The disease appears most frequently in older women (over 50% of cases are in women age 65 and above). There are a lot of differences in survival among patients due to age, cancer stage and tissue type, with younger women faring better in all stages. In ovarian cancer there does not appear to be a difference based on the race of a woman as survival rates are similar.

There are over 30 known types of tumors that can be found in ovarian cancer.

They have been grouped into three major categories:
• Epithelial cancers which come from the cell lining or covering of the ovary and is considered the most common type of ovarian cancer.

• Germ cell cancers which start with germ cells (the cells that will form eggs) inside the ovary.

• Sex cord, stromal cell cancers which start in the cells that hold the ovaries together and these cells produce female hormones.

There are four stages of Ovarian Cancer:

• Stage I: The cancer is confined to one or both ovaries.

• Stage II: The cancer has spread to the pelvic organs such as the uterus or fallopian tubes but has not spread to abdominal organs.

• Stage III: The cancer has spread to the abdominal organs such as the abdominal lymph nodes , liver or bowel.

• Stage IV: The cancer has spread outside the abdomen to sites like the liver, lung, brain or lymph nodes of the neck

  Recurrent: This is ovarian cancer that has come back after a woman has completed treatment.

  In Ovarian Cancer, the tumor is also classified as follows:

• T1: The tumor is limited to one or both ovaries.
• T1a: The tumor is limited to one ovary, the wall of the tumor is intact, there is no tumor on the ovary's surface and there are no cancer cells in the abdominal fluid or cavity.
• T1b: The tumor is limited to both ovaries, the wall of the tumor is intact, there is no tumor on the ovary's surface and no cancer cells in the abdominal fluid or cavity.
• T1c: The tumor is limited to one or both ovaries with one of more of the following: The wall of the tumor has burst, there is a tumor on the ovary's surface or there are cancer cells found in the abdominal fluid or cavity.
• T2: The tumor involves one or both ovaries and has spread into the pelvic area.
• T2a: The tumor has spread and may be attached to the uterus or fallopian tubes, but there are no cancer cells in the abdominal fluid or cavity.
• T2b: The tumor has spread to other pelvic tissues, but there are no cancer cells in the abdominal fluid or cavity.
• T2c: The tumor has spread to the pelvic tissues and cancer cells are in the abdominal fluid or cavity.
• T3: The tumor involves one or both ovaries and there is microscopic peritoneal metastasis outside the pelvis and/or metastasis to nearby lymph nodes.
• T3a: Microscopic peritoneal metastasis is found beyond the pelvis.
• T3b: Macroscopic (meaning visible to the naked eye) peritoneal metastasis is found beyond the pelvis and is 2 cm or less in dimension.
• T3c: Peritoneal metastasis is found beyond the pelvis and is more than 2 cm in dimension.

There are several risk factors for ovarian cancer:
• Family history of ovarian cancer. Women have up to a 50% risk of developing ovarian cancer two or more of the following relations have had ovarian cancer: mother, sister, daughter, grandmother or aunt.

• Age: The majority of ovarian cancer occurs after menopause so 50 % of all ovarian cancers occur in women over age 65.

• Menstrual history, pregnancy history, infertility: Experts believe that the risk of ovarian cancer is increased for women who began menstruating before age 12 or experienced menopause after age 50. There also is an increased risk for women who have never completed a pregnancy or did not have their first child until after age 30. Multiple pregnancies lower the risk for ovarian cancer and women who have taken the birth control pill have a 40 to 50 % decreased risk of developing ovarian cancer.

• Fertility drugs: Women who have used fertility drugs have a slightly increased risk of ovarian cancer, but the risk returns to normal for women who become pregnant using those drugs.

• High-fat western diet: Women who have diets high in meat and animal fats have an increased risk in developing ovarian cancer.

• Talcum powder: Research has shown that there is an increased risk for ovarian cancer for women who apply talcum powder to sanitary pads or the genital area.

• Acquired genetic mutations: Researchers have not identified specific environmental factors responsible for the genetic changes causing ovarian cancer, but these make up the bulk of DNA defects that are associated with ovarian cancer.

  Ovarian cancer is considered a silent disease as it does not usually produce many symptoms in the early stages. There are some vague symptoms that one might experience that could possibly indicate ovarian cancer:

• Bloating
• Abdominal/pelvic discomfort or pressure
• Changes in bowel function or urinary frequency
• Nausea or loss of appetite
• Back or leg pain
• Malnourished or wasted appearance
• Fatigue
• Gastrointestinal symptoms (long-term stomach pain, indigestion)
• Unusual vaginal bleeding

  Screening is successful if it decreases the mortality of ovarian cancer. Unfortunately the available tests for ovarian cancer (CA-125 blood test, ovarian palpation and transvaginal ultrasound) are not sufficiently accurate for general screening so screening for ovarian cancer is not recommended.

