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Ovarian cancer is the fifth most common cancer in women, and the fourth most common cause of death ("Overview"). It is a life-threatening (malignant) tumor that develops in one or both ovaries. There are normally two ovaries, one on each side of the womb (uterus). The ovaries produce eggs as well as the female hormones estrogen and progesterone.
Ovarian tumors are named for the kinds of cells the tumor started from and whether the tumor is benign or cancerous. The three main types of tissue are epithelial cell, stromal cell, and germ cell. Epithelial cells cover the ovary, and are responsible for approximately 85% to 90% of ovarian cancers. Stromal cells are inside the ovary, account for 5% to 10% of ovarian cancers, and are the primary source of the female hormones estrogen and progesterone. Germ cells are also located within the ovary, account for up to 15% of ovarian cancers, and are the cells that make the eggs; tumors from this type of cell are more common in teenaged girls and young women. Epithelial tumors can be further divided into benign epithelial tumors, low-malignant potential (LMP) tumors, and epithelial ovarian carcinoma, and can be differentiated histologically into serous, mucinous, endometrioid, and clear cell types. Treatment depends upon the type, grade, and staging of the tumor. Epithelial tumors are graded according to how closely the cells resemble normal cells, with Grade 1 being nearly normal in appearance, Grade 2 less normal, and Grade 3 the least normal.
Ovarian tumors are staged on a scale of I to IV, according to how well- or poorly-organized they are and whether the cancer is localized or metastatic: stage I is cancer that is localized, contained in the ovary or ovaries; stage II is cancer that has spread to other pelvic organs, such as the uterus, bladder, or rectum; stage III is cancer that has spread to the lymph nodes and/or abdominal lining; and stage IV is cancer that has spread to distant organs, such as the brain, bone, lungs, or liver.
Risk: Risk factors for the development of ovarian cancer include family history, age, obesity, frequency of egg release from the ovary (ovulation), and ethnic and dietary factors. Positive family history of ovarian, breast, or uterine cancer in first-degree relatives (mother, sister, or daughter) is found in only 5% to 10% of cases. Feminine powders or deodorant sprays may be associated with increased risk. Most women who develop ovarian cancer do not have any known risk factors.
Women whose number of ovulations is decreased by pregnancies, irregular periods, birth control pills, menopause earlier than age 50, or breast feeding may be less likely to develop ovarian cancer. Tubal ligation and hysterectomy have also been associated with a reduced risk of ovarian cancer, but the evidence is less conclusive. It is unclear if short-term hormone replacement therapy (HRT) contributes to the risk, but those using HRT longer than 10 years show twice the risk for ovarian cancer as those who do not ("Overview"). Incidence and Prevalence: The incidence of ovarian cancer increases with age from approximately 20 per 100,000 for women age 30 to 50, to 40 per 100,000 for women age 50 to 75. Although ovarian cancer occurs most commonly after menopause (average age is 63), it may occur at any age.
Ovarian cancer is the fifth most commonly diagnosed cancer in women, and is the fourth most common cause of death; it accounts for 3% of all cancers in women ("Overview"). Approximately 22,220 new cases are projected for the year 2005 in the US, with 16,210 deaths; a woman's risk of developing and dying from ovarian cancer in her lifetime is 1 in 98, with a higher risk for white women than black women ("Overview"). |
Source: Medical Disability Advisor
| History: History is nonspecific in that symptoms are vague and may resemble menopausal symptoms and intestinal illnesses. Individuals may report indigestion, gas, nausea, vomiting, loss of appetite, a feeling of fullness after small meals, pelvic or abdominal pain, swelling, increased frequency or urgency of urination, unexplained change in bowel habits, unexplained weight gain or loss, pain during intercourse, ongoing fatigue, lower back pain, shortness of breath, and, in rare cases, postmenopausal vaginal bleeding. These symptoms do not usually become apparent until the later stages of the disease when the cancer mass is large enough to interfere with pelvic organs such as the bladder or rectum, or has spread to the abdominal cavity (metastasized). Physical exam: There is not yet a physical exam or screening test to detect ovarian cancer in its early stages. Unfortunately, because ovarian cancer often has no symptoms in its earliest stages, over 70% of women are in an advanced stage of the disease when diagnosed.
