Ovarian cancer

This type of ovarian cancer begins in the tissue that lines the outside of the ovaries called the epithelium. Women over 50 are more likely to be diagnosed with epitehlial ovarian cancer, however it can happen at any age.

The subtypes of epithelial ovarian cancer are:

• serous
• mucinous
• endometrioid
• clear cell
• transitional cell
• undifferentiated types

Stromal

Stromal ovarian cancer is fairly uncommon and grows in the connective tissue that holds the ovary together. This tissue is also where the hormones estrogen and progesterone are produced. Stromal cancers are usually slow-growing compared to other ovarian cancers. The subtypes are as follows:

• granulosa cell
• granulosa-theca
• fibromas
• Sertoli cell
• Sertoli-Leydig
• steroid

Germ Cells

Germ cell ovarian cancer develops in the areas of the ovary that create your eggs. Germ cell cancers usually affect women under the age of 30, but that is not always the case. There are 5 subtypes of germ cell tumors which include

• dysgerminoma
• yolk sac (also called endodermal sinus tumor, or EST)
• embryonal carcinoma
• choriocarcinoma
• teratoma

In even more rare scenarios there can be ovarian cancer called primary peritoneal cancer. These can be similar to epithelial ovarian cancers but it starts in the pelvis and abdomen. A woman can be diagnosed with this cancer even if she no longer has her ovaries.

Who is more likely to get it?

Anyone who has female organs can develop ovarian cancer at any stage in her life, however there are some factors that can make some people more susceptible to being diagnosed with ovarian cancer than others. These factors include:

• being an older women - usually those over the age of 60 are diagnosed with ovarian cancer, however women can get it at much younger ages as well, especially when it comes to germ cell tumors
• family history of ovarian cancer
• having no children - women who have had one or more children are less likely to develop ovarian cancer than women who have never had children
• hormone replacement therapy - estrogen therapy over long periods of time can make you more at risk
• starting your period early at a young age
• starting menopause later than typically expected
• certain genetic factors - there are certain genes and syndromes when may have that make them at higher risk for ovarian cancer than other women such as the BRCA1 & BRCA2 mutation, BRIP1, RAP51C or RAD51D genes, hereditary breast ovarian cancer syndrome or hereditary non-polyposis colorectal cancer (Lynch syndrome)

Is there any way I can prevent or screen for this?

There is no absolute way to prevent getting ovarian cancer, however there are things that you can do to help your chances.

Women who take oral contraceptives, or more commonly known as birth control pills, may be less likely to develop ovarian cancer. This is not true for all cases, and birth control can come with its own risks and negative side effects, so speak with your doctor if you're interested in taking birth control for prevention.

There is also no current screening service for ovarian cancer like other big female cancers, such as breast or cervical cancer. However, there are certain blood "cancer markers" such as testing for something called CA-125 that professionals have considered for current and future screening.

I'm worried somethings up. How can I check for it?

To diagnose ovarian cancer first your doctor will do a pelvic exam to see if they can feel for any masses or anything abnormal. Then your doctor may order some imaging which can be done by a transvaginal (via the vagina) ultrasound, CT scan or an MRI scan.

At this same time the doctor may take blood samples to test for certain "cancer markers" in the blood. These markers are proteins that can be in higher volumes if cancer is present.

If the doctor suspects cancer, surgery may also be done to remove one or both ovaries to be tested for cancer.

I have it. Now what?

If you have been diagnosed with ovarian cancer, your doctor will come up with a treatment plan based on the type of ovarian cancer you have, the size and location of your tumor, and if the cancer has spread. On average both surgery and chemotherapy are used to treat ovarian cancer.

Surgery for ovarian cancer is typically done before chemotherapy, but in some cases if the cancer is difficult to surgically remove, your team of doctors may suggest doing chemotherapy first to shrink the size of the tumor before surgery.

Surgeries can be to...

• remove only one ovary and corresponding fallopian tube - This is called a unilateral salpingo oophorectomy and is done when the cancer can not spread beyond one ovary. This surgery is usually done on women who would still like to preserve an ovary to have children.
• remove both ovaries and fallopian tubes - This is called a bilateral salpingo oophorectomy and allow you to preserve the womb (uterus) in which you can become pregnant from your own frozen egg, embryo (fertilized egg with sperm) or a donor egg.
• remove both ovaries and uterus - If the cancer has spread, this might be the best option. This surgery will usually include the fallopian tubes, nearby lymph nodes (glands) and omentum (fatty later of tissue that holds the organs).

Chemotherapy is also a standard treatment for ovarian cancer and will usually be done after surgery. The type of chemo and how many cycles you have of it will depend on the type of ovarian cancer that you're diagnosed with.

If your cancer has returned or if it isn't responding well to other treatments, you might consider targeted drug therapy or immunotherapy. There is ongoing research on new treatments all the time, especially in the field of targeted therapy, so ask your doctor and your cancer networks about any new treatments if this applies to you.