Diagnosis

  In order to diagnose ovarian cancer, you will need to meet with your physician. The first thing your doctor will do is obtain a complete medical history including finding out about your use of oral contraceptives, pregnancy and breast-feeding history, family history of ovarian cancer, previous gynecologic surgery and previous cancer history.

  Next your doctor will perform a pelvic examination of your abdomen and pelvic area, including feeling for unusual growths, masses or nodules (small masses of tissue in the form of a knot). During palpation, the doctor may detect a mass on either or both sides of the uterus and if it is larger than 2 inches in diameter, solid rather than sac-like or is bilateral (present on both sides), ovarian cancer may be present. Ovarian cancer may also be present if your doctor finds nodules on the floor of your pelvis. Ovarian cancer may also be suspected if a woman experiences abdominal swelling due to fluid, though other non-cancerous diseases must be ruled out. If fluid is present, it may be removed with a needle and examined to detect any cancer cells.

 Also during the pelvic exam, the doctor may perform a pap test. In addition to the pelvic exam, your doctor may order an imaging examination. One imaging exam would be an ultrasound. They normally do an abdominal ultrasound and a transvaginal ultrasound as the transvaginal ultrasound improves the quality of the ultrasound. Other imaging exams that may be done are a CAT scan or MRI (magnetic resonance imaging).

Treatment

 There are three main types of treatment for ovarian cancer: surgery, chemotherapy and radiotherapy or a combination of these treatment methods.

  In almost all cases, surgery is required to treat ovarian cancer. Surgery will help your doctor stage the tumor and remove as much of the tumor as possible. Normally a sample of the tumor is sent to the lab, called a frozen section, to confirm or rule out ovarian cancer. If cancer is confirmed, the doctor will normally do a complete hysterectomy including removal of the uterus, both ovaries and fallopian tubes, removal of the fatty tissue that covers the bowels and removal of one or more lymph nodes.

 Chemotherapy may be done following surgery. There are several different chemo medications currently used for ovarian cancer. Most patients will receive therapy with drugs that contain platinum and taxane though other drugs such as melphalan and anthracyclines have also been found to show some activity in fighting ovarian cancer. The dosage, timing and choice of chemo will depend up the patient's stage and type of cancer, her body's response to and recovery from the chemo and her health status.

  Radiation is not a common treatment for ovarian cancer in the United States due to most women having late stage ovarian cancer when detected and the radiation must include all cancer cells. If cancer has spread to abdominal organs, they may not be able to withstand does of radiation. However, if the cancer is confined to one or both ovaries, radiation may be an option.

  Treatment for recurrent ovarian cancer may include chemotherapy, combination chemotherapies and surgery to relieve symptoms caused by the cancer. There is no standard treatment and these are clinical trials.

 Continuous follow up is very important for all women with ovarian cancer. You can expect to be seen by your doctor every 3 months for the first 2 years and then have follow-up appointments every 4 to 6 months after that. During each visit your doctor will check the CA 125 level in your blood and if the level has increased, your doctor may order a cat scan or biopsy to locate the new cancer site.

 The surgery performed to treat ovarian cancer will cause sexual changes. Sexual intercourse may be painful after a hysterectomy because the vagina has been shortened and also due to vaginal dryness due to estrogen deficiency. You can use vaginal moisturizers or lubricants to help with the dryness. You also may experience decreased sexual desire and poor self image after therapy and may benefit from psychological and/or sex counseling. Young women may experience symptoms of menopause due to the removal of the ovaries.

  Researchers are still investigating ways to prevent ovarian cancer. There are ways to reduce your risk of developing ovarian cancer. Using oral contraceptives can reduce your risk by 40% to 50%. Experts also recommend eating a low-fat, high fiber diet and exercise at least three times per week. Pregnancy and breast-feeding will also lower your risks of developing ovarian cancer (pregnancy lowers it by 30% to 60%). In addition experts recommend genetic counseling if your family history includes ovarian cancer. Ovarian cancer risk can also be reduced by tubal ligation (tubes tied to prevent pregnancy). Also if a woman is over 40 and having a hysterectomy for non-cancerous reasons, ovary removal at that time would lower her risk of ovarian cancer, though this method is controversial since it will cause early menopause.