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Clinical Corner

Ovarian Cancer

Babak Litkouhi, MD

September is ovarian cancer awareness month. Dr. Babak Litkouhi, a specialist in gynecologic oncology at Beth Israel Deaconess Medical Center, answers some common questions about this often silent disease.

How common is ovarian cancer?

According to the National Cancer Institute, close to 22,000 women in the United States are expected to get ovarian cancer in 2010, with close to 14,000 women dying of the disease each year. Over the course of a lifetime, approximately 1 in 70 women will be affected by ovarian cancer and 1 in 10 women will have surgery for some type of a tumor or abnormality of the ovary (the majority of which will be non-cancerous). The most common type of ovarian cancer, called epithelial cancer, arises in the cells on the surface of the ovary, and generally affects women at or after menopause. Other types of ovarian cancer, such as germ cell cancers, are more rare and tend to affect women in the teens and twenties.

Cancerous mass in the left ovary

Who is at risk of ovarian cancer?

There are a number of factors that put women at higher risk of ovarian cancer. Those include:

  • Having a family history of cancer (a mother, daughter or sister with ovarian cancer, or a family history of breast cancer, or more rarely uterine cancer or colon cancer)
  • A personal history of breast cancer
  • Being postmenopausal
  • Never having been pregnant
  • Infertility
  • The use of genital talcum powder

Other factors are protective, and include:

  • Having been pregnant or having breast fed
  • Having used birth control pills
  • Having had a tubal ligation

What are the symptoms of ovarian cancer?

Unfortunately, many women with ovarian cancer report they had little warning early on. The ovary is a small organ that exists in a large space (the belly). Often, by the time the ovary becomes large enough to cause symptoms, it has already spread to other organs. Yet, as the cancer grows, some symptoms may become apparent and include pressure or pain in the abdomen or back; a swollen or bloated abdomen; nausea, indigestion, gas, constipation or diarrhea, fatigue. These symptoms are common in a variety of normal and abnormal conditions, but women who have these symptoms should talk to their doctor. This is particularly important because treatment is most successful when cancer is caught in the early stages. Women with these symptoms may be asked to have a pelvic exam, ultrasound, special blood tests (CA125 test), or CT scan to help make a diagnosis.

What are the treatment options?

Most women who are diagnosed with ovarian cancer are treated with surgery. The goals of surgery are to confirm the diagnosis, define the extent of disease, and to remove all the visible tumor that has spread to other organs. After surgery, almost all patients need chemotherapy to reduce the likelihood that the cancer will come back. Chemotherapy is a type of medication that aims at killing rapidly dividing cells, such as cancer cells. It is often given either by injecting into a vein through an IV, or, in the case of ovarian cancer, it can also be given directly into the belly. Most women will get a similar chemotherapy. However, variations do exist and treatment is tailored by considering a variety of factors such as the patient's age, general health, their other medical conditions, and the extent of cancer spread. There are a variety of medications and treatments available to help control the side-effects of chemotherapy, such as nausea.

Are there any special considerations for ovarian cancer surgery?

The cornerstone of ovarian cancer surgery is having it performed by a surgeon who has expertise dealing with these cancers. Surgery is best performed by a Gynecologic Oncologist. Gynecologic oncologists have special training in the surgical techniques necessary to appropriately deal with these cancers, both in terms of making sure the cancer has not spread to other organs, and if it has, having the ability to completely remove it. These surgeries are most commonly performed through a large incision in the abdomen and may involve the removal of tumors from organs such as the intestines. At times, for very early cancers, the surgery can be performed laparoscopically or robotically through small incisions in the belly.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted September 2010

Contact Information

Gynecologic Oncology
Dept. of Obstetrics & Gynecology
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 8th floor
330 Brookline Avenue
Boston, MA 02215