Ovarian Cancer
Ovarian cancer occurs from the growth of cancer cells that form in the ovaries. These cells quickly grow, invade and then damage healthy tissue. In the female reproductive system, two ovaries lie on either side of the uterus. The ovaries, small almond size structures, create eggs (ova) and the hormones estrogen and progesterone. Cells from one of the two ovaries can grow and become cancerous, invading and then damaging healthy tissue.
The main risk factors for ovarian cancer are:
Menstruation age: If menstruation onset at an early age, menopause onset at a later age, or both, there may be a greater risk of ovarian cancer.
Hormone replacement therapy: Undergoing hormone replacement therapy to combat menopausal symptoms increases a likelihood of developing ovarian cancer.
Being overweight or obese: The risk of ovarian cancer rises if overwight or obese.
No pregnancies: If you’ve never been pregnant, you may have an increased risk of ovarian cancer.
Genetic Changes: A small percentage of ovarian cancers are caused by gene mutations, such as BRCA1 and BRC2, which increase the risk of ovarian cancer and also breast cancer.
Family history: If any blood relatives have been diagnosed with ovarian cancer, you may have greater likelihood of developing the disease.
Ovarian cancer may not exhibit any symptoms in the early stages. As it develops, more symptoms may occur, such as bloating, weight loss, pelvic area pain, and back pain. It may also contribute to changes in bowel movements and increase the frequency of urination.
Routine screening occurs commonly for women with symptoms. Women with no symptoms but at high risk may be asked to draw a blood test. An ultrasound scan may also be performed, either in a transvaginal scan, where the scan is placed into your vagina, or in an abdominal scan, where the scan moves over your stomach area.
The following exams and methods your doctor may use to determine whether or not you have ovarian cancer:
Pelvic exam: For a pelvic exam, your doctor examines the inside of your vagina while pressing the lower part of your belly to feel your pelvic organs.
Imaging tests: Some imaging tests, such as an ultrasound or CT scan may be ordered. Imaging tests may aid in determining the form and size of your ovaries.
Blood tests: Your doctor might test your blood for tumor markers that indicate ovarian cancer. For example, a cancer antigen (CA) 125 test can detect a protein that’s often found on the surface of ovarian cancer cells. These tests may provide clues about your diagnosis and prognosis.
Surgery: Sometimes your doctor can’t be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer.
If you are diagnosed with ovarian cancer, your doctor will need to perform more tests to determine the extent of your cancer, which is called staging. The stage of your cancer is used to determine what kind of treatment is most appropriate for your type of cancer. Ovarian cancer stages range from 1 to 4. In the lowest stage, cancer remains strictly in the ovaries. As the cancer grows and spreads to other parts of the body, it advances to higher stages.
Treatment for ovarian cancer depends on many factors, including the stage of your cancer, other health problems you may have, and your preferences. For treatment, you can undergo surgery, chemotherapy, or both. For early-stage ovarian cancer, treatment with surgery involves removing one or both ovaries. This decision depends on how much the cancer has spread. In either case, you may still maintain the ability to have children. In cases of late-stage ovarian cancer, the surgical option may require complete removal of both ovaries, fallopian tubes, and uterus.
There are also drug treatments for ovarian cancer: chemotherapy, targeted therapy, and hormone therapy. Chemotherapy involves drugs that will kill the cancer cells in the body. Chemotherapy drugs enter the body by injection into a vein or taken by mouth. This technique can be used before, during, or after surgical treatment options; however, after surgical treatment is most common. Targeted therapy attacks specific weaknesses within cancer cells that cause them to die.
Hormone therapy drugs block the effects of estrogen on ovarian cells. Estrogen helps in ovarian cell growth, so inhibiting this may limit the spread of the ovarian cancer cells. Immunotherapy utilizes the body’s immune system to attack these fast-growing cancer cells. In all, your doctor will determine whichever therapy option(s) work best for you.
Supportive or palliative care offers an additional level of medical care to a disease. It involves providing pain relief and other support forms from a team of doctors, nurses, and other health professionals.
PARP Inhibitors in Ovarian Cancer
- PARP [poly [ADP-ribose) polymerase] enzymes are involved in the repair of single-strand DNA breaks and the recruitment of additional DNA repair proteins; inability to properly repair DNA ultimately leads to cell death.
- Cancer cells with homologous recombination deficiency (HRD), such as BRCA-mutated ovarian, breast, prostate, and pancreatic cancer, are particularly sensitive to PARP inhibitor (PARPI) treatment.
- Olaparib and niraparib are two PARPIs, used as oral maintenance therapy in patients with advanced ovarian cancer who are in complete or partial response to platinum-based chemotherapy, in the first-line or recurrent ovarian cancer setting; efficacy data are strongest in BRCA-mutated tumours and in those with HRD.
- For treatment decisions, tumour testing is preferred as it identifies both somatic and germline mutations; patients with BRCA-mutated tumours should undergo germline testing (blood samples) to ascertain hereditary risk and facilitate appropriate genetic counselling.
Access the full English version.
Access the full French version.
Best Practice and Quick Reference Tips for Real World Management
- Describe which patients would potentially benefit from treatment with a PARP inhibitor.
- Identify and review potential adverse events from PARP inhibitors.
