Ovarian Cancer

The ovaries are two reproductive glands that sit on each side of the uterus and produce the eggs that can develop into a fetus. Ovaries are also the main source of estrogen and progesterone in females, and are in close proximity to the fallopian tubes and peritoneum. Epithelial cells make up the surface lining of the ovaries, fallopian tubes, and peritoneum, and are the cell from which cancer usually originates. Cancer that arises from any of those sites is often referred to generally as ovarian cancer, and the treatment is similar even if the cancer originated in a fallopian tube, for example.

Ovarian malignancies are in a group known as gynecological cancers. Wilmot Cancer Institute offers comprehensive, advanced patient care for ovarian cancer — including expertise in using biomarkers to detect ovarian cancer — as part of our Gynecological Oncology Program.  Our investigators also conduct research at the University of Rochester Medical Center’s Targeted Therapeutics Laboratory for Gynecological Cancers at Wilmot.

Wilmot’s physicians have received additional specialty training in gynecological cancers, which means they are not just specialists in cancer but in gynecological cancers. All gynecological cancer surgeries are performed at UR Medicine’s Highland Hospital in Rochester.

Ovarian cancer types

Epithelial carcinomas: They account for nearly 90 percent of ovarian cancers.  This type can be further classified into four or five different subtypes based on how the cancer cells look under a microscope, with the most common being serous type.

Ovarian germ cell tumors: These are exceedingly rare, accounting for less than two percent of ovarian cancers. They have different subtypes; germ cells form the eggs in females and the sperm in males.

Ovarian stromal tumors: This type accounts for less than one percent of all ovarian cancers. It usually occurs in women older than 50 who experience abnormal vaginal bleeding.

Ovarian cancer facts

It is the fifth leading cause of death in women in the U.S.  However, ovarian cancer accounts for only 3 percent of all cancers in women. The lifetime risk of getting ovarian cancer is about one in 75. Unfortunately, women are often diagnosed when the cancer is in advanced stages due to a lack of distinct symptoms and effective screening tests, which accounts for the higher death rate. More than 22,000 U.S. women are diagnosed annually.

Causes and risk factors

Aging is perhaps the biggest risk factor because more than half of all ovarian cancers are found in women 63 or older. A family history (mother, sister or daughter with ovarian cancer) and the presence of certain inherited gene mutations (such as BRCA1 and BRCA 2 mutations, which are also associated with breast cancer) are strong risk factors. The risk gets higher the more relatives you have with ovarian cancer, including people on your father’s side of the family.

Additional risk factors include:

• Obesity, with a body mass index of 30 or higher.
• Reproductive history. Having children before age 26 lowers the risk; having no children or having children after age 35 boosts the risk of ovarian cancer.
• About five to 10 percent of ovarian cancer is linked to family cancer syndromes that result in mutations of certain genes. Some of these syndromes include: Cowden disease (due to a mutation in the PTEN gene); Lynch syndrome or hereditary nonpolyposis colon cancer (due to mutations in many different genes that reduce the body’s ability to repair DNA); and Peutz-Jeghers syndrome (caused by mutations in the STK11 gene).

Prevention

Some risk factors for ovarian cancer are within a woman’s control and others, such as having an inherited predisposition to the disease, are not. To prevent ovarian cancer, doctors recommend maintaining a healthy weight and eating a low-fat, plant-based diet, and using oral contraceptives (the pill) for five or more years. Women who take the pill for long periods have about a 50 percent lower risk of getting ovarian cancer.

Surgery is another prevention strategy, although it’s important to talk to your doctor about the risk and benefits. Women with a strong family history that suggests a genetic mutation (such as BRCA1 or BRCA2) might consider genetic counseling. Premenopausal women beyond the childbearing years sometimes elect to have their fallopian tubes and ovaries removed to substantially reduce their risk of ovarian cancer as they age.