Types of Ovarian Cancer

Ovarian cancer
Ovarian cancer is diagnosed in nearly a quarter of a million women

globally each year. It is the eighth most common cancer in women and
the seventh leading cause of cancer death among women, responsible
for approximately 140,000 deaths each year. It has the highest mortality
rate of all gynecological cancers.1 The prognosis for ovarian cancer
patients is poor, particularly when the disease is diagnosed in its later
stages.2 Symptoms are ambiguous and often misdiagnosed3, 4 so the
majority of patients are only identified in the advanced stages of the
disease.2 Ovarian cancer is therefore often referred to as “The Silent
Killer”. The current standard of care for ovarian cancer - surgery and
chemotherapy - has remained unchanged for many years and the 5-year
US survival rate has improved by only 9% since 1975.5 Statistics show
that just 45% of women with ovarian cancer are likely to survive for five
years compared to up to 89% of women with breast cancer.6, 7 In most
cases front-line treatment (with surgery and chemotherapy) does not
stop the disease returning. Most women with advanced ovarian cancer
will have a relapse following initial treatment, usually within 15 months
of initial diagnosis.8 There is a real need for new, more effective
.treatment options for women with ovarian cancer
Types of ovarian cancer

The vast majority (over 90%) of ovarian tumors arise from the
uncontrolled growth and replication of epithelial cells which form the
surface of the ovary. Cancer involving this type of cell is known as
epithelial ovarian cancer.9 Other types of ovarian cancer develop from
the egg producing germ cells or the connective Ovary Endometrial
Myometrium Fallopian Tube Cervix Vagina Corpus Latium Epithelial
cancer, accounting for 90% of malignant ovarian cancers1 Germ cell
cancer starts from germ cells (cells that are destined to form eggs)
within the ovaries Growing follicle Empty follicle Ovulation Struma cell
cancer begins in the cells that hold the ovaries together and produce
female hormones Mature egg 1. Source: Rosen DG et al. (2010). Front
Causes and risk factors
The underlying mechanism that leads to ovarian cancer is not well
understood, but it is thought to be linked to reproduction and ovulation.
A number of factors may increase a woman’s risk of developing ovarian
:cancer
Family history: If a woman’s mother or sister has had ovarian, breast, or

uterine cancer she is at greater risk of developing ovarian cancer.11
Age: The risk of ovarian cancer increases with age. Women over 50 have
the highest risk of developing ovarian cancer.12
Childbirth and menopause: Women who have not had children, never
taken the contraceptive pill, who started menstruating at an early age or
whose menopause started later than average have a higher risk of
developing ovarian cancer. Most ovarian cancers are diagnosed after the
menopause.11
Genetics: Certain genetic traits can also increase the risk of developing
ovarian cancer
Symptoms and diagnosis
Early diagnosis has the potential to improve survival rates but
symptoms of ovarian cancer, particularly in the early stages may be
ambiguous and non-specific making early diagnosis difficult.3 They can
be confused with symptoms of other less severe diseases, particularly
gastrointestinal complaints. In addition, there is no routine, simple test
to accurately and reliably detect ovarian cancer in the general
population so reliable screening for the disease is not yet feasible.13
This means the majority of women are not diagnosed until the disease
has reached an advanced stage when the tumor may be large and could
have spread (metastasized) to other parts of the body. Approximately
70% of women with ovarian cancer are diagnosed at stage III or IV (see
staging) of the disease.12 Cancerous cells can greatly increase the
volume of peritoneal fluid (the natural fluid that coats and lubricates the
lining of the abdomen and covers internal organs) in ovarian cancer. This
can cause the buildup of fluid in the abdomen called as cites which is a
common complication of ovarian cancer that can cause swelling, fatigue
and shortness of breath. Being aware of the frequency and combination
of certain symptoms can help with early diagnosis. Symptoms to watch
out for include:4, 14
Persistent bloating 2- Abdominal pain 3- Irregular periods -1
Loss of appetite 4- Fatigue 5- Change in bowel movements - -4

constipation, excess wind 6- Abnormal vaginal bleeding
Methods of diagnosis vary from country to country but typically when a

woman goes to her doctor with symptoms, she will be given a physical
examination. If this raises any concerns, a number of additional tests
:may be performed
A blood test to check for raised levels of a protein in the blood called •
CA-125
An MRI (Magnetic Resonance Imaging) or CT (Computerized (Axial) •

Tomography) scan
Ultrasound •
Staging
:Staging of ovarian cancer is confirmed along with surgery using
Biopsies 2_ CT scans 3_ chest X-rays 4_ colonoscopies17 _1
Staging is defined by the FIGO (International Federation of Gynecology

