Ovarian cancer is a type of cancer that begins in the ovaries. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen and progesterone. The most common type of ovarian cancer is called ovarian epithelial cancer. It begins in the tissue that covers the ovaries. Cancer sometimes begins at the end of the fallopian tube near the ovary and spreads to the ovary. Cancer can also begin in the peritoneum and spread to the ovary. The stages and treatment are the same for ovarian epithelial, fallopian tube, and primary peritoneal cancers. Another type of ovarian cancer is ovarian germ cell tumor, which is much less common. It begins in the germ (egg) cells in the ovary.

Ovarian Cancer Statistics 

The American Cancer Society estimates for ovarian cancer in the United States for 2015 are: About 21,290 women will receive a new diagnosis of ovarian cancer. About 14,180 women will die from ovarian cancer. Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. A woman's risk of getting ovarian cancer during her lifetime is about 1 in 75. Her lifetime chance of dying from ovarian cancer is about 1 in 100. 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 than African-American women. The rate at which women are diagnosed with ovarian cancer has been slowly falling over the past 20 years.

What causes Ovarian Cancer? 

It's not clear what causes ovarian cancer. In general, cancer begins when a genetic mutation turns normal cells into abnormal cancer cells. Cancer cells quickly multiply, forming a mass (tumor). They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize). Certain factors may increase your risk of ovarian cancer:

• Age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.
• Inherited gene mutation. A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer. The gene mutations that cause Lynch syndrome, which is associated with colon cancer, also increase a woman's risk of ovarian cancer. If you have a genetic predisposition to ovarian cancer, your doctor may recommend regular pelvic imaging and blood tests to screen for the disease. Women with an increased risk of ovarian cancer may consider surgery to lessen the risk.
• Estrogen hormone replacement therapy, especially with long-term use and in large doses.
• Never being pregnant.
• Fertility treatment.
• Smoking.
• Use of an intrauterine device.
• Polycystic ovary syndrome.

What are early symptoms of Ovarian Cancer? 

Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel. Signs and symptoms of ovarian cancer may include:

• Abdominal bloating or swelling
• Quickly feeling full when eating
• Weight loss
• Discomfort in the pelvis area
• Changes in bowel habits, such as constipation
• A frequent need to urinate

How does my doctor know I have Ovarian Cancer? 

The doctor is likely to start with a pelvic examination: The outer part of your genitals is carefully inspected. The doctor then inserts two gloved fingers into the vagina and simultaneously presses a hand on your abdomen to feel your uterus and ovaries. A device (speculum) is inserted into the vagina so that the doctor can visually check for abnormalities. Your doctor also may recommend imaging tests, such as ultrasound or CT scans, of your abdomen and pelvis. These tests can help determine the size, shape and structure of your ovaries. He or she may also recommend a blood test, which can detect a protein (CA125) found on the surface of ovarian cancer cells. Ultimately surgery can be recommended to remove a tissue sample and abdominal fluid to confirm a diagnosis of ovarian cancer. Minimally invasive or robotic surgery may be an option. If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible.

What does Classification and Staging of my Ovarian Cancer mean? 

The existing current classification of ovarian epithelial malignancies is based on descriptive histopathology and grading of the degree of differentiation. Using this approach the disease is broken out into six major classes as follows: Borderline malignancies, clear cell carcinomas, mixed mullerian tumors (MMT), mucinous adenocarcinomas, endometrioid adenocarcinomas, and papillary serous carcinomas (most common form constituting more than 80% of the cases). There are obvious differences in the traditional pathologic classifications of the various ovarian epithelial cancers based on their histologic appearance. There is also variability in recurrence rates depending on the histologic subtype. Despite this, all of these cancers are treated in the same manner outlined below. While the descriptive pathology can be helpful in assigning some prognostic information, it tells us little about what might be “driving” the underlying pathogenesis of the disease. Little is known about the molecular pathogenesis of these ovarian cancer subtypes.

Within the UCLA Translational Cancer Research Laboratories at the Jonsson Comprehensive Cancer Center (JCCC) at UCLA we are attempting to better understand the genetic causes and molecular drivers of ovarian cancer. To this end, we have accessed large cohorts of clinical ovarian lesions that are annotated with clinical and demographic information. These lesions have been carefully molecularly characterized and we have been able to identified 4 new distinct molecular subgroups in ovarian cancer with very distinct dominant signaling pathways and signaling alterations. This information is being used to identify, develop and test novel and innovative approaches for the treatment of ovarian cancers. Broad preclinical testing of a growing number of directed inhibitors is being performed in parallel in the UCLA Translational Oncology Research Laboratory in Santa Monica using reliable preclinical ovarian cancer models.  The initial “proof of concept” clinical trials are being conducted in the TRIO US clinical research network. With the large number of targeted therapies now in development, rational approaches for deciding which of the new therapies to test in clinic in which molecular ovarian cancer subtype and which ones to use in which combination are urgently needed. Our laboratory and clinical work has helped to develop promising novel treatment rationales are currently undergoing clinical validation in trials conducted within the existing TRIO US and Global clinical research networks.

Doctors use the results of surgery to help determine the extent — or stage — of the cancer. The cancer's stage helps determine prognosis and treatment options.

Stages of ovarian cancer include:

What are treatments for Ovarian Cancer? 

The initial treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Surgery treatment generally involves removing both ovaries, the fallopian tubes, the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue (omentum) where ovarian cancer often spreads. The surgeon removes as much cancer as possible from the abdomen. Less extensive surgery may be possible if the ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children. After surgery, most patients are treated with chemotherapy to kill any remaining cancer cells. Chemotherapy drugs can be injected into a vein (intravenous) or directly into the abdominal cavity (intraperitoneal) or both. Chemotherapy may be used as the initial treatment even before surgery in some women with advanced ovarian cancer. In some cases intraperitoneal (IP) chemotherapy is recommended as treatment following the initial surgery. Combining IP chemotherapy with intravenous (IV) chemotherapy has shown to improve survival in some women with advanced ovarian cancer, though its use in clinical practice has been limited, according to findings from a new study. IP chemotherapy is delivered through an implanted subcutaneous port that drains into the cavity of the abdomen, allowing direct access for the drug to the peritoneal cavity, where ovarian cancer has spread. Its use, however, can cause more frequent and more severe side effects than IV chemotherapy, including abdominal pain, nausea, and vomiting.

Certain factors affect treatment options and prognosis (chance of recovery):

• The stage and grade of the cancer.
• The type and size of the tumor.
• Whether all of the tumor can be removed by surgery.
• Whether the patient has swelling of the abdomen.
• The patient’s age and general health.
• Whether the cancer has just been diagnosed or has recurred (come back).

Recurrent ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer is cancer that has recurred (come back) after it has been treated. Persistent cancer is cancer that does not go away with treatment. Treatment of recurrent ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer may include the following:

• Chemotherapy using one or more anticancer drugs, with or without surgery.
• Targeted therapy with novel agent either alone or combined with chemotherapy.
• A clinical trial of a new treatment.