The Medical Minute: Ovarian cancer awareness

September 29, 2004

By John Messmer
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine

The American Cancer Society estimates there will be more than 25,000 new cases of ovarian cancer diagnosed this year, with more than 16,000 deaths. Ovarian cancer accounts for only 4 percent of all cancers for women, yet it creates much anxiety because it is difficult to detect and causes vague symptoms.

When diagnosed, almost 70 percent of the most common type of ovarian cancer is in the advanced stage. Most ovarian cancers occur in women age 40 or older with an average age of 61, but younger women are not immune. One in 55 women will develop ovarian cancer.

There are three general categories of ovarian cancer that are classified according to the type of ovary cell from which they arise. The outer covering of the ovary gives rise to epithelial cell tumors. Most of these are benign, but when they are malignant, they are the most dangerous.

Germ-cell tumors start in the cells that develop into eggs. As with epithelial tumors, most are benign. Malignant germ-cell tumors are more common in women in their teens or 20s. Fortunately, progress is being made in their treatment so most can be cured and fertility often can be preserved.

Stromal tumors develop in the supporting tissue of the ovary. They are rare and commonly present early in the disease, making them less of a threat.

There is some genetic basis for ovarian cancers, although most occur in women with no family history. About 5 percent to 7 percent result from inherited cancer susceptibility genes, BRCA1 and BRCA2. Everyone has two copies of these genes that act as tumor suppressors. If a woman has a defective copy, her risk of ovarian and breast cancer is significantly higher than tht of the general population. These mutations are more common in women with Ashkenazi (Eastern European) Jewish ancestry. Increased risk of genetic susceptibility in a family is suspected when the family has two or more women with breast and/or ovarian cancer, especially premenopausal; a woman who has had breast and ovarian cancer; a woman with breast cancer in both breasts; a man with breast cancer in addition to a woman with breast or ovarian cancer; or a woman with ovarian cancer who is an Ashkenazi Jew.

Many cancers have screening tests to aid in early detection and treatment: Pap smears for cervical cancer, mammography for breast cancer, colonoscopy for colon cancer and so on. Unfortunately, there is no good screening test for ovarian cancer, a conclusion supported by the U.S. Preventive Services Task Force. Some popular magazines and Internet rumors have given the impression that the tumor marker, CA-125, should be used for screening. Because other conditions can raise CA-125 levels and many women with ovarian cancer do not have elevated levels, it is not good for screening, although it is used to follow disease progress if it is elevated at the time of diagnosis.

Ovarian cancer once was thought to be silent, because it did not cause symptoms. Recent research has found otherwise, although the symptoms are rather non-specific and commonly are seen in other, non-cancerous conditions. Pelvic or abdominal pain or discomfort and bloating; unexplained weight loss or gain; changes in bowel habits; gastrointestinal upset; and urinary frequency have been seen in ovarian cancer, but by themselves are not specific to it. What these symptoms should do is raise the question of ovarian cancer in a woman for whom no other explanation has been found.

Many diseases can be prevented or the risk can be lowered and the same goes for ovarian cancer. The risk of epithelial cell cancer is lower with a decrease in the number of monthly ovulations. Increased number of pregnancies regardless of outcome, breast-feeding and oral contraceptive use reduces risk. A small reduction in risk occurs with tubal ligation. Diets low in animal fat and high in vegetables have some protective effect. Whole-milk drinkers have increased risk compared to those who drink skim or 2 percent milk. Fertility drugs and hormone replacement is associated with a small increase in risk.

It is important to remember that the best way to detect ovarian cancer early is to consider it when there are vague abdominal or pelvic symptoms not explained by another cause, and if they are persistent. Pelvic examination may not be sensitive enough to detect ovarian tumors in many cases. Transvaginal ultrasound is helpful but not always diagnostic when looking for ovarian tumors, and most tumors found are benign. If you are concerned you may have an ovarian tumor, ask your doctor if he or she has considered it.

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Last Updated March 19, 2009