The Ovaries

The ovaries are a pair of organs located in a woman's pelvis. There's usually one on each side of the uterus, each about the size and shape of a walnut. The ovaries produce the female hormones estrogen and progesterone (Read about "Endocrine System"), which help regulate a woman's menstrual cycle and produce testosterone, which helps with the sex drive. The ovaries also contain a woman's egg cells. Eggs grow, develop, and mature in the follicles of the ovaries and then are released during ovulation, part of the monthly menstrual cycle that occurs during the childbearing years. The egg is released into the fallopian tube. If the egg is fertilized, it should then attach itself to the endometrium or lining of the uterus. If the woman does not become pregnant, the endometrium sheds and the unfertilized egg is discharged through the cervix and vagina during the woman's next period. Below you'll find information on ovarian cysts and ovarian cancer.

Ovarian Cysts

The American College of Obstetricians and Gynecologists (ACOG) says ovarian cysts are fairly common in women of childbearing age. Ovarian cysts are fluid-filled sacs that can form on the ovary when one or more of the egg-containing follicles mature, but do not release the egg into the fallopian tube. The National Women's Health Information Center (NWHIC) says a woman can develop one cyst or many cysts.

There are several different types of cysts:

• Functional or follicular cysts - These cysts are completely normal and form during ovulation, according to NWHIC. They usually either disappear during menstruation, or shrink within a few months. Only women who are ovulating form functional cysts. If you are in menopause and not having periods, you should not have functional cysts. (Read about "Menopause") However, small clear cysts do occur occasionally but many times do not need treatment.
• Endometriomas - These cysts develop in women who have endometriosis (Read about "Endometriosis"), a condition in which tissue from the lining of the uterus (endometrium) grows in other areas, such as on the fallopian tubes, the ovaries, and on other organs outside of the uterus. Because uterine tissue is sensitive to hormones, it bleeds monthly, which may cause it to form a growing cyst on the ovary. These cysts can be painful during sexual intercourse and during menstruation.
• Benign cystic tumors or cystadenomas - These cysts are non-cancerous and are often filled with liquid. They develop from cells on the outer surface of the ovary.
• Dermoid cysts - Because of the ability of certain cells in the ovaries to develop into any number of types of cells, occasionally a cyst will develop that contains cells of hair, teeth, and other growing tissues. They are often small and may not cause symptoms. They can, however, become large and cause pain.
• Multiple Cysts - Women who do not ovulate regularly can develop multiple cysts. This can be caused by a hormonal imbalance called polycystic ovary syndrome or PCOS. (Read about "Polycystic Ovary Syndrome") Symptoms of PCOS include irregular menstrual periods, infertility, and increased body hair.
• Paraovarian cysts - These cysts are located along side the ovaries or on the fallopian tubes and can mimic true cysts of the ovaries. They can become large and should be watched.

Cysts can also twist, bleed, or they can rupture. Most cysts are benign or not cancerous. However, cysts can sometimes be malignant or cancerous. For this reason, your doctor should check all cysts. If a cyst is benign and not causing problems, it may go away on its own and not require any treatment other than observation. If cysts are a recurring problem, hormonal therapy can be used to shrink an existing cyst and/or keep new cysts from forming. A doctor may also suggest removing a cyst, especially if it seems to be growing. The Agency for Healthcare Research and Quality (AHRQ) says surgery may be needed if the cyst is causing symptoms or is more than 2 inches across. If surgery is needed, a benign cyst can often be removed without removing the ovary. Ovarian cystectomy refers to removal of the ovarian cyst. An oophorectomy is a procedure that removes the entire affected ovary.

Ovarian Cancer

According to the National Cancer Institute (NCI), about one in every 71 women in the United States will develop ovarian cancer during their lifetime. (Read about "Cancer: What It Is") Most cases occur in women over the age of 50, but this disease can also affect younger women.

There are several types of ovarian cancer. NCI says the most common ovarian cancer begins on the surface of the ovary and is called epithelial carcinoma. Ovarian cancer can also begin in the egg-producing cells or in the supportive tissue surrounding the ovaries, though these types of tumors are considered rare.