- Be aware of how to prepare for and manage adverse events from PARP inhibitors.
- Identify resources for managing PARP inhibitors.
- Risk Factors
-
The main risk factors for ovarian cancer are:
Menstruation age: If menstruation onset at an early age, menopause onset at a later age, or both, there may be a greater risk of ovarian cancer.
Hormone replacement therapy: Undergoing hormone replacement therapy to combat menopausal symptoms increases a likelihood of developing ovarian cancer.
Being overweight or obese: The risk of ovarian cancer rises if overwight or obese.
No pregnancies: If you’ve never been pregnant, you may have an increased risk of ovarian cancer.
Genetic Changes: A small percentage of ovarian cancers are caused by gene mutations, such as BRCA1 and BRC2, which increase the risk of ovarian cancer and also breast cancer.
Family history: If any blood relatives have been diagnosed with ovarian cancer, you may have greater likelihood of developing the disease.
- Signs and Symptoms
-
Ovarian cancer may not exhibit any symptoms in the early stages. As it develops, more symptoms may occur, such as bloating, weight loss, pelvic area pain, and back pain. It may also contribute to changes in bowel movements and increase the frequency of urination.
- Screening
-
Routine screening occurs commonly for women with symptoms. Women with no symptoms but at high risk may be asked to draw a blood test. An ultrasound scan may also be performed, either in a transvaginal scan, where the scan is placed into your vagina, or in an abdominal scan, where the scan moves over your stomach area.
- Diagnosis
-
The following exams and methods your doctor may use to determine whether or not you have ovarian cancer:
Pelvic exam: For a pelvic exam, your doctor examines the inside of your vagina while pressing the lower part of your belly to feel your pelvic organs.
Imaging tests: Some imaging tests, such as an ultrasound or CT scan may be ordered. Imaging tests may aid in determining the form and size of your ovaries.
Blood tests: Your doctor might test your blood for tumor markers that indicate ovarian cancer. For example, a cancer antigen (CA) 125 test can detect a protein that’s often found on the surface of ovarian cancer cells. These tests may provide clues about your diagnosis and prognosis.
Surgery: Sometimes your doctor can’t be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer.
- Staging
-
If you are diagnosed with ovarian cancer, your doctor will need to perform more tests to determine the extent of your cancer, which is called staging. The stage of your cancer is used to determine what kind of treatment is most appropriate for your type of cancer. Ovarian cancer stages range from 1 to 4. In the lowest stage, cancer remains strictly in the ovaries. As the cancer grows and spreads to other parts of the body, it advances to higher stages.
- Treatment
-
Treatment for ovarian cancer depends on many factors, including the stage of your cancer, other health problems you may have, and your preferences. For treatment, you can undergo surgery, chemotherapy, or both. For early-stage ovarian cancer, treatment with surgery involves removing one or both ovaries. This decision depends on how much the cancer has spread. In either case, you may still maintain the ability to have children. In cases of late-stage ovarian cancer, the surgical option may require complete removal of both ovaries, fallopian tubes, and uterus.
There are also drug treatments for ovarian cancer: chemotherapy, targeted therapy, and hormone therapy. Chemotherapy involves drugs that will kill the cancer cells in the body. Chemotherapy drugs enter the body by injection into a vein or taken by mouth. This technique can be used before, during, or after surgical treatment options; however, after surgical treatment is most common. Targeted therapy attacks specific weaknesses within cancer cells that cause them to die.
Hormone therapy drugs block the effects of estrogen on ovarian cells. Estrogen helps in ovarian cell growth, so inhibiting this may limit the spread of the ovarian cancer cells. Immunotherapy utilizes the body’s immune system to attack these fast-growing cancer cells. In all, your doctor will determine whichever therapy option(s) work best for you.
Supportive or palliative care offers an additional level of medical care to a disease. It involves providing pain relief and other support forms from a team of doctors, nurses, and other health professionals.
- Clinical Practice Resources
-
PARP Inhibitors in Ovarian Cancer
- PARP [poly [ADP-ribose) polymerase] enzymes are involved in the repair of single-strand DNA breaks and the recruitment of additional DNA repair proteins; inability to properly repair DNA ultimately leads to cell death.
- Cancer cells with homologous recombination deficiency (HRD), such as BRCA-mutated ovarian, breast, prostate, and pancreatic cancer, are particularly sensitive to PARP inhibitor (PARPI) treatment.
- Olaparib and niraparib are two PARPIs, used as oral maintenance therapy in patients with advanced ovarian cancer who are in complete or partial response to platinum-based chemotherapy, in the first-line or recurrent ovarian cancer setting; efficacy data are strongest in BRCA-mutated tumours and in those with HRD.
- For treatment decisions, tumour testing is preferred as it identifies both somatic and germline mutations; patients with BRCA-mutated tumours should undergo germline testing (blood samples) to ascertain hereditary risk and facilitate appropriate genetic counselling.
Access the full English version.
Access the full French version.
Best Practice and Quick Reference Tips for Real World Management
- Describe which patients would potentially benefit from treatment with a PARP inhibitor.
- Identify and review potential adverse events from PARP inhibitors.
- Be aware of how to prepare for and manage adverse events from PARP inhibitors.
- Identify resources for managing PARP inhibitors.