.and Obstetrics) system
Treatment
Treatment options vary depending on the stage of the cancer, and are
:assessed taking into account the following variables
Tumor size 2- Tumor position 3- Degree of spread 5- Patient’s -1

physical condition
Until recently treatment options for ovarian cancer were limited to

surgery and chemotherapy. However in 2011, the European Commission
(EC) announced the approval of a biological therapy in combination with
standard chemotherapy (carboplatin and paclitaxel) as initial treatment
for advanced (stages III B, III C and IV) epithelial ovarian, fallopian tube,
or primary peritoneal cancer. This marked the first new effective
treatment option for women with advanced ovarian cancer in 15 years.
.Radiotherapy is not frequently used to treat ovarian cancer
References
WHO, IARC GLOBOCAN, Cancer Incidence and Mortality Worldwide in 1

/2008 at http://globocan.iarc.fr
Heintz APM, Odicino F, Maisonneuve P, et al. Int J Gynaecol Obstet 2

2006;95 (Suppl 1):S161–92
Goff BA, Mandel L, Muntz HG, Melancon CH. Cancer 2000;89:2068–75 3

4 Goff BA, Mandel L, Melancon CH, Muntz HG. JAMA 2004;291:2705–12
5 Jemal A, Siegel R, Xu J, Ward E.. CA Cancer J Clin 2010;60:277–300
American Cancer Society. Cancer Facts and Figures 2007. Atlanta, 6

American Cancer Society 2007
American Cancer Society. Breast Cancer Facts and Figures 2009-2010. 7

.Atlanta. American Cancer Society Inc
Hennessy B et al. Lancet 2009; 9698: 1371-1382 8
Rosen DG et al. (2010). Front Biosci. 14:2089-2102 9
Cancer Research UK. Types of ovarian cancer. Last accessed March 10

2011 at http://www.cancerhelp.org.uk/type/ovarian-
cancer/about/types-of-ovarian-cancer
Permuth-Wey and Sellers. Epidemiology of Ovarian Cancer. Methods 11

of Molecular Biology, Cancer Epidemiology. 2009;472:413-37
Roett MA, Evans P. American Academy of Family Physicians (2009). 12

80(6):609-616
Badgwell D, Bast RC. Markers 2007;23:397–410 13
Gynecologic Cancer Foundation Ovarian Cancer Symptoms 14

Consensus Statement. Last accessed March 2011 at
http://www.wcn.org/articles/types_of_cancer/ovarian/symptoms/index
.html
.Gubbels JAA et al. Journal of Ovarian Research (2010) 3:8 15

Types of Ovarian Cancer

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Ovarian cancer

Ovarian cancer is diagnosed in nearly a quarter of a million women

Types of ovarian cancer

Family history: If a woman’s mother or sister has had ovarian, breast, or

Persistent bloating 2- Abdominal pain 3- Irregular periods -1

Loss of appetite 4- Fatigue 5- Change in bowel movements - -4

Methods of diagnosis vary from country to country but typically when a

An MRI (Magnetic Resonance Imaging) or CT (Computerized (Axial) •

Biopsies 2_ CT scans 3_ chest X-rays 4_ colonoscopies17 _1

Staging is defined by the FIGO (International Federation of Gynecology

Tumor size 2- Tumor position 3- Degree of spread 5- Patient’s -1

Until recently treatment options for ovarian cancer were limited to

WHO, IARC GLOBOCAN, Cancer Incidence and Mortality Worldwide in 1

Heintz APM, Odicino F, Maisonneuve P, et al. Int J Gynaecol Obstet 2

Goff BA, Mandel L, Muntz HG, Melancon CH. Cancer 2000;89:2068–75 3

American Cancer Society. Cancer Facts and Figures 2007. Atlanta, 6

American Cancer Society. Breast Cancer Facts and Figures 2009-2010. 7

Hennessy B et al. Lancet 2009; 9698: 1371-1382 8

Rosen DG et al. (2010). Front Biosci. 14:2089-2102 9

Cancer Research UK. Types of ovarian cancer. Last accessed March 10

Permuth-Wey and Sellers. Epidemiology of Ovarian Cancer. Methods 11

Roett MA, Evans P. American Academy of Family Physicians (2009). 12

Badgwell D, Bast RC. Markers 2007;23:397–410 13

Gynecologic Cancer Foundation Ovarian Cancer Symptoms 14

.Gubbels JAA et al. Journal of Ovarian Research (2010) 3:8 15

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