What Is Ovarian Cancer?
Ovarian cancer is cancer that begins in the cells that constitute the ovaries, including surface epithelial cells, germ cells, and the sex cord-stromal cells. Cancer cells that metastasize from other organ sites to the ovary (most commonly breast or colon cancers) are not then considered ovarian cancer.
According to the American Cancer Society, ovarian cancer accounts for 4 percent of all cancers among women and is ranked fifth as a cause of their deaths from cancer. The American Cancer Society statistics for ovarian cancer estimate that there will be 25,580 new cases and 16,090 deaths in 2004. The death rate for this disease has not changed much in the last 50 years.
Unfortunately, almost 70 percent of women with the common epithelial ovarian cancer are not diagnosed until the disease is advanced in stage—i.e., has spread to the upper abdomen (stage III) or beyond (stage IV). The 5-year survival rate for these women is only 15 to 20 percent, whereas the 5-year survival rate for stage I disease patients approaches 90 percent and for stage II disease patients approaches 70 percent.
There are many types of tumors that can start in the ovaries. Some are benign, or noncancerous, and the patient can be cured by surgically removing one ovary or the part of the ovary containing the tumor. Some are malignant or cancerous. The treatment options and the outcome for the patient depend on the type of ovarian cancer and how far it has spread before it is diagnosed.
Ovarian tumors are named according to the type of cells the tumor started from and whether the tumor is benign or cancerous. The three main types of ovarian tumors are:
The cells that make up EOC have several forms that can be recognized under the microscope. They are known as serous, mucinous, endometrioid, and clear cell types. Undifferentiated EOC's lack distinguishing features of any of these four subtypes and tend to grow and spread more quickly.
In addition to their classification by cell type, EOC's are given a grade and stage. The grade is on a scale of 1, 2, or 3. Grade 1 EOC more closely resembles normal tissue and tends to have a better prognosis than Grade 3 EOC, which looks less like normal tissue and usually implies a worse outlook than Grade 1 EOC.
The stage of the tumor can be ascertained during surgery, when it can be determined how far the tumor has spread from where it started in the ovary. The following are the various stages of ovarian cancer:
Stage I—Growth of the cancer is limited to the ovary or ovaries.
Stage IA—Growth is limited to one ovary and the tumor is confined to the inside of the ovary. There is no cancer on the outer surface of the ovary. There are no ascites present containing malignant cells. The capsule is intact.
Stage II—Growth of the cancer involves one or both ovaries with pelvic extension.
Stage III—Growth of the cancer involves one or both ovaries, and one or both of the following are present: (1) the cancer has spread beyond the pelvis to the lining of the abdomen; and (2) the cancer has spread to lymph nodes. The tumor is limited to the true pelvis but with histologically proven malignant extension to the small bowel or omentum.
Stage IV— This is the most advanced stage of ovarian cancer. Growth of the cancer involves one or both ovaries and distant metastases (spread of the cancer to organs located outside of the peritoneal cavity) have occurred. Finding ovarian cancer cells in pleural fluid (from the cavity which surrounds the lungs) is also evidence of stage IV disease.
Primary Peritoneal Carcinoma
This condition is a cancer much like epithelial ovarian cancer but it starts outside of the ovaries. It grows from cells that line the pelvis or abdomen. These cells look like the cells along the surface of the ovaries. Women who have had their ovaries removed can still get this type of cancer. Symptoms of this cancer are much like those of ovarian cancer. Treatment is also similar. (From: www.4women.gov)
Germ Cell Tumors
These statistics, and the information regarding tumor stage and grade, demonstrate that there is a critical need to establish an agenda for more research into the areas of basic and translational research, genetic susceptibility and prevention, diagnostic imaging, screening and diagnosis, and therapy. These could hold the most promise for future discoveries that will lead to improved prevention, detection, and treatment of ovarian cancer, particularly the common epithelial cancers.
From: The national Ovarian Cancer Coalition, www.ovarian.org
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