There are a few different types of ovarian cancer. The most common type is epithelial cancer. It begins in the cells that cover the ovary.

There are also two related types of epithelial cancer that can spread to the ovaries:

• Fallopian tube cancer forms in the tissue lining a fallopian tube. The fallopian tubes are a pair of long, slender tubes on each side of the uterus. The uterus is the female reproductive organ where a fetus grows during pregnancy.
• Primary peritoneal cancer forms in the tissue lining the peritoneum. Your peritoneum is a tissue lining that covers the organs in the abdomen (belly).

These two cancers are like ovarian cancer, and they have the same treatments. So some medical experts also consider those two types as ovarian cancer.

Some other rarer types of ovarian cancer are malignant germ cell tumors and stromal tumors.

What causes ovarian cancer?

From: MedlinePlus, National Library of Medicine

Ovarian cancer happens when there are changes (mutations) in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown.

Most ovarian cancers are caused by genetic changes that happen during your lifetime. But sometimes these genetic changes are inherited, meaning that you are born with them. Ovarian cancer that is caused by inherited genetic changes is called hereditary ovarian cancer.

There are also certain genetic changes that can raise your risk of ovarian cancer, including changes called BRCA1 and BRCA2. These two changes also raise your risk of breast and other cancers.

Besides genetics, your lifestyle and the environment can affect your risk of ovarian cancer.

Who is more likely to develop ovarian cancer?

From: MedlinePlus, National Library of Medicine

Certain people are more likely to develop ovarian cancer. They include those who:

• Have a family history of ovarian cancer in a mother, aunt, grandmother, or sister
• Have inherited changes in the BRCA1 or BRCA2 genes
• Have certain other genetic conditions, such as Lynch syndrome
• Have endometriosis
• Took hormone therapy for menopause
• Are overweight or have obesity
• Are tall
• Are older, especially those who have gone through menopause
• Have never been pregnant

What are the symptoms of ovarian cancer?

From: MedlinePlus, National Library of Medicine

Ovarian cancer may not cause early signs or symptoms. By the time you do have signs or symptoms, the cancer is often advanced.

The signs and symptoms may include:

• Pain, swelling, or a feeling of pressure in the abdomen (belly) or pelvis
• Sudden or frequent urge to urinate (pee)
• Trouble eating or feeling full
• A lump in the pelvic area
• Gastrointestinal problems, such as gas, bloating, or constipation

How is ovarian cancer diagnosed?

From: MedlinePlus, National Library of Medicine

To find out if you have ovarian cancer, your health care provider:

• Will ask about your medical history, including your symptoms
• Will ask about your family health history, including relatives who have had ovarian cancer
• Will do a physical exam, including a pelvic exam
• Will likely do imaging tests
• May do blood tests such as a CA-125 blood test

Often the only way to know for sure that you have ovarian cancer is by having a biopsy of the tissue. A biopsy is done during surgery to remove the tumor.

What are the treatments for ovarian cancer?

From: MedlinePlus, National Library of Medicine

Treatments for ovarian cancer may include:

• Surgery to remove as much of the cancer as possible
• Chemotherapy
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells

Your provider may suggest that you have genetic testing to look for the gene changes that raise the risk for ovarian cancer. Knowing whether you have the gene change may help your provider decide on your treatment plan.

Genetic causes described in the linked summary

From: MedlinePlus Genetics

Cancers occur when a buildup of mutations in critical genes—those that control cell growth and division or repair damaged DNA—allow cells to grow and divide uncontrollably to form a tumor. Most cases of ovarian cancer are sporadic; in these cases the associated genetic changes are acquired during a person's lifetime and are present only in certain cells in the ovary. These changes, which are called somatic mutations, are not inherited. Somatic mutations in the TP53 gene occur in almost half of all ovarian cancers. The protein produced from this gene is described as a tumor suppressor because it helps keep cells from growing and dividing too fast or in an uncontrolled way. Most of these mutations change single protein building blocks (amino acids) in the p53 protein, which reduces or eliminates the protein's tumor suppressor function. Because the altered protein is less able to regulate cell growth and division, a cancerous tumor may develop. Somatic mutations in many other genes have also been found in ovarian cancer cells.