Who's at risk

The exact causes of ovarian cancer are not known. However, according to the American Cancer Society, studies show that the following factors may indicate a woman has a higher risk:

• Family history - If your mother, daughter or sister had ovarian cancer, you can be at a higher risk. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.
• Age - The risk increases as a woman gets older, with the highest risk in women over age 60.
• Personal history - Women who have had breast or colon cancer may have a greater chance of developing ovarian cancer than women who have not had breast or colon cancer.

Research also continues into genetic mutations (Read about "Genetics"), specifically mutations in the genes BRCA1 and BRCA2, which have been linked to an increased risk of developing both breast and ovarian cancer.

NCI says studies are also looking into possible connections between a higher risk of ovarian cancer and other factors. One area being looked into concerns fertility drugs. Here, the results of studies looking into a possible connection between risk of ovarian cancer and use of drugs that cause a woman to ovulate have been mixed, according to NCI; some studies indicate a connection, others find no connection, still other studies are looking into infertility itself as a risk factor. Talcum powder is also under study. Some studies suggest that women who have used talc in the genital area for many years may be at increased risk of developing ovarian cancer. Hormone replacement therapy is another area under examination. Some evidence suggests that women who use HRT after menopause may have a slightly increased risk of developing ovarian cancer.

In addition, ACOG says women who have never had children are more likely to develop ovarian cancer than women who have had children. Some studies have also shown that breastfeeding may decrease a woman's likelihood of developing ovarian cancer.

Possible ovarian cancer symptoms

Ovarian cancer often shows no early warning signs. If symptoms are present, however, ACOG says they can include:

• general abdominal discomfort and/or pain such as gas, indigestion, pressure, swelling, bloating, and/or cramps (Read about "Indigestion")
• nausea, diarrhea, constipation, or frequent urination (Read about "Diarrhea" "Constipation" "Urinary System")
• loss of appetite
• feeling of fullness even after a light meal
• weight gain or loss with no known reason
• abnormal bleeding from the vagina
• an overall increase in the waistline without changes in exercise or diet (clothes are tighter at the waistline)

If ovarian cancer is spreading, NCI says it can form new tumors in the abdominal area and on the diaphragm. This can cause fluid to collect in the abdomen, which is what can lead to a condition called ascites. Since bloating and other symptoms can also be caused by other, often less serious conditions, it's essential to check with a doctor if you're concerned.

Detecting Ovarian Cancer

Because there are often no early warning symptoms, researchers have been trying to find ways to detect ovarian cancer before symptoms develop. One possible indication of ovarian cancer is an elevated level of a "tumor marker" called CA-125, which is often found in higher-than-normal amounts in the blood of women with ovarian cancer. However, not all women with ovarian cancer will have elevated levels. In addition, an elevated level can be present in women who do not have the disease. As a result, this test is not considered a screening test in and of itself. It is used in conjunction with other diagnostic procedures such as transvaginal sonography and a rectovaginal pelvic exam. During a pelvic exam, a doctor will examine the uterus, vagina, ovaries, fallopian tubes, bladder (Read about "The Urinary System") and rectum to find any abnormality in their shape or size. Ultrasound, a barium enema, a CAT or CT scan and/or a biopsy can also be used to ensure a thorough examination. (Read about "Ultrasound Imaging" "CT Scan - Computerized Tomography" "Biopsy")

Staging and Treatment

If ovarian cancer is found, treatment depends on the extent of the cancer. This is called staging.

The following stages are used for ovarian epithelial cancer, according to NCI:

• Stage I

  In stage I, cancer is found in one or both of the ovaries. Stage I is divided into:

  • Stage IA: Cancer is found in a single ovary.
  • Stage IB: Cancer is found in both ovaries.
  • Stage IC: Cancer is found in one or both ovaries and one of the following is true:
    • Cancer is found on the outside surface of one or both ovaries.
    • The tumor has ruptured the ovary wall.
    • Cancer cells are found in fluid from the peritoneal cavity (the body cavity that contains most of the organs in the abdomen). The fluid may already be in the peritoneal cavity or it may be added by the doctor to wash the peritoneum (tissue lining the peritoneal cavity).

