Ovarian Cancer Sugar Land

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What is cancer?

Normal cells in the body grow, divide, and are replaced on a routine basis. Sometimes, cells divide abnormally and begin to grow out of control. These cells may form growths or tumors.

Tumors can be benign (not cancer) or malignant (cancer). Benign tumors do not spread to other body tissues. Malignant tumors can invade and destroy nearby healthy tissues and organs. Cancer cells can also spread to other parts of the body and form new cancerous areas.

What is ovarian cancer?

Ovarian cancer is cancer that affects one or both ovaries. Ovarian cancer is not common. But because ovarian cancer often goes undetected until it is in an advanced stage, it is the number one cause of deaths from gynecologic cancer in the United States.

What is the most common type of ovarian cancer?

Ovarian cancer can develop on the surface of the ovary or from tissues inside the ovary. There are three main types of ovarian cancer. The type that develops on the surface of the ovary, epithelial ovarian cancer, is the most common type. About 9 in 10 cases of ovarian cancer involve epithelial tumors. This page discusses epithelial ovarian cancer.

What are the stages and grades of ovarian cancer?

  • Stage I- The earliest stage. Cancer is found in one or both ovaries.
  • Stage II- Cancer is found in the pelvic region.
  • Stage III- Cancer has spread to areas of the abdomen.
  • Stage IV- The most advanced stage. Cancer has spread beyond the abdomen to other parts of the body, such as the lungs.

Grade refers to how abnormal cancer cells look under a microscope. Ovarian tumors are graded as low-grade or high-grade. Low-grade tumors look the most like normal ovarian tissue. High-grade tumors look the least like normal ovarian tissue.

The stage and grade of ovarian cancer help guide treatment decisions.

Risk Factors and Symptoms

What are the risk factors for ovarian cancer?

Certain risk factors are associated with epithelial ovarian cancer. These risk factors include the following:

  • Age older than 55
  • Family history of breast cancer, ovarian cancer, colon cancer, or endometrial cancer (cancer of the lining of the uterus)
  • Personal history of breast cancer
  • Mutations in BRCA1 and BRCA2 genes
  • Never having had children
  • Infertility
  • Endometriosis
  • Lynch syndrome

Another risk factor is a strong family history of ovarian and breast cancer. Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited risk of breast cancer, ovarian cancer, and other types of cancer. HBOC syndrome is most commonly linked to mutations in two genes called BRCA1 and BRCA2. As many as 24 in 100 cases of ovarian cancer are due to mutations in BRCA1 and BRCA2.

There are other genes that may cause ovarian cancer too. These genes include BRIP1, RAD1C, and RAD51D. For these reason, health care professionals may recommend genetic testing that looks for mutations in several genes at once. This is called multigene panel testing.

How does age affect my risk of ovarian cancer?

Ovarian cancer can occur at any age, but the risk increases as you get older. Most cases occur after menopause in women age 55 to 64. Ovarian cancer is much less common in pre-menopausal women.

What are the symptoms of ovarian cancer?

If you have any of the following symptoms, especially if you have them for more than 12 days per month, contact your obstetrician–gynecologist (ob-gyn) or other health care professional:

  • Bloating or an increase in abdominal size
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (frequency and urgency)

Other symptoms can include vaginal bleeding, especially after menopause, and a change in bowel habits. Having these symptoms does not mean that you have ovarian cancer, but it is a good idea to find out what is causing them.

Be alert to any changes in your body and discuss them with your health care professional. The earlier that ovarian cancer is diagnosed, the more likely that treatment will be successful.

Diagnosis and Treatment

Is there a screening test for ovarian cancer?

A screening test is a test that is done when no symptoms are present. Examples of screening tests are colonoscopy for colorectal cancer and the Pap test for cervical cancer. Currently, there is no screening test for ovarian cancer.

There are tests marketed to consumers as ovarian cancer screening tests. These tests are not accurate and not reliable for screening women who do not have symptoms of ovarian cancer. These tests have not been approved by the U.S. Food and Drug Administration (FDA) and should be avoided.

How is ovarian cancer diagnosed?