In hereditary ovarian cancer, the associated genetic changes are passed down within a family. These changes, classified as germline mutations, are present in all the body's cells. In people with germline mutations, other inherited and somatic gene changes, together with environmental and lifestyle factors, also influence whether a woman will develop ovarian cancer.

Germline mutations are involved in more than one-fifth of ovarian cancer cases. Between 65 and 85 percent of these mutations are in the BRCA1 or BRCA2 gene. These gene mutations are described as "high penetrance" because they are associated with a high risk of developing ovarian cancer, breast cancer, and several other types of cancer in women. Compared to a 1.6 percent lifetime risk of developing ovarian cancer for women in the total population, the lifetime risk in women with a BRCA1 gene mutation is 40 to 60 percent, and the lifetime risk in women with a BRCA2 gene mutation is 20 to 35 percent. Men with mutations in these genes also have an increased risk of developing several forms of cancer. The proteins produced from the BRCA1 and BRCA2 genes are tumor suppressors that are involved in fixing damaged DNA, which helps to maintain the stability of a cell's genetic information. Mutations in these genes impair DNA repair, allowing potentially damaging mutations to persist in DNA. As these defects accumulate, they can trigger cells to grow and divide without control or order to form a tumor.

A significantly increased risk of ovarian cancer is also a feature of certain rare genetic syndromes, including a disorder called Lynch syndrome. Lynch syndrome accounts for between 10 and 15 percent of hereditary ovarian cancers. Other rare genetic syndromes may also be associated with an increased risk of ovarian cancer. The proteins produced from the genes associated with these syndromes act as tumor suppressors. Mutations in any of these genes can allow cells to grow and divide unchecked, leading to the development of a cancerous tumor. Like BRCA1 and BRCA2, these genes are considered "high penetrance" because mutations greatly increase a person's chance of developing cancer. In addition to ovarian cancer, mutations in these genes increase the risk of several other types of cancer in both men and women.

Germline mutations in dozens of other genes have been studied as possible risk factors for ovarian cancer. These genes are described as "low penetrance" or "moderate penetrance" because changes in each of these genes appear to make only a small or moderate contribution to overall ovarian cancer risk. Some of these genes provide instructions for making proteins that interact with the proteins produced from the BRCA1 or BRCA2 genes. Others act through different pathways. Researchers suspect that the combined influence of variations in these genes may significantly impact a person's risk of developing ovarian cancer.

In many families, the genetic changes associated with hereditary ovarian cancer are unknown. Identifying additional genetic risk factors for ovarian cancer is an active area of medical research.

In addition to genetic changes, researchers have identified many personal and environmental factors that contribute to a woman's risk of developing ovarian cancer. These factors include age, ethnic background, and hormonal and reproductive factors. A history of ovarian cancer in closely related family members is also an important risk factor, particularly if the cancer occurred in early adulthood.

Inheritance described in the linked summary

From: MedlinePlus Genetics

Most cases of ovarian cancer are not caused by inherited genetic factors. These cancers are associated with somatic mutations that are acquired during a person's lifetime, and they do not cluster in families.

A predisposition to cancer caused by a germline mutation is usually inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to increase a person's chance of developing cancer. Although ovarian cancer occurs only in women, the mutated gene can be inherited from either the mother or the father. It is important to note that people inherit an increased likelihood of developing cancer, not the disease itself. Not all people who inherit mutations in these genes will ultimately develop cancer.

In many cases of ovarian cancer that clusters in families, the genetic basis for the disease and the mechanism of inheritance are unclear.

Which doctor should you see?

The suggested department for discussing Ovarian Cancer is Oncology, with a oncologist and relevant organ specialist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

Additional services that may be relevant, depending on the findings, include: Clinical Genetics; Relevant organ specialist / Surgical Oncology as indicated.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Has the exact tumour type been confirmed, and is staging relevant?
• What is the goal of each proposed treatment option?
• How will side effects, daily function and supportive care be addressed?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.