• Stage II

  In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into:

  • Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).
  • Stage IIB: Cancer has spread to other tissue within the pelvis.
  • Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and one of the following is true:
    • Cancer is found on the outside surface of one or both ovaries.
    • The tumor has ruptured the ovary wall.
    • Cancer cells are found in fluid from the peritoneal cavity (the body cavity that contains most of the organs in the abdomen). The fluid may already be in the peritoneal cavity or it may be added by the doctor to wash the peritoneum (tissue lining the peritoneal cavity).

• Stage III

  In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen and/or nearby lymph nodes Stage III is divided into:

  • Stage IIIA: The tumor is found only in the pelvis, but cancer cells have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen), the small intestines, or the tissue that connects the small intestines to the wall of the abdomen.
  • Stage IIIB: Cancer has spread to the peritoneum but is not larger than 2 centimeters (less than 1 inch) in diameter.
  • Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen. (Lymph nodes are small bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.) (Read about "The Lymph System")

• Stage IV

  In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body. Cancer is found in the tissues of the liver.

The following stages are used for ovarian germ cell tumor, according to NCI:

• Stage I

  Stage I is divided into stage IA, stage IB, and stage IC as follows:

  • Stage IA: Cancer is limited to one ovary.
  • Stage IB: Cancer is found in both ovaries.
  • Stage IC: Cancer is found in one or both ovaries and one of the following occurs:
    • Cancer has spread to the outside surface of one or both ovaries
    • The outer covering of the tumor has ruptured (broken open)
    • Cancer cells are found in the fluid of the peritoneal cavity or in washings of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen).

• Stage II

  Stage II is divided into stage IIA, stage IIB, and stage IIC as follows:

  • Stage IIA: Cancer is found in one or both ovaries and has spread into the pelvis and/or to the uterus and/or fallopian tubes.
  • Stage IIB: Cancer is found in one or both ovaries and has spread to other tissue within the pelvis.
  • Stage IIC: Cancer is found in one or both ovaries, has spread to the uterus, fallopian tubes, and/or to other tissues in the pelvis, and one of the following occurs:
    • Cancer is on the surface of one or both ovaries
    • The outer covering of the tumor has ruptured (broken open)
    • Cancer cells are found in the fluid of the peritoneal cavity or in washings of the peritoneum.

• Stage III

  Stage III is divided into stage IIIA, stage IIIB, and stage IIIC as follows:

  • Stage IIIA: Cancer is found in one or both ovaries and the pelvis, and microscopic cancer cells are found in the peritoneum, the small intestines, or the tissue that connects the small intestines to the wall of the abdomen.
  • Stage IIIB: Cancer is found in one or both ovaries and has spread to the peritoneum. The peritoneal tumors are no larger than 2 centimeters (about 3/4 inch).
  • Stage IIIC: Cancer is found in one or both ovaries and has spread beyond the pelvis to the peritoneum. The peritoneal tumors are larger than 2 centimeters and/or cancer is found in lymph nodes in the pelvis. (Read about "The Lymph System") Cancer that has spread to the surface of the liver is also considered stage III disease.

• Stage IV

  In stage IV, cancer is found in one or both ovaries and has metastasized (spread) not only to the pelvis and abdomen but also to other parts of the body. Cancer cells in the fluid around the lungs is also considered stage IV.

Treatments can include surgery, often to remove the ovaries, the fallopian tubes, the uterus, the cervix and the lymph nodes. The surgery may be done conventionally or robotically. (Read about "Robotic Surgery") This type of surgery is best performed by a surgeon experienced with ovarian cancer, such as a gynecologic oncologist (a gynecologist who is specially trained in the treatment of pelvic cancer). You may want to consider a second opinion to help you decide the best option for you.

In addition, chemotherapy and/or radiation may be needed. (Read about "Radiation Therapy") Radiation therapy uses radiation to kill cancer cells or keep them from growing. The radiation can be delivered externally, from a machine outside the body, or it may be delivered internally, from a radioactive substance that is placed or injected directly into or near the cancer. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells. Chemotherapy may be taken by mouth or injected into the body.

Targeted therapy may be another option. It uses drugs or other substances to identify and attack specific cancer cells. Some targeted therapies use antibodies that can identify substances on cells that may be helping the cancer grow. Other targeted therapies block DNA repair so as to cause cancer cells to die. (Read about "Cancer Treatments")

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

Related Information:

    Genital Health - Female

    Woman's Health Terms Glossary