Annual gynecologic exams (pelvic exams) can reveal the presence of the disease, usually in its later stages. During the pelvic exam, which also includes a Pap smear, the physician examines the ovaries for size, shape, and consistency, and evaluates the abdomen for fluid in the abdominal cavity (ascites). Tests: At the present time, there is no definitive screening test for detection of ovarian cancer in its early stages comparable to mammography for early detection of breast cancer. Exploratory abdominal surgery (laparoscopy) performed to confirm the presence of cancer suspected from physical exam is the only definitive way to diagnose ovarian cancer. During laparoscopy, the tumor is removed for laboratory evaluation and fluid from the abdominal cavity is assessed for presence of cancer cells.
Noninvasive tests such as ultrasound performed with a small instrument in the vagina (transvaginal ultrasound), CT, MRI, and the CA-125 blood test may help distinguish between benign and cancerous tumors. X-ray tests (barium enema or intravenous pyelogram) are used if involvement of the colon or urinary system is suspected. The CA-125 blood test measures a protein secreted by ovarian cancer cells that is elevated in over 80% of individuals with ovarian cancer. However, the test is not perfect. Normal levels of CA-125 are somewhat ambiguous, as the protein is also secreted by other cancerous and precancerous conditions. Furthermore, approximately 50% of women with early ovarian cancer do not show elevated CA-125 levels. So, only females at great risk for the development of ovarian cancer need CA-125 levels and transvaginal ultrasound as screening tests ("Overview"). |
Source: Medical Disability Advisor
| Ovarian cancer treatment usually involves a combination of surgery to remove (excise) the tumor, chemotherapy that uses drugs to kill the cancer cells, and radiation (high energy x-rays) to kill cancer cells.
The initial treatment for ovarian cancer is surgery. Complete surgical intervention includes surgical staging and debulking. Surgical staging is the examination of tissues and organs in the pelvic cavity to accurately assess the disease. Debulking is removal of as much of the cancerous tissue as possible. The ovaries, fallopian tubes, uterus, the fold of fatty tissue covering and padding the organs in the abdomen (omentum), and affected lymph nodes or surrounding tissues are usually removed.
After surgery, most individuals are treated with chemotherapy. Chemotherapy becomes the mainstay of the treatment process if the cancer recurs. New combinations of chemotherapy drugs have demonstrated improved survival rates in recent years. It is usually administered intravenously on an outpatient basis within a few weeks after surgery. The treatment is repeated every 3 weeks for a total of 6 times. Each 3-week interval is referred to as a "cycle" of chemotherapy. Chemotherapy can also be given by injecting it directly into the fluid inside the abdominal and pelvic cavity (intraperitoneally).
Radiation therapy is not administered as often as chemotherapy because of its toxicity; however, it is used when afflicted areas are painful and not responding to chemotherapy, or when the disease has spread to the brain, bones, or lungs. Radiation is usually given by aiming radiation beams at the abdomen. Radioactive phosphorus can also be injected intraperitoneally.
Treatment with surgery and chemotherapy is tailored to the four stages of the disease. For epithelial ovarian cancer, in stage I (cancer confined to the ovary), surgery is performed for staging and removal of the ovary (oophorectomy). In stage II (cancer spread outside of the ovary but confined to the pelvis), both surgery and chemotherapy or radiation therapy are used. In stages III and IV (cancer spread to the abdomen, and cancer spread to distant organs), surgery, debulking, and chemotherapy are used. After treatment, blood tests are performed to determine if tumor marker levels have returned to normal, and are sometimes followed by a second operation (second-look laparoscopy) to see if more treatment is required. If both ovaries need to be removed (bilateral oophorectomy), the individual will go through a surgical menopause and will become sterile.
For low-malignant potential (LMP) tumors, surgery is performed to remove the affected ovary and the fallopian tube on the same side (salpingo-oophorectomy). If the cancer returns, chemotherapy and radiation may be used in conjunction with further surgery.
