Ovarian cancer is a type of cancer that begins in the ovaries. Women have two ovaries, one on each side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen and progesterone.

Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Surgery and chemotherapy are generally used to treat ovarian cancer.

Symptoms

Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel

Signs and symptoms of ovarian cancer may include:

• Abdominal bloating or swelling

• Quickly feeling full when eating

• Weight loss

• Discomfort in the pelvis area

• Changes in bowel habits, such as constipation

• A frequent need to urinate

Causes

It's not clear what causes ovarian cancer. In general, cancer begins when a genetic mutation turns normal cells into abnormal cancer cells. Cancer cells quickly multiply, forming a mass (tumor). They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize).

Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:

• Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.

• Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal.

• Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

Risk factors

Certain factors may increase your risk of ovarian cancer:

• Age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.

• Inherited gene mutation. A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer.

The gene mutations that cause Lynch syndrome, which is associated with colon cancer, also increase a woman's risk of ovarian cancer.

• Estrogen hormone replacement therapy, especially with long-term use and in large doses.

• Age when menstruation started and ended. If you began menstruating before age 12 or underwent menopause after age 52, or both, your risk of ovarian cancer may be higher.

• Never being pregnant.

• Fertility treatment.

• Smoking.

• Use of an intrauterine device.

• Polycystic ovary syndrome.

Prevention

There's no sure way to prevent ovarian cancer. But certain factors are associated with lower risk:

• Use of oral contraceptives, especially for more than 10 years

• Previous pregnancy

• History of breast-feeding

• Daily use of aspirin

Tests for Ovarian Cancer Diagnosis

 Physical exam:

Your doctor will first take your history and do a physical exam to look for signs of ovarian cancer. These include an enlarged ovary (on a pelvic exam) and signs of fluid in the abdomen (which is called ascites). If there is reason to suspect you have ovarian cancer based on your symptoms and/or physical exam, your doctor will order some tests to check further.

Imaging tests:

 Imaging tests like computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and ultrasound studies can confirm whether a pelvic mass is present. These studies cannot confirm that the mass is a cancer, but they may be useful if your doctor is looking to see if ovarian cancer has spread (metastasized) to other tissues and organs.

Blood test:

1. CA125 is produced by some ovarian cancer cells. A high level of CA125 in your blood could be a sign of ovarian cancer. But a raised CA125 level doesn't mean you definitely have cancer, as it can also be caused by less serious things such as endometriosis, fibroids and even pregnancy. If the test finds a high level of CA125, you'll be referred for a scan to check for possible causes (see below).

2. HE4 is a marker for earlier detection of ovarian carcinoma. It is over-expressed in patients with ovarian cancers. Normal ovarian tissue has minimal production of HE4. When combined with CA125, HE4 raises the level of sensitivity for the detection of ovarian cancer. HE4 is consistently expressed in patients with ovarian cancer and has demonstrated an increased sensitivity and specificity over that of CA125 alone.

3. Roma Factor The number of women with potential ovarian cancer is, quite often, quite high. With the ovarian malignancy risk estimator (ROMA Algorithm) the stratification of the women under examination into low and high-risk groups for developing epithelial ovarian cancer (90% of all cancer cases in the ovaries) can be achieved. This particular algorithm controls for the menopause factor as well as for the HE4 and CA-125 indicator levels before the surgical intervention. The mathematical formula for the calculation of the algorithm is adjusted depending on whether the woman is at a pre or post-menopause stage. According to the literature, using the ROMA algorithm has resulted in the correct categorisation of 94% of women with epithelial ovarian cancer.