If you have frequent or persistent symptoms of ovarian cancer, you may have a physical exam, including a pelvic exam. An imaging test of the ovaries, such as a transvaginal ultrasound exam, may be done.

If a growth is found on an ovary, your health care professional may recommend a blood test to measure your CA 125 level. CA 125 is a protein in the blood. The level of CA 125 is sometimes increased in women with ovarian cancer.

Results of these tests are used to assess the likelihood that the growth is cancer. Test results also guide the next steps in evaluation.

Based on your age and symptoms, other tests such as a colonoscopy, computed tomography (CT), magnetic resonance imaging (MRI), and chest X-ray may be done. These tests can show if there is cancer in other areas of the body.

What if I have a growth but no symptoms?

Sometimes a growth is found during a routine pelvic exam, and an ultrasound exam is done to find out more. If the growth does not have the appearance of cancer and you do not have symptoms, the chance that you have cancer is low.

Periodic ultrasound exams may be recommended to see if the growth changes in size or appearance. Often, benign growths go away on their own.

How is ovarian cancer treated?

If the first tests suggest that cancer is present, your health care professional may recommend exploratory surgery. If possible, it’s best that a doctor specially trained or experienced in cancer, such as a gynecologic oncologist, perform the surgery.

This surgery is usually done through an incision in the abdomen. In some cases, this surgery may be done with a minimally invasive procedure called laparoscopy. (Read Laparoscopy to learn more)

During exploratory surgery, tissue is removed and immediately tested for cancer. If this test shows that cancer is present, the surgeon usually removes the uterus, ovaries, and fallopian tubes. Lymph nodes and tissues in the pelvis and abdomen are checked for cancer and may be removed as well. In some cases, only the ovary with cancer may be removed.

Chemotherapy after surgery is recommended for most cases of ovarian cancer. Chemotherapy is the use of drugs that kill cancer cells. In some cases, chemotherapy may be recommended before surgery.

What type of follow-up is needed after treatment?

Regular checkups are needed to be certain that the cancer has not come back. A checkup after cancer treatment usually includes a review of symptoms and a physical exam

The checkup may also include a CA 125 test. Imaging tests are not routinely done but may be recommended. These may include ultrasound, chest X-ray, magnetic resonance imaging (MRI), or computed tomography (CT).

Reducing Risk

How can I reduce my risk of ovarian cancer?

Combined hormonal birth control pills (those that contain estrogen and progestin) may reduce the risk of ovarian cancer. The longer you take the pill, the more the risk is reduced.

This benefit needs to be balanced against the risks of using the pill. The pill is safe for most women, but it is associated with a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke. Your health care professional can help you weigh the benefits and risks of using the pill.

Current theories suggest that some types of ovarian cancer may start in the fallopian tubes. If you need to have your uterus removed or you have chosen sterilization  as a permanent method of birth control, you may want to ask your ob-gyn or other health care professional about having your fallopian tubes removed. This operation is called a salpingectomy. In this procedure, only the fallopian tubes are removed. The ovaries are left in place. A salpingectomy may help reduce the risk of future ovarian cancer.

What should I know if I am at high risk of ovarian cancer?

If you are at high risk of ovarian cancer, such as if you have BRCA1 or BRCA2 mutations, periodic tests to check for ovarian cancer may be recommended. These tests may include a transvaginal ultrasound exam to look for changes in the ovaries and a CA 125 test.

Risk-reducing salpingo-oophorectomy also is an option. This is the removal of the fallopian tubes and the ovaries in a woman who does not have cancer. It is recommended for women with BRCA1 or BRCA2 mutations between ages 35 to 45, or when childbearing is complete. It may also be recommended for women with Lynch syndrome. This operation reduces the risk of ovarian cancer. When it is done before menopause, it also reduces the risk of getting breast cancer.

Having this surgery before menopause will cause immediate menopause symptoms, which are often more severe than when menopause occurs naturally. Symptoms can be managed with a variety of hormonal and nonhormonal medications, as well as lifestyle changes. Also, once both ovaries are removed, you cannot get pregnant using your own eggs.