The ovaries are small, paired female reproductive glands
that serve as the main source of the hormones estrogen
and progesterone. Ovarian cancer is cancer that begins in
the ovaries and may arise from 3 main kinds of cells: epithelial
cells (cells that cover the ovaries), germ cells (cells
that produce the eggs) and stromal cells (cells that form
the supporting or structural tissue holding the ovaries together).
Ovarian carcinomas are the most common ovarian cancers,
accounting for about 85% to 90% of all ovarian cancers.
Subtypes include serous, mucinous, endometrioid,
clear cell and undifferentiated. The main focus of this document
is epithelial ovarian carcinomas.
Ovarian cancer often goes undetected. Often the cancer is
found after it has spread within the pelvis and abdomen.
As a result the cancer is difficult to treat.
Fallopian tube and primary peritoneal cancer are closely
related to epithelial ovarian cancer
Poor appetite; weight loss; abdominal pain or vague discomfort
above navel; sense of fullness in upper abdomen
after eating a small meal; heartburn or indigestion; nausea;
vomiting (+/- blood); swelling or fluid build-up in abdomen.
There are no screening testrecommendations for ovarian
cancer at this time. Transvaginal ultrasonography and
CA–125 testing may be suggested when appropriate.
Surgery to remove the tumor is the primary
treatment. The grade of the cancer, which
determines aggressiveness, may suggest
watchful surveillance or treatment with chemotherapy
Surgery for staging and debulking the cancer
is generally indicated. This includes removal
of the uterus along with the fallopian tubes
and ovaries (total abdominal hysterectomy
with bilateral salpingo-oophorectomy). In
addition, the omentum, fluid in the pelvis or
abdominal cavity, and lymph nodes in the
pelvis and abdomen are removed and analyzed.
Chemotherapy is recommended for at
least 6 cycles.
Treatment options include surgery and
combination chemotherapy, which involve
more than one medication at a time. Different
options of administrating chemotherapy,
such as intraperitoneal chemotherapy, may
be suggested. Patients who are too weak to
have full staging and debulking surgery are
sometimes treated with chemotherapy as the
first treatment. Clinical trials for combination
chemotherapy, biologic therapy and/or targeted
therapy may be considerations.
Demographics: Older age
Medical History: Early menarche/late menopause, obesity,
fertility drugs; estrogen hormonal therapy
Risk reduction options: Birth control pills; injectable hormonal
contraceptives; pregnancy; breastfeeding; tubal
ligation; hysterectomy; bilateral salpingo-oophorectomy;
other contraception that prevents ovulation; low-fat diet
Inherited: Family history of disease; inherited genetic syndromes
Associated Myriad MyRisk™ Genes: BBRCA1, BRCA2, MLH1,
MSH2, MSH6, PMS2, EPCAM, TP53, STK11, BRIP1, RAD51C, RAD51D