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Among the three main types of ovarian cancer, epithelial ovarian cancer is by far the most common. It represents nearly 9 of 10 cases of ovarian cancer. In this type of cancer, tumors begin growing in the epithelial cells found on the outer surface of the ovary.
Other types of ovarian cancer are less common. Germ cell tumors affect the cells that produce the eggs in the ovaries. Stromal tumors develop from the tissue that provides structure for the ovary and makes reproductive hormones. Epithelial ovarian cancers may require different treatments and lead to different outcomes compared to germ cell or stromal cell cancers.
Doctors further divide epithelial tumors into types based on the way the tumors grow and what the cancer cells look like. Not all tumors that develop from epithelial cells are diagnosed as cancer. Some are benign (noncancerous) and don’t grow out of control like a cancerous tumor. Others are called “borderline” or “low malignant potential.” These tumors have cells that grow abnormally but rarely spread into nearby tissues.
Malignant (cancerous) epithelial tumors contain very abnormal cells. They spread throughout the body if they’re not treated. Several types of epithelial cancers grow in the ovaries:
Cancers of the fallopian tube and peritoneum (inner lining of the abdomen) are often grouped with epithelial ovarian cancer. These cancers often grow in similar ways and are usually treated with the same types of treatment.
Cancer starts when something changes in a cell’s DNA and causes it to grow out of control. These changes, called mutations, can make cells grow too fast or stop them from fixing damage.
Some gene mutations are inherited (passed down within families). Everyone has these in all their cells at birth. The most commonly mutated genes that can lead to ovarian cancer are BRCA1 and BRCA2. About 10 percent to 15 percent of epithelial ovarian tumors have BRCA mutations. These mutations can also increase breast cancer risk. Other changes in genes that cause cancer can also be passed down from family members. Up to 1 in 5 people with ovarian cancer have inherited gene mutations. Doctors often recommend genetic testing to look for these mutations.
More often, ovarian cancer is caused by acquired gene changes. These develop in cells during a person’s lifetime. Different environmental or lifestyle-related factors associated with these mutations increase someone’s chances of developing epithelial ovarian cancer.
These risk factors include:
Some of these risk factors can’t be controlled. However, there are steps a person can take to reduce their ovarian cancer risk. People who breastfeed develop ovarian cancer at lower rates. Additionally, using hormonal birth control methods such as oral contraceptives (birth control pills) or IUDs can lower a person’s risk.
Epithelial ovarian cancer may not cause any signs at first. But as it grows, it’s more likely to lead to symptoms such as:
If you notice any of these symptoms, talk to your healthcare team.
Epithelial cancers of the ovary can be diagnosed after a series of tests. If you or your doctor notices possible symptoms of ovarian cancer, your cancer care team may perform a pelvic exam. Your doctor will examine your vagina, cervix, and the other tissues in the pelvis and feel for any lumps.
A CA-125 blood test may also find signs of cancer. The CA-125 molecule is released by cells into the blood. High CA-125 levels can be a sign of epithelial ovarian cancer or other benign conditions, like endometriosis — a condition where tissue similar to the lining of the uterus grows outside the uterus.
Your doctor may want to use imaging tests to get a better look at your reproductive organs. These tests often include an ultrasound, which uses sound waves to form images. Some people may need another imaging test, such as a CT or MRI scan.
The only way to know whether a mass is cancerous is through a biopsy. During this procedure, a small piece of tissue is removed so that it can be examined under a microscope. Masses on the ovaries or fallopian tubes are usually biopsied during surgery.
Doctors may recommend several different types of treatments for epithelial ovarian cancer. These include surgery, chemotherapy, and targeted therapy. Your ovarian cancer treatment plan may depend on the gene changes found in your cancer cells and whether it’s possible to surgically remove your cancer, as well as other factors.
Those other factors include your:
Epithelial ovarian cancer treatment usually begins with surgery. The surgeon often performs a bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries) and hysterectomy (removal of the uterus). These procedures lead to infertility.