For stromal and germ cell tumors, part of or the entire affected ovary may be removed. Since this type of tumor is usually benign, surgery will enable staging and assessment of the need for further surgery or chemotherapy. |
Source: Medical Disability Advisor
| The most significant predictor of outcome is the stage of the cancer at the time of diagnosis. Ovarian cancers are staged (stages I to IV) according to whether they are localized (remain in the ovary) or have spread beyond the ovary. The 5-year survival rates for the four stages are stage I, 80% to 90%; stage II, 65% to 70%; stage III, 30% to 60%; and stage IV, 20% ("Overview").
Outcome is also contingent on the cell type and grade of the cancer at the time of diagnosis and other factors. Clear cell carcinomas are the most difficult to treat even when the cancer is confined to the ovary.
Overall, past research indicates that 33% of all individuals with ovarian cancer will be alive 5 years following diagnosis. This low survival rate is due to the fact that the disease is rarely detected early. The best survival rates are in women whose disease has not spread beyond the ovary (80% to 90% of women diagnosed with stage I disease will survive for 5 years). Outcome also depends on what is discovered during a second exploratory surgery (laparoscopy) performed after the individual is treated. |
Source: Medical Disability Advisor
| Women diagnosed with ovarian cancer may require physical and/or occupational therapy prior to discharge from the hospital to improve strength, balance, and self-care. Additional home therapy to address weakness and decreased endurance due to chemotherapy and/or radiation may also be necessary. In addition to progressive exercises, therapists address any equipment needs and other safety issues that may be present.
Individuals who are in the end stages of ovarian cancer may require palliative therapy, in which the primary focus is pain control. Rehabilitation specialists and hospice workers all provide palliative care services. Women with the diagnosis of cancer may find it beneficial to undergo psychological counseling either on an individual basis or in a support group setting. |
Source: Medical Disability Advisor
| Complications of ovarian cancer are caused by spread of the cancer to other organs with progressive loss of function in those organs. Examples of complications include bowel obstruction, urinary obstruction, fluid collection in the chest (pleural effusion), and ascites. Bowel and urinary obstructions can result in loss of the use of the bowel and urinary tract. Pleural effusions cause shortness of breath and sometimes a mild, nonproductive cough. The symptoms of ascites increase with the increasing amount of fluid and include abdominal enlargement (distention), loss of appetite, shortness of breath, abdominal pain, low blood pressure, weakness, and fatigue. |
Source: Medical Disability Advisor
| Work restrictions and accommodations include restricting the number of hours worked per day and number of days per week. Work responsibilities may need to be largely sedentary. Because of fatigue and weakness from the surgery and extended chemotherapy (and radiation therapy if it is a part of the treatment program), a woman may need a place at the work site where she can periodically rest. Women undergoing chemotherapy and/or radiation may need additional leave from work to attend appointments. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual complain of indigestion, gas, nausea, vomiting, loss of appetite, or a feeling of fullness after small meals?
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Is there pelvic or abdominal pain, increased frequency or urgency of urination, unexplained change in bowel habits, unexplained weight gain or loss, pain during intercourse, ongoing fatigue, lower back pain, or shortness of breath?
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Did the physician note ovarian and abdominal enlargement and fluid in the abdominal cavity (ascites) during a pelvic exam?
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Does the physician believe the ovaries to be the primary site for the cancer or could the tumor be a secondary breast, lung, or other type of cancer that has spread to the ovaries?
Regarding treatment:
- Did surgery successfully remove all evidence of cancer cells?
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Has individual undergone chemotherapy and/or radiation therapy?
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Did individual tolerate and complete those therapies? If not, would individual benefit from experimental treatments?
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Did individual receive treatment from a gynecologic oncologist?
Regarding prognosis:
- What stage of ovarian cancer does individual have?
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Were all treatment options explored?
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Would individual benefit from second opinion consultations?
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Would individual benefit from counseling for psychological and emotional effects from the disease?
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What, if any, complications have developed? How can these be treated? What is expected outcome of the complication with treatment? How do these complications affect the activities of daily living for individual?
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Source: Medical Disability Advisor
| "Overview: Ovarian Cancer." American Cancer Society. 22 Sep. 2004 <http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_ovarian_cancer_33.asp?sitearea=>. |
Source: Medical Disability Advisor
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