tumors may straddle the border. Doctors classify
such tumors as low malignant potential (LMP);
though cancerous these tumors grow slowly, have
little propensity to metastasize (spread) and usually
respond very well to treatment. Ovarian epithelial
cancer that develops in women under age 60 is
often LMP. Ovarian germ cell cancer and ovarian
stromal cell cancer are rare; they are more likely to
occur in women under age 50 (before menopause).
Doctors in the United States diagnose ovarian
cancer in about 22,000 women each year. Because
ovarian cancer typically causes few symptoms
until it has metastasized (spread), the prognosis
(outlook) for ovarian cancer overall is rather
bleak. However, early diagnosis allows successful
treatment and a promising outlook. Any woman
who has her OVARIESis vulnerable to ovarian can-
cer, even if she has had a HYSTERECTOMY(OPERATION
to remove the UTERUS). Bilateral OOPHORECTOMY
(operation to remove both ovaries) ends the risk
for ovarian cancer, though it remains possible for
epithelial cancer very much like ovarian cancer to
develop in the peritoneum, the membranous lin-
ing of the abdominal cavity.
Symptoms and Diagnostic PathEarly symptoms of ovarian cancer are often gener-
alized and vague. Both the woman and her doctor
commonly mistake them for symptoms of gas-
trointestinal disorders. These early symptoms may
include
- sensation of abdominal bloating
- abdominal swelling
- unexplained weight gain
- changes in bowel habits (CONSTIPATIONor DIAR-
RHEA) - urinary urgency
As ovarian cancer progresses, symptoms
become more specific and include
- pelvic, abdominal, or low BACK PAIN
- unexplained weight loss
- unusual vaginal bleeding
- fatigue and general sense of not feeling well
(malaise)- persistent gastrointestinal symptoms (NAUSEA,
VOMITING, diarrhea, or constipation) that do not
vary with eating patterns
- persistent gastrointestinal symptoms (NAUSEA,
The diagnostic path includes comprehensive
medical examination including PELVIC EXAMINATION,
BLOODtests (cell count and differentiation as well
as CA- 125 ), abdominal ULTRASOUND or COMPUTED
TOMOGRAPHY(CT) SCAN, and often COLONOSCOPY.
Blood levels of the protein CA-125 are often
elevated in moderate to advanced ovarian cancer
though not in early ovarian cancer. As well,
numerous noncancerous conditions can elevate
CA-125 blood levels. Though the doctor may con-
sider the CA-125 level among the diagnostic indi-
cators, it does not alone confirm or rule out
diagnosis of ovarian cancer. Other tumor markers
include ALPHA-FETOPROTEIN(AFP), HUMAN CHORIONIC
GONADOTROPIN(hCG), and CARCINOEMBRYONIC ANTI-
GEN(CEA).
Because benign tumors and cysts of the ovaries
are common, noninvasive diagnostic procedures
often cannot determine whether an ovarian
growth is cancerous or noncancerous. The only
certain diagnostic procedure is laparoscopy or
laparotomy, both of which are surgical operations
to enter the abdominal cavity, to view the ovary
and remove samples of tissue (biopsy).
Laparoscopy is a MINIMALLY INVASIVE SURGERY in
which the surgeon uses several small incisions
through which he or she inserts an endoscope
(flexible, lighted viewing instrument) and special-
ized instruments to visualize the ovary via display
on a monitor. Laparotomy is an OPEN SURGERYin
which the surgeon makes a substantial incision
through the SKINin the abdomen and examines
the ovary directly.
The pathologist who examines the tissue sam-
ples determines the type of cancer cells that are
present and assesses the extent to which they are
likely to have spread to locations outside the
ovary. The results of this assessment, called STAG-
ING AND GRADING OF CANCER, help guide treatment
decisions. The pathologist also may revise the
stage or grade may change after surgery to remove
the cancer, depending on the surgeon’s findings
and the character of the cancer cells within the
tumor.310 The Reproductive System