Some people with very-early-stage ovarian cancer have tumors in only one ovary or fallopian tube. If these individuals want to get pregnant in the future, they may be able to have only the organs with cancer removed. If the remaining ovary, fallopian tube, and uterus are left in place, pregnancy may be an option. However, most people with ovarian cancer will need to have all of their reproductive organs removed.
If cancer has begun to spread to nearby tissues, doctors will perform cytoreduction (or debulking) surgery. This procedure involves removing as much cancer as possible. The surgeon may need to remove tumors from multiple areas and take out any tissues that contain cancer cells.
Most people with epithelial ovarian cancer need to have six or more rounds of chemotherapy after surgery. Doctors usually recommend two chemotherapy drugs: carboplatin (Paraplatin) and paclitaxel (formerly sold under the brand Taxol). Chemotherapy may be intravenous (injected into a vein) or intraperitoneal (delivered directly into the abdomen).
People with stage 3 or stage 4 epithelial tumors may need to undergo chemotherapy treatments before surgery to shrink the cancer and make it easier to remove. When used this way to treat ovarian cancer, it’s called neoadjuvant chemotherapy.
Sometimes, advanced ovarian cancer treatments may cause complications. For instance, chemotherapy drugs can damage the body’s normal cells as well as the abnormal cancer cells. However, targeted therapy drugs recognize specific molecules found on cancer cells and leave most of the body’s normal cells alone.
People with stage 3 or stage 4 epithelial ovarian cancer may take the targeted therapy drug bevacizumab (Avastin) along with chemotherapy.
Your oncology team may also recommend poly (ADP-ribose) polymerase (PARP) inhibitors. PARP inhibitors target cancer cells and prevent them from repairing their damaged DNA, which causes the cells to die. Drugs in the PARP inhibitor family include olaparib (Lynparza), rucaparib (Rubraca), and niraparib (Zejula).
Mirvetuximab soravtansine-gynx (Elahere) is a newer targeted therapy option. This drug is a type of antibody drug conjugate. These drugs are part of a newer and promising approach to treating ovarian cancer.
Researchers test new treatment options during clinical trials. People who participate in clinical trials may be able to access new therapies that aren’t yet part of standard treatment plans.
Clinical trials may be available for those with different stages of ovarian cancer. Some people use clinical trials as their first treatment option, while others may choose to enroll after trying other therapies.
Epithelial ovarian cancer is often diagnosed at a more advanced stage, after it has begun to spread to nearby or more distant tissues. The cancer’s stage at diagnosis plays a big role in survival rates:
The five-year survival rate is the percentage of people who are still alive five years after being diagnosed with cancer. This number can change depending on how far the cancer has spread when it’s found.
Keep in mind that these statistics are based on prior research. As treatments improve, survival numbers are also expected to rise.
To determine outlook, doctors use prognostic factors. These characteristics increase a person’s chances of having a good or poor outcome. One of the strongest prognostic factors for epithelial tumors is residual disease. This measures how much cancer is left in the body after surgery. People with little or no residual disease are more likely to have a good outlook. That’s why being treated by a doctor experienced in ovarian cancer can be especially beneficial.
Other prognostic factors that increase the chance someone will have a poor outlook include:
If you’d like to know more about your prognosis, talk to your healthcare team. Your oncologist understands your health factors and can explain how they may affect your outlook. They can also answer questions and help you plan your next steps.
On MyOvarianCancerTeam, the social network for people with ovarian cancer and their loved ones, more than 7,000 members come together to ask questions, give advice, and share their stories with others who understand life with the condition.
Have you been diagnosed with epithelial ovarian cancer? Share your experiences in the comments below, or start a conversation by posting on your Activities page.
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Originaly Diagnosed With Clear Cell & Endometriod, At MD Anderson , What Looked Like Clear Cell Was Mesoniphric Like Cancer.
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A MyOvarianCancerTeam Member
Rhonda, you go girl!!!! Love your attitude!
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